Decision Making in Patient‐Initiated Elective Cesarean Delivery: The Influence of Birth Stories

Abstract

Patient-initiated elective cesarean delivery is emerging as an urgent issue for practitioners, hospitals, and policy makers and for pregnant women. This exploratory qualitative study looks at the birth stories and cultural knowledge that women use to inform the decision about an elective cesarean without medical indication. Data collection consisted of exploratory qualitative in-depth interviews with 17 primiparous women in British Columbia, Canada. Interviews revealed the influence of socially circulated birth stories and cultural narratives on their attitudes towards mode of delivery. Participants included in their decision making process both medical information and informal birth stories that were technologically inclined and confirmed their preference for cesarean delivery. Results indicate that women who participated in this study drew heavily from social and cultural knowledge in forming their decision to give birth by patient-initiated elective cesarean delivery. Although the numbers of women who request a cesarean delivery for social reasons is still small, the persuasive influence on parturient women of positive cesarean stories and negative vaginal stories must be considered. Care providers and childbirth educators need to become familiar with the social influences impacting women's decisions for mode of delivery so that truly informed choice discussions can be undertaken.

The Cesarean Decision Survey

“…A perceived reason of safety for the baby was similar to previous reports (Arthur & Payne, 2005;Fenwick et al, 2010;Weaver & Statham, 2005;Wiklund et al, 2007). Another similarity to prior research was the use of friends/family and the Internet as sources of information (Lagan et al, 2010;Munro et al, 2009). Future studies could compare the women's perceived reasons for the cesarean with the actual diagnosis listed by the health-care provider.…”

“…by women to guide decision making for a cesarean surgery (Lagan, Sinclair, & Kernohan, 2010;Morris & McInerney, 2010;Munro, Kornelson, & Hutton, 2009). Munro et al (2009) conducted a qualitative study to explore the influence of birth stories and cultural knowledge on women's decisions to have cesarean surgeries.…”

“…Munro et al (2009) conducted a qualitative study to explore the influence of birth stories and cultural knowledge on women's decisions to have cesarean surgeries. The sample consisted of 17 Canadian first-time mothers who requested to deliver by cesarean.…”

Family Physicians’ Views on Caesarean Delivery on Maternal Request

“…Moreover, Munro et al [12] evaluated women who underwent caesarean delivery without any medical indication or influence of birth stories. They found that, negative vaginal birth stories and positive caesarean stories affected the decisions of the women and hence this must be considered by healthcare providers.…”

Childbirth related fears and psychological birth trauma in younger and older age adolescents

“…Specific study on normal stress responses has indicated that novel situations often lead to greater stress responses (Ayers, 2004), such as with a first pregnancy and birth. Other triggers potentially leading to childbirth related fear may include negative mood, negative stories and television shows, alarming information heard, child-related problems, and previous negative birth experiences (Melender, 2002;Munro, Kornelsen, & Hutton, 2009).…”