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028 Improving the childbirth options, information and person-centered explanation (CHOICEs) tool, a patient-reported experience measure of shared decision-making in maternity care
  1. Rachel Blankstein Breman1,
  2. Amy Goh2
  1. 1University of Maryland, School of Nursing, Baltimore Maryland, US
  2. 2Boston College, Boston Medical Center, Boston Massachusetts, US


Introduction Birthing people report lack of shared decision-making (SDM), feeling disrespected and having little autonomy during perinatal care. The CHildbirth Options, Information and person-Centered Explanation (CHOICEs) is a patient-reported experience measure of SDM in perinatal care designed for research and quality improvement. The original analysis of CHOICEs indicated additional items were needed to capture the full scope of SDM, specifically related to labor and birth. This study’s objective was to understand people’s experiences during decision-making processes around interventions during labor and birth in the United States to improve items in CHOICEs.

Methods A purposive sample of 29 postpartum people from across the United States, who gave birth between August 2019-June 2021, participated in semi-structured interviews. A qualitative descriptive approach was used to analyze and interpret the data. An interview guide with questions about the CHOICEs labor and birth items addressed the research question: How did decision-making occur during your birth?

Results Four major themes emerged: provider/clinician told me what to do; communication about interventions in labor and birth; preferences overlooked; multiple clinicians. The theme of provider/clinician told me what to do, had a sub- theme, induction of labor.

Discussion Participants noted lack of SDM, poor communication, and obstetric violence, specifically related to a lack of consent during vaginal examinations. Clinicians need to improve communication with birthing people on fetal monitoring, induction of labor, and amongst the multiple team members who participate in their care.

Conclusion Revisions of CHOICEs will include new items to further address birth preferences, feeling heard, and multiple clinicians. Because there was minimal SDM around interventions such as induction of labor and Pitocin administration, communication on these topics need additional research. Based on our study findings, in-depth examination of how multiple perinatal clinicians’ impact SDM is necessary.

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