Women’s decision-making processes and the influences on their mode of birth following a previous caesarean section in Taiwan: a qualitative study

Abstract

BackgroundVaginal birth after caesarean (VBAC) is an alternative option for women who have had a previous caesarean section (CS); however, uptake is limited because of concern about the risks of uterine rupture. The aim of this study was to explore women’s decision-making processes and the influences on their mode of birth following a previous CS.MethodsA qualitative approach was used. The research comprised three stages. Stage I consisted of naturalistic observation at 33-34 weeks’ gestation. Stage II involved interviews with pregnant women at 35-37 weeks’ gestation. Stage III consisted of interviews with the same women who were interviewed postnatally, 1 month after birth. The research was conducted in a private medical centre in northern Taiwan. Using a purposive sampling, 21 women and 9 obstetricians were recruited. Data collection involved in-depth interviews, observation and field notes. Constant comparative analysis was employed for data analysis.ResultsEnsuring the safety of mother and baby was the focus of women’s decisions. Women’s decisions-making influences included previous birth experience, concern about the risks of vaginal birth, evaluation of mode of birth, current pregnancy situation, information resources and health insurance. In communicating with obstetricians, some women complied with obstetricians’ recommendations for repeat caesarean section (RCS) without being informed of alternatives. Others used four step decision-making processes that included searching for information, listening to obstetricians’ professional judgement, evaluating alternatives, and making a decision regarding mode of birth. After birth, women reflected on their decisions in three aspects: reflection on birth choices; reflection on factors influencing decisions; and reflection on outcomes of decisions.ConclusionsThe health and wellbeing of mother and baby were the major concerns for women. In response to the decision-making influences, women’s interactions with obstetricians regarding birth choices varied from passive decision-making to shared decision-making. All women have the right to be informed of alternative birthing options. Routine provision of explanations by obstetricians regarding risks associated with alternative birth options, in addition to financial coverage for RCS from National Health Insurance, would assist women’s decision-making. Establishment of a website to provide women with reliable information about birthing options may also assist women’s decision-making.Electronic supplementary materialThe online version of this article (10.1186/s12884-018-1661-0) contains supplementary material, which is available to authorized users.

Factors influencing decision-making to accept elective caesarean section in a hospital in Ghana: A descriptive cross-sectional study

“…The current caesarean section for 33 (20.2%) of the respondents was due to previous CS, giving a high incidence (60%) among this category of respondents. This is consistent with ndings of earlier researches on the possibilities of having repeat CS [27] and the respondents' fore-knowledge of this in uenced their decision-making [28,29]. This was however contrary to ndings where respondents with previous CS were reluctant to have another CS because of fear of death and mockery [20] which contributed to women preferring vaginal delivery.…”

Perceptions and expectations of pregnant women about the type of birth

“…The choice for vaginal birth is justified in studies, especially for its advantages such as: being natural, healthy, fast recovery and providing greater autonomy for self-care and care with the newborn (2,5,(12)(13)(14) , reasons according to what was learned in the statements of the pregnant women, since the discourses point out the advantages of vaginal birth, related to the rapid recovery and quality of the relationship with the baby in the postpartum period, identified as aspects that make vaginal birth better for the mother and the baby.…”

“…The idea of the safety provided by the cesarean section contravenes anxiety and fear of vaginal birth, justifying the desire of pregnant women for this type of birth, with the support of family members, especially of their mothers and companions who often end up guaranteeing the procedure payment (4) . A research carried out in a private medical center in northern Taiwan has shown that the medical professional can play a decisive role in choosing the cesarean section, either by presenting it as an option from the beginning of gestation, and by responding to the passive acceptance of the pregnant woman, or for supposedly leading to shared decision-making throughout gestation (5) . In Brazil, a qualitative study carried out with women who experienced both vaginal birth and cesarean section showed ambivalence of feelings: in vaginal labor, difficulty in labor as opposed to ease in recovery, being the inverse for cesarean section.…”

“…Mostly, doctors do not contradict this desire, which contributes to the high rates of the procedure, often decided at the beginning of prenatal care (6) . On the other hand, vaginal birth may not occur, even when desired, due to the lack of orientation of the pregnant women on their evolution or even by the valorization of the possible complications of this type of birth (5) .…”

Perception of Childbirth Experiences of Japanese Women in Bali, Indonesia: A Qualitative Study

“…Ethical approval was obtained from the Faculty of Medicine, Udayana University/Sanglah Hospital (493/UN.14.2/KEP/2017), and Yamaguchi Prefectural University (No. [27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45].Before data collection, the purpose and aim of the research were explained to the participants, and they were informed about their rights. Written and verbal information wasgiven to participants, and written consentwas obtainedbefore the interview.Participants were also assured that all their responses would be kept con dential; all collected information includingaudio recordings and transcripts were securely stored and accessible only to the researchteam.This study is a part of an ongoing project (2016-2021), which was implemented in cooperationwith Udayana University and Yamaguchi Prefectural University.…”