A qualitative study of nulliparous women's decision making on mode of delivery under China's two-child policy

To explore nulliparous women's perceptions of decision making regarding mode of delivery under China's two-child policy.

Qualitative descriptive design with in-depth semi-structured interviews.

Postnatal wards at a tertiary specialized women's hospital in Shanghai, China.

21 nulliparous women 2-3 days postpartum were purposively sampled until data saturation.

In-depth semi-structured interviews were conducted between October 8th, 2015 and January 31st, 2016.

Two overarching descriptive categories were identified: (1) women's decision-making process: stability versus variability, and (2) factors affecting decision making: variety versus interactivity. Four key themes emerged from each category: (1) initial decision making with certainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise, anticipated caesarean delivery; (2) initial decision making with uncertainty: anticipated trial of labour, failed trial of labour, 'shy away' and compromise; (3) internal factors affecting decision making: knowledge and attitude, and childbirth self-efficacy; and (4) external factors affecting decision making: social support, and the situational environment.

At the initial period of China's two-child policy, nulliparous women have perceived their decision-making process regarding mode of delivery as one with complexity and uncertainty, influenced by both internal and external factors. This may have implications for the obstetric setting to develop a well-designed decision support system for pregnant women during the entire pregnancy periods. And it is recommended that care providers should assess women's preferences for mode of delivery from early pregnancy and provide adequate perinatal support and continuity of care for them.