'Informed and uninformed decision making'--women's reasoning, experiences and perceptions with regard to advanced maternal age and delayed childbearing: a meta-synthesis.

Objectives: To identify what factors affect women's decisions to delay childbearing, and to explore women's experiences and their perceptions of associated risks.
Design: Systematic procedures were used for search strategy, study selection, data extraction and analysis. Findings were synthesised using an approach developed from meta-ethnography.
Data Sources: We included qualitative papers, not confined to geographical area (1980-2009). Databases included CINAHL, MEDLINE, EMBASE, PsycInfo, ASSIA, MIDIRS, British Nursing Index and the National Research Register. We selected qualitative empirical studies exploring the views and experiences of women of advanced maternal age who were childless or primigravidae with a singleton pregnancy or primiparous.
Review Methods: Twelve papers fulfilled the selection criteria and were included for synthesis.
Results: Women appear to face an issue of 'informed and uninformed decision making'; those who believe they are informed but may not be, those who are not informed and find out they are at risk once pregnant, and those who are well informed but choose to delay pregnancy anyway. Maternity services could provide information to enable informed choice regarding timing of childbearing.
Conclusions: Health professionals need to be mindful of the fact that women delay childbearing for various reasons. A strategy of pre-conception education may be beneficial in informing childbearing decisions. Obstetricians and midwives should be sensitive to the fact that women may not be aware of all the risks associated with delayed childbearing.
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