The project collected questionnaire data and interview transcripts with women who were currently pregnant or had recently given birth. as well as interview transcripts with maternity care professionals. Given the protocols used and inability to obtained retrospective consent the data cannot be shared.This study explores women’s childbirth preferences, decisions, outcomes, whether they are aligned and the factors that shape this within the context of NHS England’s Better Births (2016) maternity care policy. Much like previous maternity care policies, Better Births promises to create safer and more personalised maternity experiences for women, utilising a rhetoric of choice to prioritise women’s control. However, complex and dominant social and (bio)medical discourses of risk and uncertainty affect Better Births’ implementation. Whilst (bio)medical care for birth became normalised within society during the second half of the twentieth century, emergent discourses of ‘good’ motherhood have, in contrast, privileged natural birth and minimised the need for medical interventions. In this broader social context, as well as immense resource and financial pressures, pregnant women and maternity care providers find themselves caught between competing ideologies and practices of birth, with various implications for the concept of maternal choice. To investigate these issues, this study takes a mixed methods approach, including an analysis of the Better Births (2016) policy, 49 online questionnaires and 14 follow-up interviews with pregnant women and new mothers in a Better Births early adopter site. The study also includes 13 interviews with a range of different maternity care providers operating inside and outside the NHS. This research found that women’s childbirth preferences were not realised in their decisions and outcomes but were incrementally medicalised as they moved through the trajectory of childbirth preferences, decisions and outcomes. Discourses of risk and uncertainty were found to constrain women’s choices and limit providers’ practices in various ways. This study concludes that women need to be better empowered to navigate risk and uncertainty throughout pregnancy and childbirth, and that providing them with means to do this might be more effective in improving women’s experiences of maternity than Better Births’ rhetoric of choice.

Online questionnaires and semi-structured interviews with pregnant women and new mothers, as well as semi-structured telephone interviews with a range of maternity care providers working inside or outside the NHS.