‘The interface between evidence-based maternity care clinical practice guidelines and the pregnant woman’s autonomy’.

The importance of the pregnant woman’s autonomy and the role of increased choice in decision-making relating to her maternity care have gained widespread recognition. This is borne out in the healthcare and bioethics literature, key initiatives in policy documents and clinical guidelines. Although guidelines are a central feature of maternity care, little is known about how their recommendations are experienced by women and the impact on their autonomy. This thesis addresses that gap in knowledge. The methods I used in this research comprised a literature review and an empirical study consisting of semi-structured interviews with 20 participants in an inner-city teaching hospital. Data collection, transcription and analysis were informed by adaptation of the Constructivist Grounded Theory approach (Charmaz: 2006). My analysis generated two main thematic categories. First, women lack the appropriate in-depth pregnancy and birth knowledge to make decisions independently. Second, interactions with trusted professional carers were highly valued. Analysis suggested new insights, namely that the meaning of autonomy to women is more complex than self- government, a range of options and relational responsibilities can account for. Women felt empowered by being a genuine participant in the decision-making process. They expressed their autonomy by being invited to share their previous experiences, current expectations and concerns and request information in a manner consistent and timely with their own agendas. Women’s responses were also shaped by considered reflection of the impact of their decisions on others. My analysis revealed that some level of interdependence may be a precondition for women to exercise their autonomy. It is a paradox that the recommendation professionals should follow guidelines and be non-directive may result in the unintended consequence of women exercising their autonomy by in part reinstating authority to professional carers. Interpretation of findings led to the development of my grounded theory, ’Choosing when to choose’.