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

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. Conclusion  Women 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.