Women’s insights into choice, empowerment, and control in a subsequent pregnancy following a negative birth experience: A multimethod study

<p dir="ltr">Background: Lack of control and choice contributes to women experiencing birth as negative or distressing. Wanting a different experience in a subsequent pregnancy following a negative experience is invariably uppermost in women’s minds. A woman-centred approach is associated with a more positive maternity care experience. </p><p dir="ltr">Aim: To establish women’s agreement on elements of care that place them at the centre of their maternity care, following a negative birth experience and to identify enablers and constraints influencing perception of woman-centred care </p><p dir="ltr">Methods: This multimethod study combined quantitative and qualitative approaches to explore women’s perspectives on aspects of woman-centred care. Fifty-seven multiparous pregnant women with a history of negative maternity experiences and/or fear of birth completed a survey assessing eleven co-designed elements of care identified in a modified Delphi study. Fourteen of these women participated in semi-structured interviews about their current maternity care. Quantitative data were analysed using descriptive statistics, and qualitative data using content and thematic analysis. </p><p dir="ltr">Findings: Women valued acknowledgment of previous experiences and comprehensive information supporting informed decision-making and control. Holistic care from known caregivers enhanced these outcomes, although some women felt centred in their care when supported by unknown clinicians who adopted woman-centred practices. </p><p dir="ltr">Conclusion: Meeting women's values, preferences, and informational needs promotes a sense of control and empowerment. Continuity of care enhances woman-centred approaches, though relational care can also be provided within fragmented systems. Continuity during pregnancy should be prioritised for women who have experienced a negative birth experience and have a current fear of birth.</p>