Decision making about mode of delivery among pregnant women who have previously had a caesarean section: a qualitative study

Abstract

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.

Incongruence between the Preferred Mode of Delivery and Risk of Childbirth Complications among Antepartum Women in Mulago Hospital, Uganda

“…Health workers should agree on patients' preference with caution [29]. Mothers are often not adequately involved in decision-making during intrapartum care [29]- [31] and often find it difficult to make informed decision for mode of delivery [32] [33].…”

Women׳s views on partnership working with midwives during pregnancy and childbirth

“…As a consequence it is particularly beneficial for identifying events that are socially situated and significant to the diarist. (Elliott, 1997;Clayton et al, 2000;Plummer, 2001;Moffat et al, 2007).…”

“…This is particularly the case in the diary-interview method, which allows the researcher to clarify diary entries to ensure a clear understanding of the participants' meaning, thereby improving internal consistency. This method also allows exploration of significant issues in more depth, using the diary as a memory prompt allowing the researcher to move the agenda forward (Zimmerman et al, 1977;Jacelon et al, 2005;Moffat et al, 2007), and is considered to be one of the most reliable methods of obtaining information (Corti, 1993).…”

Conducting Labor in Women with Previous Caesarean Section in a Low Gestational Week

“…Currently it is not only purely obstetrical criteria that play a role in the choice of the mode of delivery [8][9][10][11] , even the most careful selection of pregnant women cannot guarantee complete safety for both the mother and child. It may only reduce the risk rate to the lowest possible level [12] .…”