New study highlights challenges of giving women in labour choices about their care

University of York

While most women plan to be involved in decisions about their care during childbirth, inpractice most decisions are led by midwives, a new study reveals.

Inviting women to make decisions during labour may be in tension with midwives

The study, which used video and audio recordings to analyse real-time conversations between women in labour and their midwives, also found that postnatally the majority of women reported being satisfied with decision-making being led by staff.

Guidelines from the NHS and the Department of Health and Social care endorse patient involvement in decisions during childbirth. However, the authors of the study say their results highlight the practical challenges of offering choice, beyond establishing consent.

The study demonstrates how inviting women to make decisions during labour may be in tension with midwives’ also needing to follow clinical guidelines on risk management, the researchers suggest.


Co-author, Professor Ellen Annandale from the Department of Sociology at the University of York said: “We know what is said during labour matters for how women experience birth. However, policy recommendations to staff about how to communicate with women in labour have not yet been based on real-time analysis of what actually happens in birth.

“Our study shows that while many women report wanting to be involved in decision making, postnatally, they also reported wanting to accept midwives’ advice during labour.

“Midwives can find themselves caught between guidelines which say they must offer women choices, and a need to minimise clinical risks.”


The researchers used conversation analysis, antenatal and postnatal questionnaires as well as interviews with midwives and obstetricians, to study interactions during decision-making between 37 women in labour and their midwives.

The study, which was carried out at two midwife-led units, is the first to explore how interactions between labouring women and NHS midwives play out in real time.

While most of the women who participated in the study reported high levels of satisfaction with their care, the researchers did identify instances around pain relief where the clinical view and the choice women wanted at that time could be different, with some women who took the lead on decisions around this reporting not feeling listened to.

Pain relief

Co-author of the study, Dr Clare Jackson from the Department of Sociology at the University of York, said: “Our analysis revealed that strategies employed by midwives to avoid giving pain relief due to escalating clinical reasons at certain stages of labour – particularly when it came to opiates – left some women feeling unheard by staff. This identifies the resolution of requests for pain relief as an important area for further research.”

Professor Annandale added: “Our study shows women are willing to participate in research of this kind and further analysis of the real-time birth experiences of people in labour will help healthcare providers and policy makers to improve care.

“We would like to expand our research to look at the experiences of birth in obstetric units and, in particular, the experiences of Black, Asian and minority ethnic women who are less likely than their white counterparts to give birth in midwife-led units and are disproportionately affected by risks around childbirth.”

Interactional practices of decision-making during childbirth in maternity units was funded by the National Institute for Health Research (NIHR).

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