Women’s experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks

• Published in: BJOG : an international journal of obstetrics and gynaecology 2006-12, Vol.113 (12), p.1438-1445
• Main Authors: Emmett, CL, Shaw, ARG, Montgomery, AA, Murphy, DJ
• Format: Article
• Language: English
• Subjects: Adult; Attitude to Health; Biological and medical sciences; Births; Caesarean section; Cesarean Section; Decision Making; Delivery, Obstetric - psychology; Delivery. Postpartum. Lactation; Female; Gynecology. Andrology. Obstetrics; Health education; Humans; Medical sciences; Patient Education as Topic; Pregnancy; Pregnant Women - psychology; Professional-Patient Relations; qualitative methods; Risk Assessment; Risk Factors; vaginal birth after caesarean; Vaginal Birth after Cesarean - psychology; Women
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2006.01112.x

Objective  To explore women’s experiences of decision making about mode of delivery after previous caesarean section. Design  A qualitative interview study. Setting  Two city maternity units in southwest England and Eastern Scotland. Sample  Twenty‐one women who had recently delivered a baby and whose previous child was delivered by caesarean section. Methods  Semi‐structured interviews analysed using the framework approach. Main outcome measures  Women’s views on the influence of uncertainty on decision making, issues concerning information provision and decision‐making roles. Results  Experiences of decision making varied considerably. Some women were certain about choosing either vaginal birth after caesarean or repeat elective caesarean section, others were very uncertain and for some this uncertainty persisted after the birth. Information was most commonly provided by hospital doctors (mainly consultants) and more often related to procedural issues rather than possible health risks and benefits. Women felt they had to actively seek information rather than it being provided routinely. Most women were able to make their own decision about mode of delivery. Health professionals generally took a supportive role whichever mode of delivery was chosen. Although many women were comfortable with this approach, some felt they would have liked more guidance. Conclusion  On the whole, women experienced having control over the decision about planned mode of delivery. For many, making this decision was difficult and for some it was the cause of prolonged anxiety. Women were often making the decision without being provided with comprehensive and specific information about possible health risks and benefits. We are currently conducting a randomised controlled trial to investigate whether access to a decision aid is beneficial to women in this situation.