Objective To explore prospectively women's decision making regarding mode of delivery after a previous caesarean section.Main outcome measures The evolution of decision making, women's participation in decision making, and factors affecting decision making.Design and methods A qualitative study using diaries, observations and semi-structured interviews. Data were analysed thematically from both a longitudinal and a cross-sectional perspective.Setting An antenatal unit in a large teaching hospital in Scotland and participants' homes.Sample Twenty-six women who had previously had a caesarean section for a nonrecurrent cause.Results Women were influenced by their own previous experiences and expectations, and the final decision on mode of delivery often developed during the course of the pregnancy. Most acknowledged that any decision was provisional and might change if circumstances necessitated. Despite a universal desire to be involved in the process, many women did not participate actively and were uncomfortable with having responsibility for decision making. Feelings about the amount and quality of the information received regarding delivery options varied greatly, with many women wishing for information to be tailored to their individual clinical circumstances and needs. In contrast to the impression created in the media, there was no evidence of clear preferences or strong demands for elective caesarean section.
ConclusionWomen who have had a previous caesarean section do not usually have firm ideas about mode of delivery. They look for targeted information and guidance from medical personnel based on their individual circumstances, and some are unhappy with the responsibility of deciding how to deliver in the current pregnancy.
Objectives
To determine the perinatal outcome of fetuses who had birthweights less than that expected from early third trimester ultrasound scanning.
Design
Retrospective estimation of centile fetal weight at early third trimester ultrasound scanning compared with actual centile birthweight corrected for gestational age, parity and sex.
Setting
Teaching Hospital Obstetric Unit, London.
Subjects
197 unselected women with singleton cephalic pregnancies who were delivered at term in our unit between October 1989 and May 1990.
Main outcome measures
CTG abnormality, need for fetal blood sampling in labour, meconium‐staining of the amniotic fluid, mode of delivery, Apgar scores at 1 and 5 min, need for transfer of baby to neonatal unit, and need for neonatal intubation of the neonate at delivery.
Results
An actual birthweight >5% less than the birthweight estimated from ultrasound scanning identified 44 babies (22%) with an increased risk of CTG abnormalities (χ2= 8.38, P <0.0025; Odds ratio (OR) = 2.54; 95% CI1 1.6 to 4.78) and need for operative delivery (x= 5.81, P <0.0125; OR = 1.94; 95% CI 1.15 to 3.27), when compared with the remainder of the sample. Overall 14 (32%) of this group had birth‐weights above the 50th centile. A group of 44 babies selected as being the smallest for gestational age, without reference to growth pattern, had a similar excess morbidity. (All this group had birthweights below the 39th centile.)
Conclusions
This study supports the hypothesis that in‐utero fetal growth pattern is as important for perinatal outcome as being small for gestational age per se.
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