Women's experiences of declining recommended or routine maternity care: A systematic review

Women have the right to decline recommended or routine maternity care. While informed choice is increasingly emphasised in maternity care, the experiences of women who decline recommended or routine care remain underexplored.

To synthesise evidence on women's experiences of declining recommended or routine aspects of maternity care.

A systematic review was conducted using a structured approach informed by Joanna Briggs Institute (JBI) principles for qualitative synthesis. Eight studies were appraised using the Critical Appraisal Skills Programme (CASP) checklist. Data were analysed through a narrative synthesis process, developing categories and dimensions that were synthesised into overarching themes.

Through narrative synthesis, two overarching categories were developed to answer the review question: 'Women's Characteristics' supported by two subcategories: 1) Women's birth philosophy, autonomy, and trust in the birth process and 2) Informed and values-based decisions to decline care. The second category, 'Maternity Care Professionals' Influence', is supported by subcategories 1) paternalism and the erosion of trust, and 2) risk-averse culture and defensive practice.

This review synthesised literature on why women decline recommended or routine maternity care. Findings indicate that women who decline care demonstrate values-driven, informed decision-making and have a desire for autonomy and respectful care. Maternity care can be improved by recognising women's rights to decline care, supporting informed choice through advocacy, and providing individualised woman-centred care.