Facilitating and making informed choices during pregnancy : a study of midwives and pregnant women.

Over the past several years various authors and Government reports have urged that women be enabled to make informed choices regarding their care during pregnancy and childbirth. The facilitation and making of these choices involves complex processes, however, which apparently have not yet been studied in depth; this is the purpose of this study. A grounded theory approach to data collection and analysis has been used within a interpretive framework, influenced by symbolic interaction, to develop middle range, substantive theory. Mid, Arives and pregnant women were accessed from four maternity units. Data were collected by means of loosely structured interviews and observation. All 48 interviews were transcribed and provided the main source of data. Convenience sampling was supplemented later in the study by theoretical sampling. Data were analysed and theoretical frameworks constructed according to grounded theory method. Several strategies were used to confirm the trustworthiness of the data and their analysis. From the midwives data, the core category was identified as Protective Steering, whereby midwives tried to steer the women and themselves through various pitfalls and dilemmas. Substantive categories were Orienting, Raising Awareness and Protective Gatekeeping. The core category emerging from the women's data was Maintaining Equilibrium, whereby the woman attempted to make decisions that would preserve the balance of her life, and that of her family. Substantive categories were Regulating, Contextualising and Actioning. The category which linked the two sets of data and theoretical frameworks was named Balancing: Walking a Tightrope. Two main over-arching issues emerged as power and trust. Issues of power related to the study are discussed mainly in terms of Foucault's and Lukes' interpretations of power. Trust is discussed in relation to existing theories and their application to this study. Recommendations for midwifery practice are made, together with hypotheses for further exploration.