Birth Care Gaps in the CHildbirth Options, Information, and person-Centered Explanation (CHOICEs) Measure

Abstract

Abstract Purpose: The objective of this study was to revise and improve the intrapartum items of the shared decision-making (SDM) measure, CHildbirth Options, Information and person-Centered Explanation (CHOICEs). Study Design and Methods: Methodological sequential triangulation was used to select a purposive sample of 29 people who gave birth in the United States between August 2019 and June 2021. A qualitative descriptive approach was used to analyze and interpret the data. We used an interview guide with questions related to the nine intrapartum items in CHOICEs to address the question: How did decision-making occur during your most recent birth? Results: Four major themes were identified: provider told me what to do; communication about interventions during labor and birth; preferences overlooked; multiple team members. Under the theme of provider told me what to do, there was one sub-theme of induction of labor. Clinical Implications: Participants noted lack of shared decision-making, poor communication, and obstetric violence. We found the need for perinatal providers to improve communication with birthing people on topics such as fetal monitoring, induction of labor, and multiple team members who may participate in their care. Revisions of CHOICEs will include seven new items to further address birth preferences, feeling heard, and multiple team members.