title: "Choice" and place of delivery: a qualitative study of women in remote and rural Scotland.
abstract: OBJECTIVE
  To explore women's perceptions of "choice" of place of delivery in remote and rural areas where different models of maternity services are available.
  
  
  METHODS
  Remote and rural areas of the North of Scotland. A qualitative study design involved focus groups with women who had recent experience of maternity services.
  
  
  RESULTS
  Women had varying experiences and perceptions of choice regarding place of delivery. Most women had, or perceived they had, no choice, though some felt they had a genuine choice. When comparing different places of birth, women based their decisions primarily on their perceptions of safety. Consultant-led care was associated with covering every eventuality, while midwife-led care was associated with greater quality in terms of psycho-social support. Women engaged differently in the choice process, ranging from "acceptors" to "active choosers." The presentation of choice by health professionals, pregnancy complications, geographical accessibility and the implications of alternative places of delivery in terms of demands on social networks were also influential in "choice."
  
  
  CONCLUSIONS
  Provision of different models of maternity services may not be sufficient to convince women they have "choice." The paper raises fundamental questions about the meaning of "choice" within current policy developments and calls for a more critical approach to the use of choice as a service development and analytical concept.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK. e.pitchforth@lse.ac.uk
authors.forename: E
authors.initials: E
authors.lastname: Pitchforth
authors.forename: E
authors.initials: E
authors.lastname: van Teijlingen
authors.forename: V
authors.initials: V
authors.lastname: Watson
authors.forename: J
authors.initials: J
authors.lastname: Tucker
authors.forename: A
authors.initials: A
authors.lastname: Kiger
authors.forename: J
authors.initials: J
authors.lastname: Ireland
authors.forename: J
authors.initials: J
authors.lastname: Farmer
authors.forename: A-M
authors.initials: AM
authors.lastname: Rennie
authors.forename: S
authors.initials: S
authors.lastname: Gibb
authors.forename: E
authors.initials: E
authors.lastname: Thomson
authors.forename: M
authors.initials: M
authors.lastname: Ryan
mesh_terms: D000328:Adult; D002755:Choice Behavior; D036861:Delivery, Obstetric / Q000523:psychology*; D005069:Evaluation Studies as Topic; D005260:Female; D017144:Focus Groups; D006801:Humans; D008880:Midwifery; D011247:Pregnancy; D019035:Rural Health Services; D012606:Scotland