Patient-led decision making: Measuring autonomy and respect in Canadian maternity care

Abstract

Objective: The Changing Childbirth in British Columbia study explored women's preferences and experiences of maternity care, including women's role in decision-making.

Methods: Following content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers.

Results: A geographically representative sample of Canadian women (n = 2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores.

Conclusion: Women's autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women's ability for self-determination.

Practice implications: If health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve.

Keywords: Autonomy; Childbirth; Decision-making; Participatory research; Patient-oriented; Person-centered; Pregnancy; Quality measure; Respectful maternity care.