{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T16:49:50Z","timestamp":1791650990701,"version":"4.3.4"},"reference-count":49,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,8,18]],"date-time":"2023-08-18T00:00:00Z","timestamp":1692316800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Birth"],"published-print":{"date-parts":[[2023,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Numerous studies show that negative birth experiences are often related to birthing people's loss of autonomy. We argue that a fetal\u2010focused decision\u2010making framework and a maternal\u2013fetal conflict lens are often applied, creating a false dichotomy between autonomy and fetal beneficence. Given the high prevalence of autonomy\u2010depriving decision\u2010making, it is important to understand how autonomy can be enhanced.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We interviewed 15 Swiss perinatal care practitioners (eight midwives, five physicians, and two doulas) and employed reflexive thematic analysis. We offer a reflection on underlying assumptions and researcher positionality.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We generated two descriptive themes: advancing and limiting factors of autonomy. Numerous subthemes, grouped at the levels of companion, birthing person, practitioners, birthing person\u2013practitioner relationship, and structural determinants are also defined. The most salient advancing factors were practitioners' approaches to decision\u2010making, antenatal contacts, and structural determinants. The most salient limiting factors were various barriers within birthing people (e.g., expertise, decisional capacity, and awareness of own rights), practitioners' attitudes and behavior, and structural determinants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>The actualization of autonomy is multifactorially determined and must be understood against the background of power structures both underlying and inherent to decision\u2010making in birth. Practitioners attributed a significant proportion of limited autonomy to birthing people themselves. This reinforces a \u201cmother\u2010blame\u201d narrative that absolves obstetrics of primary responsibility. Practitioners' recognition of their contributions to upholding limits on autonomy should be leveraged to implement training towards rights\u2010based practice standards. Most importantly, autonomy can only fully materialize if the underlying sociocultural, political, and medical contexts undergo a fundamental change.<\/jats:p><\/jats:sec>","DOI":"10.1111\/birt.12757","type":"journal-article","created":{"date-parts":[[2023,8,21]],"date-time":"2023-08-21T13:30:17Z","timestamp":1692624617000},"page":"1068-1080","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Between \u201ca lot of room for it\u201d and \u201cit doesn't exist\u201d\u2014Advancing and limiting factors of autonomy in birth as perceived by perinatal care practitioners: An interview study in Switzerland"],"prefix":"10.1111","volume":"50","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6537-9793","authenticated-orcid":false,"given":"Michael","family":"Rost","sequence":"first","affiliation":[{"name":"Institute for Biomedical Ethics University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelda","family":"Stuerner","sequence":"additional","affiliation":[{"name":"Institute for Biomedical Ethics University of Basel  Basel Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5231-3760","authenticated-orcid":false,"given":"Paulomi","family":"Niles","sequence":"additional","affiliation":[{"name":"Rory Meyers College of Nursing New York University  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Arnold","sequence":"additional","affiliation":[{"name":"Institute of Psychology Friedrich\u2010Schiller University Jena  Jena Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,8,18]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001847"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-021-03826-1"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12978-019-0729-2"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0252645"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1891\/1058-1243.23.1.9"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.midw.2017.09.003"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12231"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1348\/014466500163095"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2017.00560"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pec.2018.10.023"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.314.7088.1143"},{"key":"e_1_2_9_13_1","first-page":"104","article-title":"Breaking the frame: obstetric violence and epistemic rupture","volume":"1","author":"Chadwick R","year":"2021","journal-title":"Age"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmqr.2022.100077"},{"key":"e_1_2_9_15_1","unstructured":"World Health Organization.The prevention and elimination of disrespect and abuse during facilitybased childbirth: WHO statement. 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