Choice in childbirth : psychology, experiences and understanding

Current policy (DoH 2004a), in response to critiques of the biomedical model of pregnancy, advocates choice and control for women within maternity care and promotes women as active childbirth consumers and decision-makers. This model equates choice to increased quality of experience, in the recognition that pregnancy and childbirth are both a physical and psychological experience. However to date the assumed psychological benefit of offering women choice remains unproven. The aim of this thesis is to explore women's psychology and experiences of pregnancy, and early motherhood, within the context of choice in contemporary maternity care. This will be achieved by assessing the impact of women's pregnancy and childbirth management choices on psychological well-being in the antenatal and postnatal periods and examining the ways in which women perceive and relate their experiences of pregnancy and childbirth and early motherhood in the context of their choice. This thesis argues that understanding of women's maternity experiences necessitates a need to go beyond traditional accounts. Whilst it is important to assess how women respond emotionally to pregnancy, childbirth and new motherhood, there is further a need to comprehend the meanings and understandings that women attach to their maternity experience. Hence, in an attempt to address its own critique, this study adopts a mixed methodology design and uses both a prospective cohort research design and a narrative approach within a single study. In doing so, it addresses the conflict inherent in the use of traditionally opposing methodological stances and argues for a pragmatic approach which aims to understand women's psychology and experiences through a multi-dimensional and integrated frame. Results revealed that no one care option revealed psychological benefit. The statistically significant differences observed occurred over time and exposed largely corresponding profiles across the groups. The mixed method approach promoted a powerful and illuminating interpretation of the concept of choice in maternity care. Women's narratives revealed the strong and powerful role that maternity influences and discourses play in constructing idealised identities, for women, across their maternity experience. These influences underpin and inform how women represent their psychological status and both facilitate and/or constrain maternity choices.