Risk perception and decision making in women with high risk pregnancies

Background: How women with high risk pregnancies perceive the risks they face can affect the decisions they make during pregnancy and labour and their attitude toward medical advice. Existing evidence states pregnant women and healthcare professionals do not define or assess risk in the same way. Homebirth is regarded as safe for women with straightforward, low risk pregnancies. Some women with complicated pregnancies will also choose to give birth at home, generally against medical advice. Aim and Objectives: To investigate women’s perceptions of risk and how these affect their decisions to give birth at home or in hospital Method: A qualitative study using semi-structured interviews. Participants were pregnant and had a medical or obstetric condition which put the pregnancy at higher risk. They were recruited via referral from obstetricians and midwives. Twenty six women were interviewed. Thirteen were planning to give birth at home (against medical advice) and thirteen in hospital. Thematic analysis was used to analyse transcripts. Results: Themes emerging from the data included: judgement of risk, the degree of risk women perceived; impact of risk, how they were affected by the risks; philosophy of childbirth, what women believed about pregnancy and birth; and weighing up, how women balance and prioritised different factors. There were some differences and some similarities between women planning to give birth in hospital and at home. Interpretation: Women planning homebirths define risk and safety differently to women planning hospital births. Both groups of women prioritise their babies’ wellbeing but have different interpretations of how this is best achieved. Conclusions: Risk perception is individual and subjective and is related to decision making regarding place of birt