Achievement of a physiological birth: insights from a qualitative study on women's motivations and decisions

An increasing number of women are seeking a more physiological birth, opting to give birth without epidural analgesia. However, most of them ultimately opt for it.

A qualitative study using semi-structured interviews was conducted to explore women's final decisions regarding epidural analgesia among those who initially desired a physiological birth.

Fourteen women were interviewed. Decision-making regarding epidural analgesia emerged as a dynamic and evolving process occurring throughout labour, shaped by interacting factors including personal motivations, fear-related considerations, previous childbirth experiences, prenatal preparation, pain management strategies, and perceived support. These factors influenced women's capability to maintain or revise their initial birth plan. Positive motivations include the desire for a more intimate and active birth experience while negative motivations were mainly related to fear of immobility or epidural analgesia failure, often driven by stress or anxiety. Some characteristics, such as parity, were described as non-modifiable, whereas perceived support and opportunities for mobility were reported as contextual factors influencing women's experiences and decisions.

These findings highlight the importance of a personalised, woman-centered approach that recognises childbirth decision-making as an evolving process and supports women's changing needs throughout labour.