"Choice" and Place of Delivery

A Qualitative Study of Women in Remote and Rural Scotland

Published in: Quality & Safety in Health Care, v. 18, no. 1, Feb. 2009, p. 42-48

Posted on RAND.org on February 01, 2009

by Emma Pitchforth, Edwin van Teijlingen, Verity Watson, Janet Tucker, Alice Kiger, Jilly C. Ireland, Jane Farmer, Anne-Marie Rennie, Elizabeth Thomson, Mandy Ryan

Read More

Access further information on this document at qualitysafety.bmj.com

This article was published outside of RAND. The full text of the article can be found at the link above.

OBJECTIVE: To explore women's perceptions of "choice" of place of delivery in remote and rural areas where different models of maternity services are available. SETTING AND METHODS: Remote and rural areas of the North of Scotland. A qualitative study design involved focus groups with women who had recent experience of maternity services. RESULTS: Women had varying experiences and perceptions of choice regarding place of delivery. Most women had, or perceived they had, no choice, though some felt they had a genuine choice. When comparing different places of birth, women based their decisions primarily on their perceptions of safety. Consultant-led care was associated with covering every eventuality, while midwife-led care was associated with greater quality in terms of psycho-social support. Women engaged differently in the choice process, ranging from "acceptors" to "active choosers." The presentation of choice by health professionals, pregnancy complications, geographical accessibility and the implications of alternative places of delivery in terms of demands on social networks were also influential in "choice." CONCLUSIONS: Provision of different models of maternity services may not be sufficient to convince women they have "choice." The paper raises fundamental questions about the meaning of "choice" within current policy developments and calls for a more critical approach to the use of choice as a service development and analytical concept.

Research conducted by

This report is part of the RAND Corporation external publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.