Patient decision making: the case of delivery method after a previous cesarean section

In recent years, vaginal birth after cesarean section has become increasingly available to American women. Presently, about two-thirds of women who have had one previous cesarean section choose in their current pregnancies to attempt a "trial of labor" for normal vaginal delivery. About one-third who are given the option still choose elective repeat cesarean section. This paper reports findings from a study conducted to explore how women with a previous cesarean section evaluated the two delivery options and what factors were important to them in making their choices. The data for the analysis were collected during semi-structured interviews of 100 prenatal care patients at three San Francisco Bay Area hospitals during their third trimester of pregnancy. Particular attention is given to two dimensions of patient decision making that clinical researchers studying childbirth after previous cesarean delivery have overlooked. The first describes the social motives that lead women to prefer one delivery option over the other. The second describes negotiation strategies that patients use with physicians to gain decision making power and to reduce uncertainty surrounding labor and delivery.