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Decision-Making of pregnant women regarding the mode of birth after one previous caesarean section

07/11/2012

MLI logo  Andrea Matterne, M.Sc:


Decision-Making of pregnant women regarding the mode of birth after one previous caesarean section – a hermeneutic-interpretative analysis of problem-centered interviews.

(until now unpublished awarded Masterthesis at the Martin-Luther-University Halle-Wittenberg, Institute of Health and Care Sciences)

 

Abstract:

Background:

Through increasing rates of caesarean sections health professionels, especially midwifes and obstetricians, meet cumulatively pregnant women with a caesarean in their history. These women have to decide, which mode of birth they will choose: vaginal birth after caesarean (VBAC) or an elective repeat caesarean section (ERCS). Here, a variety of medical, social and psychological aspects were involved.

The Question and aim:

How do pregnant women make a decision regarding their desired mode of birth after a previous caesarean section, and what factors influence this process?

For this purpose, hypotheses should be generated to focus the mother´s perspective with the aim to make a contribution for counseling these women, suitable to their needs.

Methods and Participants:

A hermeneutic-interpretative approach was chosen using problem-centered interviews by Witzel and subsequent qualitative content analysis by Mayring. Six women, who were pregnant with their second baby and had already completed their decision making process, were interviewed in the time period after 35 weeks until 40 weeks of pregnancy.

Results:

An important stimulus for considering the future mode of birth represents the experience of the first birth and conversations with other significant persons. In their decision-making process the women ponder various contexts, or eventualities. In each case reaching their decision may take place before getting pregnant again, in the early weeks of pregnancy, or in late pregnancy.

Significant considerations and influences may also be: the belief in natural birth as a significant life event, a (lack of) confidence in their own ability to give birth normally, pragmatic factors (e.g. predictability, child care, mobility), and a future desire to have children. Finally women wish, in anticipation of the time after childbirth, that they evaluate their decision to be correct retrospectively too.

Conclusions:

The decision making process regarding the mode of delivery after a previous caesarean section is complex, requires the consideration of a variety of very individual factors, and is a challenge not only to the women themselves but also the professions providing health care.


Keywords: Decision making process, (vaginal) birth after caesarean, VBAC, maternal perspective