title: Socially disadvantaged women's views of barriers to feeling safe to engage in decision-making in maternity care.
abstract: BACKGROUND
  Although midwifery literature suggests that woman-centred care can improve the birthing experiences of women and birth outcomes for women and babies, recent research has identified challenges in supporting socially disadvantaged women to engage in decision-making regarding care options in order to attain a sense of control within their maternity care encounters.
  
  
  OBJECTIVE
  The objective of this paper is to provide an understanding of the issues that affect the socially disadvantaged woman's ability to actively engage in decision-making processes relevant to her care.
  
  
  METHODS
  The qualitative approach known as Interpretative Phenomenological Analysis was used to gain an understanding of maternity care encounters as experienced by each of the following cohorts: socially disadvantaged women, registered midwives and student midwives. This paper focuses specifically on data from participating socially disadvantaged women that relate to the elements of woman-centred care-choice and control and their understandings of capacity to engage in their maternity care encounters.
  
  
  RESULTS
  Socially disadvantaged women participants did not feel safe to engage in discussions regarding choice or to seek control within their maternity care encounters. Situations such as inadequate contextualised information, perceived risks in not conforming to routine procedures, and the actions and reactions of midwives when these women did seek choice or control resulted in a silent compliance. This response was interpreted as a consequence of women's decisions to accept responsibility for their baby's wellbeing by delegating health care decision-making to the health care professional.
  
  
  CONCLUSIONS
  This research found that socially disadvantaged women want to engage in their care. However without adequate information and facilitation of choice by midwives, they believe they are outsiders to the maternity care culture and decision-making processes. Consequently, they delegate responsibility for maternity care choices to those who do belong; midwives. These findings suggest that midwives need to better communicate a valuing of the woman's participation in decision-making processes and to work with women so they do have a sense of belonging within the maternity care environment. Midwives need to ensure that socially disadvantaged women do feel safe about having a voice regarding their choices and find ways to give them a sense of control within their maternity care encounters.
authors.affiliation: School of Nursing & Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. Electronic address: lyn.ebert@newcastle.edu.au.
authors.forename: Lyn
authors.initials: L
authors.lastname: Ebert
authors.affiliation: School of Nursing & Midwifery, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW 2308, Australia. Electronic address: Helen.Bellchambers@newcastle.edu.
authors.forename: Helen
authors.initials: H
authors.lastname: Bellchambers
authors.affiliation: Faculty of Education and Arts, School of Humanities and Social Science, Speech Pathology, University of Newcastle, Callaghan, NSW 2308, Australia. Electronic address: Alison.Ferguson@newcastle.edu.au.
authors.forename: Alison
authors.initials: A
authors.lastname: Ferguson
authors.affiliation: Faculty of Health, University of Canberra, ACT 2308, Australia. Electronic address: Jenny.browne@canberra.edu.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Browne
mesh_terms: D000328:Adult; D003657:Decision Making; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D008427:Maternal Health Services / Q000458:organization & administration*; D008880:Midwifery; D009723:Nurse-Patient Relations; D009774:Obstetrics; D010358:Patient Participation; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology; D036301:Qualitative Research; D035862:Vulnerable Populations / Q000523:psychology*
keywords: Choice; Control; Maternity care; Midwifery; Responsibility