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ABSTRACT: Background: Increasingly, women seek involvement in decisions about their health care. The purpose of this study was to examine women's experience of, and satisfaction with, their involvement in health care decisions during a high-risk pregnancy.

Methods: Forty-seven women with hypertension or threatened preterm delivery (including multiple births) were interviewed after the birth of their child. They received prenatal care at home from nurses in a community program or were hospitalized. The in-depth interviews were audiotaped and transcribed; data were analyzed using constant comparative methods.

Results: Women identified an increased feeling of responsibility for the health of their baby and themselves, but differed in choosing active or passive involvement in health care decisions. Women who wanted active involvement achieved it through one of three processes: struggling for, negotiating, or being encouraged. Women who wanted passive involvement and women facing health crises used the process of trusting in the expertise of nurses and physicians. Women were satisfied if the care from health care professionals was congruent with how they wanted to be involved in decision-making.

Conclusions: Although most women want to be actively involved in health decision-making during a high-risk pregnancy, some prefer a passive role. The setting of prenatal care, community-based or in-hospital, was less important than the ability of nurses and physicians to support the woman in her preferred role in decision-making. (BIRTH 30:2 June 2003)