A new study of women’s experiences of delay in labour has revealed that many mums-to-be are prepared to abandon their antenatal plans for how they wanted their labours and births to be.

Researchers from the Universities of Birmingham and Leicester found that women were willing to let go their ideal of choice when unanticipated complications occurred.

Published in the journal Health, the NIHR-funded study is based on interviews with 18 women. These women were all involved in a pilot study, led by Dr Sara Kenyon at the University of Birmingham, which compared different doses of a drug used when a woman’s contractions are not frequent and/or strong enough for labour to progress. When this kind of delay occurs, women may have greatly reduced choices about how the labour and birth will go.

By examining women’s experiences of their labours not progressing as they would have wished, the study was able to reveal what was important to women about retaining choice compared to other outcomes.

It showed that a simplistic model of patient choice is not always applicable to the complex and uncertain reality of some healthcare situations: women may not always prioritise choice, and they may be willing to rely on the judgements of medical professionals when unplanned circumstances arise.

The study suggests that the key challenge for health professionals is to effectively bring about a smooth transition from a system of ‘choice’ to a system of ‘care’, and to do so in a person-centred way that affords people dignity, compassion and respect.

Dr Kenyon said: “Giving patients choice and involving them in decision-making about their care is increasingly seen as important, and a key way of ensuring that healthcare is really person-centred.  However, attempts to translate these principles into practice have revealed several potential problems. One such problem is that patients may not always want to take on this level of involvement; a second problem is that it simply may not be possible in some circumstances e.g. emergency situations.”

Study co-lead Dr Natalie Armstrong of the University of Leicester, said: “For women experiencing delays in labour,  the need for medical ‘care’ can easily replace ideals of ‘choice’. The women who were interviewed accepted that the ideal of making choices had to be abandoned, that clinical circumstances legitimately changed events and reduced the range of possibilities, and that the professionals treating them had the expertise to identify the best course of action. The safe delivery of a healthy baby took priority over all else.

“Although the vast majority of women had made detailed choices antenatally for how they wanted their labours and births to be, these were let go fairly easily when unanticipated complications arose. Sometimes choice really is limited and what seems important is that the healthcare professionals involved are able to skilfully manage this so that the experience does not become a negative one for those involved It was heartening to hear that for most women .” 

The accounts of women interviewed in the study suggest that in the vast majority of cases this had been achieved, although future work into how best to manage this transition would be valuable.

Notes to editors:

For interview requests, a copy of the full paper or for more information, please contact Luke Harrison, Media Relations Manager, University of Birmingham on +44 (0)121 414 5134.

For out of hours media enquiries please call: +44 (0) 7789 921 165

The article presents independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme (Grant Reference No. PB-PG-0407-13193).

Paper Reference

Armstrong N, Kenyon S. When choice becomes limited: Women's experiences of delay in labour. Health first published on December 9, 2015 as doi:10.1177/1363459315617311

The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government’s strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (www.nihr.ac.uk).