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Table 1 Analysis Framework

From: ‘I didn’t think you were allowed that, they didn’t mention that.’ A qualitative study exploring women’s perceptions of home birth

Analytic theme Descriptive theme Codes Description
Lack of knowledge about what home birth looked like What does home birth look like? Familiarity
Experience
- (Limited) Familiarity with concept of home birth
- Perceptions that homebirth may influence experience (i.e. potential offers a better experience, but home linked to negative associations if things ‘go wrong’)
   Practicalities - Uncertainty about the practicality, cost, consequences of home-birth
   Aftercare - Concerns about reduced postnatal care after a home birth
Expectation of birth in an OU Assumption’ that they would give birth in an OU OU ‘normal’
Cultural norms
- OU described as ‘normal’/‘usual’ place of birth
- Participants describe making decisions in reference to cultural norms
   Option/choice - Homebirth is an option rarely (or not) offered/discussed
  OU perceived as safer than home High Risk
OU safe
Managing emergencies
- Birth described as carrying significant risk
- OU described as safer option compared to home birth (minimizes risk)
- OU considered to have greater ability to respond to emergencies/provide specialist staff
Lack of confidence in the reliability of the maternity service Confidence in service at time of birth Safety Concerns about ability of maternity services to provide
- safe birth at home
Responsiveness Concerns about ability of maternity service to be
- available for home birth when required
Accessibility - Concerns about ability of maternity services to provide safe birth at home
- Concerns about ability of maternity service to be available for home birth when required
- Perceptions that maternity services are under-funded/under-resourced to provide appropriate level of care
Continuity in care Continuity - Concerns that would not receive adequate aftercare (including breastfeeding support)
Perceptions of birth as a ‘natural’ event Perceptions of ‘Natural Birth’ Assistance - Differing perceptions/meanings related to ‘natural’ birth linked to level of intervention
Place - Differing perceptions/meanings related to ‘natural’ birth linked to place (hospital vs home)
Medical technology - Differing perceptions on the role of medical technology in having a natural birth (safe/clean vs intrusive)
Sources of information for women Sources of information for women Mode - Mode of information - Information from people valued more than information leaflets
Credibility - Role of informants matters (having professionals experience of home birth and ‘like minded’ people are seen as credible)
Formality - Influence of formal routes (hospital antenatal classes, hospital tours)
Informal
Prioritization
- Role of family, friends in providing information
- Home birth not prioritized
The role of health care professionals The role of health care professionals Credibility - Role of Health professionals – seen as credible source of information
Gatekeepers - HPs described as consciously and unconsciously controlling (restricting) information about place of birth
Influence - HPs seen as explicitly and implicitly influencing decision-making (skewed to OU as place of birth)
Women’s responses to the offer of choice Perception of choice Choice – realities - Preferred choices not always available (e.g. alternative options not given, or unable to be delivered in practice)
Choice – acceptance - Extent to which lack of choice is perceived by women to be acceptable (e.g. most women accepting of limited choice)
Choice- skills - Exerting choice for home birth requiring special skill sets e.g. ‘confidence’ and ‘motivation’
Response to choice Responsibility - Choice experienced as a responsibility (unwanted by many)
   Rights to choose - Choice sometimes needs to ‘fought’ for if it does not align to ‘usual’ routes
   Support - Lack of support experienced for choices made (from family, health professionals)