Fooladi, EnsiehCrawford, KimberleyAlruwaili, Tahani Ali2025-08-032025-07-13Alruwaili, T. A., Fooladi, E., & Crawford, K. (2025). Shared decision-making during pregnancy and childbirth in Saudi Arabia: A mixed-methods study. Saudi Digital Library, National Center for E‑Learning, Ministry of Education.https://hdl.handle.net/20.500.14154/76088This thesis explores how women and their husbands are involved in making medical decisions during pregnancy and childbirth in Saudi Arabia. It shows that while many women actively participate in decisions about their care, others have fewer opportunities. Factors such as seeing different doctors during pregnancy, the gender of doctors, language and cultural differences, and hospital rules can limit involvement. The study proposes practical tools to improve communication and decision-making between women, families, and healthcare providers. These findings aim to support better, more respectful care for mothers and families in Saudi Arabia.Background Shared decision-making (SDM) is fundamental to quality pregnancy and childbirth, representing a collaborative approach between healthcare providers (HCPs) and women. In Saudi Arabia's obstetrician-led maternity care system, the implementation of SDM and the experiences of women and their husbands remain understudied, particularly in the context of unique cultural, religious, and healthcare factors. Aim To explore women’s and their husbands’ experiences of shared decision-making with healthcare providers during pregnancy and childbirth in Saudi Arabia. Methods The study employed a convergent parallel mixed-methods design guided by the Three-Talk Model for SDM, which conceptualises SDM as a process involving team talk, option talk, and decision talk. The quantitative strand involved a nationwide, online survey conducted between January and May 2023, targeting women aged 18 and above who were either pregnant or had experienced pregnancy/childbirth in the past 12 months. Low to very low SDM and respect were defined as scores of ≤24 on the Mothers’ Autonomy in Decision-Making (MADM) scale and ≤49 on the Mothers on Respect Index (MORi), respectively. Using the same inclusion criteria, the qualitative strand conducted semi-structured interviews with women and husbands, recruited through convenient sampling from two maternity hospitals and social media. Interview data were analysed thematically and mapped onto the Three-Talk Model for SDM. Data from both phases were integrated during the interpretation phase to provide comprehensive insights into SDM experiences. Results The survey of 505 women revealed that 34.1% (95% confidence interval [CI], 29.6–38.9) reported low to very low SDM. Statistical analysis identified significant factors associated with low SDM, including seeing different obstetricians of a different gender at each visit (adjusted odds ratio [AOR] 2.0, 95% CI, 1.0–3.9), not meeting the same obstetrician throughout the pregnancy (AOR 2.6, 95% CI, 1.2–5.6), and having an instrumental vaginal birth (AOR 6.67, 95% CI, 1.6–28.1). A strong positive association emerged between low to very low SDM and reporting of low to very low respect (χ2 = 83.8173, p < 0.001). The qualitative data from 19 women and 5 husbands identified the following three major themes aligned with the Three-Talk Model: (1) Team Talk; communication and relationship building were limited by discontinuity of care, time constraints, language barriers, emotional readiness, and gender preferences; (2) Option Talk; information exchange highlighted the importance of clarity, despite reported insufficient details and perceived HCP biases towards intervention; and (3) Decision Talk; autonomy and SDM revealed varying levels of autonomy influenced by hierarchical healthcare structures, religious beliefs, and family involvement. Many participants mistook signing consent forms for engaging in SDM, indicating a gap in understanding of SDM processes. Participants’ experiences centred primarily on interactions with obstetricians, with minimal midwifery involvement. Conclusion The findings reveal challenges in implementing SDM within Saudi maternity care, including discontinuity of care, language barriers from non-Arabic-speaking obstetricians, gender preferences, and rigid institutional hierarchies. These findings highlight the need for healthcare reforms, including professional interpretation services, improved continuity of care, and exploration of midwifery-led models. Future maternity care policies should consider the complex interplay of religious beliefs and family dynamics when developing strategies to improve SDM in Saudi pregnancy and childbirth.369enShared decision-makingMaternity careSaudi ArabiaHealthcare communicationNursingMidwiferyThesis