Informed, supported, confident: a realist evaluation of The Birth Map

Problem Birth preparation needs a standardised, communication-focused, structured and collaborative approach that acknowledges women as decision makers. Background The Birth Map is a consumer-driven, woman-led, structured approach to birth preparation in the form of a book. Aim To evaluate The Birth Map from the perspective of women across different models of care within Australian maternity services. Methods Realist Evaluation methodology, with 32 self-selected participants from various models of care who gave birth from September to December 2022 throughout Australia. Participants provided reflections of their experiences throughout pregnancy from March to December 2022, and 12 were interviewed postpartum in January and February 2023. Transcriptions of reflections and interviews were coded for context, mechanism and outcomes. Findings Women saw themselves as decision makers and used The Birth Map to help make sense of their options and to communicate their needs to their care team. Reports were positive across communication, experience and decision making. Communication barriers included short appointment times and dismissive care providers, which impacted the experience negatively and impeded decision making. Discussion Maternal Decision Making is a process of balancing information and individual circumstances. Women use a process of sensemaking to build support and confidence for decision making. Supported Maternal Decision Making is crucial to a Respectful Maternity Experience. Whilst The Birth Map was a mitigating factor to the identified barriers, care provider training is recommended. Conclusion The structured, woman-led approach to birth preparation supports effective communication in maternity services through sensemaking, relationship building and supported maternal decision making.