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Elective caesarean delivery: a mixed method qualitative investigation.

Holly Powell Kennedy¹, Jane Grant, Cathy Walton

¹Yale University School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536, USA.

|February 26, 2013

Summary

Elective caesarean delivery choices are complex, influenced by team dynamics and a culture of surgical birth. Understanding these factors is key to improving shared decision-making for better maternal and infant outcomes.

Keywords:

Decision-making Elective caesarean Qualitative research

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Area of Science:

Obstetrics and Gynecology
Maternal-Fetal Medicine
Qualitative Health Research

Background:

Rising rates of primary, repeat, and elective caesarean deliveries over recent decades.
Potential cultural shift favoring infant over maternal outcomes in birth choices.
Need to explore complexities surrounding elective caesarean delivery decisions.

Purpose of the Study:

To explore the complexities of women's and clinicians' choices regarding elective caesarean delivery.
To understand the interplay of cultural and scientific factors in birth decisions.
To investigate the decision-making process for elective caesarean births.

Main Methods:

Interpretive qualitative study using institutional ethnography.
Interviews and observations of 27 women and 34 clinicians across two NHS maternity providers.
Documentary analysis of local policy guidelines and narrative analysis of collected data.

Main Results:

Four key themes emerged: the culture of caesarean, caesarean counseling, perceptions of choice, and negotiating rules.
Variations in elective caesarean choices and outcomes linked to team collaboration and philosophies.
Decision-making reflects a complex intersection of individual concerns and institutional practices.

Conclusions:

Counselling for elective caesarean and vaginal birth after caesarean is intricate, blending culture and science.
Women and clinicians share a goal for optimal outcomes despite differing perspectives.
Future research should focus on shared decision-making, evidence-based guidelines, and the social context of maternity care.