Telling Not Asking: A Framework Method Analysis of Shared Decision-Making in Antenatal Clinic Consultations

Shared decision-making is a woman-centered approach to antenatal decision-making. Few studies have observed maternity clinicians' use of shared decision-making in antenatal clinic consultations.

The aim of this study was to explore the recorded consultations in antenatal care between pregnant women and maternity clinicians, to ascertain if, when or how shared decision-making is used in antenatal care.

Twenty-six antenatal clinic consultations were audio-recorded with maternity clinicians and women. Data were analyzed using the Framework Method, within an analytical matrix designed around the 12 items of the validated observer measure of shared decision-making, the OPTION12 scale.

A total of 12 clinicians and 26 pregnant women were recruited to the study. There were significant limitations to shared decision-making in recorded consultations. Three themes were identified through the use of the Framework Method: Who decides?, Women constrained, and Clinicians omniscient.

Reviewing the clinician communication as part of a framework matrix made visible latent themes of relationality and power imbalance between clinicians and pregnant women. Clinicians in this study shared clinical knowledge in a way that highlighted the power imbalance between the clinician and the woman. This study illustrates that shared decision-making is limited in these studied antenatal clinic consultations.

The findings of this study demonstrate how clinician communication can support or sabotage women's involvement in shared decision-making. The results of this study underscore the need for targeted efforts to more effectively integrate shared decision-making into routine antenatal care.