Choice in childbirth: a realistic expectation?

Choice has been an enduring theme of maternity policy since the advent of Changing Childbirth (1993). Maternity Matters outlines four national choice guarantees, which aim to give women choice about how to access maternity care, the type of antenatal care they receive, choice of place of birth and choice of postnatal care. This paper presents some key findings of a study which sought to explore and advance the understanding of maternity care choice through actual women's experiences. Ten women took part in conversational in-depth interviews at four time points, 12–16 weeks and 32–34 weeks pregnant and 14 days and 6 months postnatal in order to explore their choices for care, the rationale for those choices and their experiences and feelings at that point in in time. The key themes that emerged revealed that choice is not an equitable concept for women, it is constrained by inequalities but also by the health care professionals that women are in contact with, the social discourses that surround pregnancy and birth and obstetric complications. Models of care which offer choice need to be designed to take into consideration the dangers of offering choices that may not be fulfilled and the importance of choice in the postnatal environment. Above all choice needs to be presented in an honest and realistic manner.