Autonomy support in prenatal consultation: A quantitative observation study in maternity care

Maternity care professionals need to guide women through an increasing number of decision-making processes during pregnancy. Professionals tend to focus more on providing information than on decision support. According to the self-determination theory (SDT), professionals could help women make their own choices by fulfilling their three basic psychological needs: autonomy, competence, and relatedness through autonomy-supportive interactions. This study aimed to quantify autonomy-supportive and autonomy-thwarting interactions that professionals use during prenatal consultations and their association with women's perceptions of the healthcare climate during consultations.

A quantitative observation study with a cross-sectional design was conducted in the Netherlands from March to October 2020. Twenty-three maternity care professionals in 2 hospitals and 16 midwifery practices were purposefully sampled. During 104 prenatal consultations, professional interactions were audiotaped and coded using the Coding and Observing Need-Supportive Consultation in Maternity Care Consultations. The woman's perceived healthcare climate was assessed using the Healthcare Climate Questionnaire.

We observed that professionals derive their autonomy-supportive interactions from a small repertoire. They tend to use more autonomy-supportive interactions (mean=2.31, SD=0.58) that give room to the woman than interactions that stimulate active engagement (mean=1.41, SD=0.80). During structuring interactions, they tend to use more informative (mean=1.81, SD=0.59) than supportive interactions (mean=0.94, SD=0.55). Women generally perceived the healthcare climate as positive.

Women were rarely stimulated to be actively engaged in the consultations, while active woman engagement is vital in offering women-centered decision-making support. Professionals could improve their autonomy-supportive consultation climate by paying explicit attention to interactions involving women and offering structure.