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

Autor: Shu-Wen Chen, Cate Nagle, Alison M. Hutchinson, Tracey Bucknall
Rok vydání: 2016
Předmět:
medicine.medical_specialty
Attitude of Health Personnel
medicine.medical_treatment
Decision Making
Reproductive medicine
Taiwan
Repeat caesarean section (RCS)
lcsh:Gynecology and obstetrics
Choice Behavior
Vaginal birth after caesarean (VBAC)
Nonprobability sampling
03 medical and health sciences
Mode of birth
0302 clinical medicine
Naturalistic observation
Pregnancy
Qualitative research
medicine
Humans
Caesarean section
030212 general & internal medicine
Cesarean Section
Repeat
lcsh:RG1-991
030219 obstetrics & reproductive medicine
Data collection
business.industry
Parturition
Obstetrics and Gynecology
Risk evaluation
Patient Acceptance of Health Care
medicine.disease
Vaginal Birth after Cesarean
Uterine rupture
Obstetrics
Family medicine
Female
Pregnant Women
business
Research Article
Decision-making
Zdroj: BMC Pregnancy and Childbirth
BMC Pregnancy and Childbirth, Vol 18, Iss 1, Pp 1-13 (2018)
ISSN: 1471-2393
Popis: Background Vaginal 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. Methods A 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. Results Ensuring 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. Conclusions The 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 material The online version of this article (10.1186/s12884-018-1661-0) contains supplementary material, which is available to authorized users.
Databáze: OpenAIRE
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