The aim of the focus groups was to investigate the features of maternity care that influence pregnant women’s decision-making when presented with the choice of delivering in a CLU or MLU. A focus group approach was taken rather than individual
interviews to ensure wide ranging ideas emerged, and debate among participants
ensued. Group settings are known to have a synergistic effect over one-to-one
interview settings (Stewart and Shandasani 1990).
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The criteria for inclusion in the focus groups were restricted to women who were
considered to be at low risk of obstetric complications, and who were currently
pregnant. Low risk was defined according to the National Institute for Health and
Clinical Excellence (NICE) guidelines (NICE 2007), and describes women between
18 and 39 years of age with no history of obstetric complications or Caesarean section
and no contraindications of morbidities at the time of pregnancy. Women who are
considered high risk were excluded from the sample as this group does not have the
luxury of choosing to deliver in a maternity care setting where the full range of medical
services is not immediately available. The study aims to capture the views and
opinions of a range of women and invited women who had never given birth before;
women who had given birth one or more times; women who were receiving their care
publicly; and women who were receiving their care privately to participate in the focus
groups.
A sample group of women who recently had their 20 week scan (over a two week
period during May, 2012) and who booked to deliver in a large, teaching maternity
hospital in Ireland (CUMH) were invited to participate in the focus groups. 196 low
risk women were identified from the hospital’s antenatal database records. This group
comprises 138 women (70.4 per cent) who were receiving their care publicly and 58
women (29.6 per cent) who were receiving their care privately. An invitation letter,
accompanied by an information leaflet, was distributed to the full sample. Women
were informed that they can return an opt-out consent form in a pre-paid envelope
provided if they do not wish to participate in the study. Alternatively, if they were
interested in participating in the study they were informed that they would be contacted
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Four focus groups were arranged with participants in CUMH in May 2012, where each
session was audio recorded and women gave written consent to participate in the
study.24 Each focus group was facilitated by two researchers.25
A topic guide that described a list of features of maternity care which might influence
women’s decision-making when choosing place of delivery was used during the focus groups.26 The topic guide derived from a review of existing literature, along with an
analysis of policy-relevant issues, as described in Chapters 2 and 3. For instance,
access to pain relief was highlighted in the literature as an important feature of
maternity care (Byrne et al 2010; Hundley et al 2001; Pitchforth et al 2008). In the
focus groups, women were asked how important access to pain relief was to them, and
whether they would choose to deliver in a unit where they would have restricted access
to epidural anaesthesia compared with a unit that offers full access. The topic guide
served as a prompt, or cue, in the focus groups where women were asked to consider
each aspect of care and its influence on their decision-making when presented with
the choice of delivering in a CLU or MLU. Women were also given the opportunity
to stray from the topic guide in order to capture other aspects of maternity care that
were not anticipated during the development of the topic guide.
A thematic analysis was undertaken to evaluate the different aspects of maternity care that drive women’s decision-making when choosing place of delivery. This analysis is considered a useful and flexible approach for qualitative research (Braun and Clarke
2006). Other analyses were deemed inappropriate given the objective of the study,
24 Transcripts of the four focus groups are presented in Appendix A.2.
25 The author led each focus group, and was accompanied by another researcher, consistent with best
practice guidelines.
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such as grounded theory which is concerned with developing theories and concepts
using a collection of qualitative data (Strauss and Corbin 1990). The thematic analysis
followed five key stages to identify themes in the data (Braun and Clarke 2006).
Firstly, iterative reading of the transcripts and individual transcripts was undertaken.
Secondly, codes were generated to describe salient and relevant themes. The relevant
data items were collated in the third stage using mind maps and tables. The candidate
themes were continuously refined during the fourth stage to ensure that an appropriate
and coherent pattern was evident. This involves further coding and the generation of
new themes through the amalgamation and removal of certain data items. The
emerging themes and subthemes were defined during the fifth stage (Braun and Clarke
2006). The results from the thematic analysis are reported in the following section
(section 3.3).
Ethical approval for this study was granted by the Clinical Research Ethics Committee
(ECM4 06/03/12) and the Division of Obstetrics and Gynaecology in CUMH.