Autonomy-supportive decision-making in maternity care during prenatal consultations: a qualitative interaction analysis

OBJECTIVES: The aim of this study was to identify mechanisms of autonomy-supportive consultation (ASC) that maternity care professionals use during decision-making in prenatal consultations. DESIGN: This study was a descriptive, qualitative analysis of professional–patient interactions in maternity care, using concepts and analytic procedures of conversation analysis. SETTING: The prenatal consultations took place in hospitals and midwifery practices in the Netherlands. This study was part of a larger project. For the current study, we selected prenatal consultations concerning three topics in which patients make their own choices. PARTICIPANTS: The first author invited the patient who was waiting in the waiting room. Participants were not selected a priori. MAIN OUTCOME MEASURES: The main outcome measures were mechanisms of ASC. RESULTS: We selected 20 consultations which were conducted by 20 different professionals. We found eight mechanisms in the professional–patient interaction which were categorised into three overarching themes. The first theme, ‘Lightheartedness’, comprises the interactional mechanisms ‘minimising language’ and ‘humour’. The theme ‘Orientation to agreement’ describes how professionals and patients seem to be oriented towards demonstrating agreement and mutual understanding. The last theme, ‘Offering information and options’, describes the professional formally giving factual information almost completely without verbal interaction between the professional and the patient. CONCLUSION: The results of this study show that the model of ASC can be enriched by adding minimising language and humour to the mechanisms that can be used to fulfil the psychological need ‘relatedness’. Second, our results show that professionals use only few mechanisms to meet the patients’ psychological needs ‘competence’ and ‘autonomy’. They mainly use information giving to meet patients’ need competence. To meet patients’ need for autonomy, the professionals keep all options open. This suggests that professionals could pay more attention to other mechanisms to meet patients’ needs for ‘competence’ and ‘autonomy’.