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More than half of the interviews followed on from observation sessions, and this enabled us to explore issues, especially those of a sensitive nature, within the context of a previously established relationship.

Our initial observation sample was “opportunistic,” being determined by the staff on duty and whether they and their clients were willing to accommodate the researchers. I already knew what I wanted to do” (service user, intervention site) The potential of the leaflets was further diluted because they were often given out “wrapped” within advertising materials or concealed within the maternity folder.

leaflets are widely used in maternity care but little is known about their ability to influence informed choice and decision making High quality information is essential for promoting informed choice but is insufficient by itself What this study adds Time constraints and other pressures on health professionals resulted in a lack of discussion of the content of the leaflets Fear of litigation, power hierarchies, and the technological imperative in maternity care limited the choices available Health professionals promoted normative practices rather than choice, and as women valued their opinions this led to the promotion of informed compliance rather than informed choice )2 were developed by the Midwives Information and Resource Service to support consumer choice.3 The effectiveness of these leaflets has been studied in a randomised controlled trial which is reported separately.2 To understand the social context in which the leaflets were used we undertook qualitative research alongside, but independently of, the randomised trial.

Attitudes of staff are thought to influence the choices available to childbearing women 4 5 and decision making in clinical practice.6 leaflets between May and December 1998.

Objective: To examine the use of evidence based leaflets on informed choice in maternity services.

Results: Health professionals were positive about the leaflets and their potential to assist women in making informed choices, but competing demands within the clinical environment undermined their effective use.

Participants: Childbearing women and health professionals who provide antenatal care.

Intervention: Provision of 10 pairs of leaflets for service users and staff and a training session in their use.

Midwives rarely discussed the contents of the leaflets or distinguished them from other literature related to pregnancy.

The visibility and potential of the leaflets as evidence based decision aids was thus greatly reduced.