Women and husbands’ experiences and expectations of shared decision-making during pregnancy and childbirth in Saudi Arabia: A qualitative study

Background: Studies demonstrate that shared decision-making (SDM) improves maternity care outcomes globally, though implementation varies across cultural contexts. The practice of SDM within Saudi Arabia's unique cultural and religious framework remains understudied. Aim: To explore the experiences and expectations of women and husbands regarding SDM in maternity care in Saudi Arabia. Methods: This qualitative study employed semi-structured interviews with women over 18 (either pregnant or had given birth in the past 12 months) and husbands from January to May 2023 Participants were recruited through convenient sampling from two maternity hospitals and social media. Interviews were conducted in Arabic, transcribed, translated into English, and analysed through thematic analysis. Themes were mapped onto the Three-Talk Model for SDM (team talk, option talk, and decision talk). Results: Data from 19 women and five husbands revealed three themes: (1) Team Talk: Communication and Relationship Building: effective communication built rapport but was hindered by discontinuity of care, time constraints, language barriers, emotional readiness, and gender preferences; (2) Option Talk: Information Exchange: participants valued receiving clear information though they often reported insufficient details or perceived biases from obstetricians; (3) Decision Talk- Autonomy and SDM: women's autonomy varied, influenced by hierarchical healthcare structures, religious beliefs, and family involvement, with some mistaking consent forms for SDM. Conclusions: Several factors negatively impacted SDM experiences, highlighting opportunities to certify medical interpreters, enhance continuity of care, integrate midwifery-led care, and develop autonomy-respecting protocols.