Reconciling dependency and agency: The essential role of respect in birth - Swiss birthing people's understandings of and attitudes towards decision-making in birth

Decision-making interactions between birthing people and providers frequently lie at the core of negative birth experiences. It is argued that decision-making frameworks often do not prioritize birthing people's needs and preferences but, for example, fetal interests, institutional needs, or providers' preferences. As a consequence, autonomy in birth is only an illusion. However, research syntheses highlight the crucial role of choice, control, and person-led decision-making for positive birth experiences and postpartum mental health. Hence, our aim was to explore Swiss birthing people's understanding of and attitudes towards autonomy and decision-making in birth.We interviewed 16 participants and analysed data using reflexive thematic analysis. We developed three main themes: “you are kind of dependent” – dependency (subthemes: acuity, setting, persons), “being the agent of your own situation” – agency (subthemes: control, knowledge, openness), “women should simply be respected” – respect (subthemes: a birthing subject with dignity, birth as a transformative life event).Our findings demonstrate that dependency is an inescapable reality of birth, which cannot be removed, only shaped and moderated. At the same time, agency is something that birthing people desire and require, at least to some degree, to experience birth positively. On the surface, these two elements seem contradictory: dependency implies relinquishing control, while agency is about making choices. However, when birthing people feel respected, they are able to navigate between these two states – they can step into their agency while tolerating the necessary dependency inherent to birth. Respect, then, acts as a facilitator, enabling the integration of dependency and agency.