Maternity care pathway and involvement in decision making: A mixed-methods study of women's experiences in Ireland

Background: In Ireland, maternity care is provided through a mixture of public and private services, with type of maternity care offered varying according to availability, clinical need and geographic location. Aim: To explore women's perceived involvement in decisions about care depending on the maternity care pathway received. Methods: Mixed-methods secondary analysis of data from the Irish National Maternity Experience Survey 2020. Three care pathway groups reflecting maternity care provision in Ireland were created: public care with midwives and obstetricians in hospital, private/semi-private obstetric-led care and midwifery-led care. Hierarchical multiple regression determined the association between care pathways and involvement in decisions. Free-text comments from respondents were thematically analysed. Findings: 3205 women participated (50 % response rate). 64.75 % received public care, 24.11 % received consultant-led private/semi-private care and 11.13 % received midwifery-led care. Private/semi-private care and midwifery-led care were associated with greater perceived involvement in decisions during pregnancy compared to public care. Private/semi-private care was associated with greater perceived involvement in care decisions during labour and birth and decisions in hospital after birth compared to public care. Qualitative findings identified that involvement in decisions was supported by effective communication, continuity of relationship with healthcare professionals, availability of choice and support for women's preferences. Discussion: Levels of continuity of care provided by maternity care models in Ireland may account for differences in perceived involvement in decisions. Conclusion: All maternity care pathways should strive to provide continuity of care to support women to make informed choices across all stages of their maternity care.