Background
Methods
Study design
Setting and participants
Data collection and procedures
Data analysis
Results
Characteristics | Number | Percent |
---|---|---|
Age group (years) | ||
26-30 | 3 | 14.3 |
31-35 | 8 | 38.1 |
36-40 | 7 | 33.3 |
41-45 | 3 | 14.3 |
Nationality | ||
Taiwanese | 20 | 95.2 |
Chinese | 1 | 4.8 |
Education (highest level achieved) | ||
High school | 11 | 52.3 |
College | 2 | 9.5 |
Undergraduate | 6 | 28.6 |
Postgraduate | 2 | 9.5 |
Professional | ||
Business | 4 | 19.0 |
Health | 3 | 14.3 |
Housewife | 5 | 23.8 |
Other | 9 | 42.9 |
Income $AUD/month | ||
< 500 | 6 | 28.6 |
501-1000 | 4 | 19.0 |
1001-1500 | 2 | 9.5 |
1501-2000 | 6 | 28.6 |
> 2000 | 3 | 14.3 |
Religion | ||
Buddhist | 9 | 42.9 |
Taoism | 7 | 33.3 |
Christian | 2 | 9.5 |
Atheist | 3 | 14.3 |
Obstetric data | ||
Parity | ||
Two | 18 | 85.7 |
Three | 3 | 14.3 |
Reasons for primary CS | ||
Prolonged labour | 8 | 38.1 |
Foetal distress | 3 | 14.3 |
Mal-presentation | 4 | 19.1 |
Preeclampsia | 2 | 9.5 |
Other | 4 | 19.0 |
Observation of consultation between obstetricians and pregnant women
Pregnant women’s interviews
Core theme | Ensuring the safety of mother and baby | |
---|---|---|
Themes | Categories | Sub-categories |
Influences on women’s decision-making | Previous birth experience | Positive experience Negatives experience |
Evaluation of mode of birth | Positive evaluation Negative evaluation | |
Concern about the risks of vaginal birth | Uterine rupture Labour pain | |
Current pregnancy situation | Foetal presentation Foetal size | |
Informative resources | Obstetrician’s recommendations The experience of significant others Impact of internet | |
Health insurance | National Health Insurance Private insurance | |
Decision-making processes of women | Searching for information Listening obstetricians’ professional judgment Evaluating alternatives Making a decision regarding mode of birth |
Ensuring the safety of mother and baby
Influences on women’s decision-making
Positive experience
16-03: I had a vaginal birth for my first baby and a caesarean section for my second baby. The experience of vaginal birth was excellent, so I have been thinking about having a vaginal birth for my third baby. I prefer to have a vaginal birth. (Vaginal birth)
18-09: I feel that caesarean section was not really painful. I feel OK and I can endure it. Since I had the experience of a caesarean section for my first child, I will have my second child through the same method of caesarean section. (RCS)
Negative experiences
05-01: Initially, I decided to have vaginal birth for the first birth but the doctor said it was less than two centimetres. So, I had induction of labour. However, the labour course was prolonged and I couldn’t give birth for a long time.. So in the end, I still had a caesarean section. I am afraid to experience the same situation as before. So I have decided to have a caesarean section this time.
06-02: I felt that my caesarean section was terrible because it required anaesthesia and I felt terrible.
Concern about the risks of vaginal birth
Uterine rupture
11-02: Because I felt that [a caesarean section] was much safer, I was afraid that if the interval since the wound was too short, it might have caused problems at that time.
Labour pain
05-02: I am afraid that the result would be the same; that is, I will experience the pain twice!
Evaluation of modes of birth
Positive evaluation
07-01: It is for a quick recovery. My first baby was delivered by caesarean section, and my second baby was by vaginal birth. Comparing the two methods, I think the recovery was faster for the vaginal birth.
15-18: I felt that this method was more convenient. You do not need to worry when there is sudden and unexpected pain in the abdomen. I love things that can be done in accordance with a plan.
Negative evaluation
16-04: I approve of vaginal birth more, and because I had a caesarean section before, I want to have a vaginal birth even more [for my next birth]. Because a caesarean section means that you feel the pain afterwards, but for a vaginal birth, you feel the pain on the day of the birth, and it’s okay afterwards. For me, I am afraid of pain so I approve more of having a natural birth.
07-17:For my previous birth, it was for almost two years, and I still have that kind of incontinence problem. I think it had a very far reaching impact!
Current pregnancy situation
Foetal presentation
Foetal size.15-25: It was about the thirty-second week. The prenatal examination revealed an abnormal foetal position. In the later period (35weeks), I thought that I should make an appointment to have a caesarean section at that time, even though the foetal position was normal.
17-19: Actually, my fear was more or less in my mind, and then based on the size of my baby, I was more worried. But I just wanted to see the baby’s condition because my baby was not big, and then I thought, okay! Let’s give it a try.
Information resources
Obstetrician’s recommendations
13-01: Caesarean delivery! Doctor Z decided! It was not my decision. The doctor did not tell me the reason; he just took a look. Because my first baby was born with his assistance, he directly said caesarean delivery this time.
The experience of significant others
05-15: Because my older sister had the same results for her first baby, she suffered bad pain twice, exactly the same situation. She wanted to have a vaginal birth the first time, thinking that it is better for both the baby and the pregnant woman. But she tried to have a vaginal birth and got the same result. I made the decision because I asked my older sister.
Impact of internet
03-06: Many Internet rumours have been spread that the wound may rupture before the birth, and that the amniotic fluid will come out or the baby’s hair will come out. Many opinions like that saying that vaginal birth after caesarean section also puts the baby and the mother at a high risk.
Health insurance
National Health Insurance
14-13: The doctor said that the National Health Insurance program would cover it. If it did not provide cover, it would be very expensive. However, even in that situation, I would still choose a caesarean delivery because of the consideration of safety.
Private insurance
19-30: I have private insurance! The doctor said that if you have an operation this time because of the previous caesarean delivery, it is not covered by insurance according to our insurance company.
Decision-making processes of women
Postnatal women’s interviews
Birth mode | Intended mode of birth | Actual mode of birth | |
---|---|---|---|
RCS | VBAC | ||
VBAC | 9 (42.9%) | 4 (19.1%) | 5 (23.8%) |
RCS | 12 (57.1%) | 12 (57.1%) | 0 (00.0%) |
Total | 21(100.0%) | 16 (76.2%) | 5 (23.8%) |
Reflection on birth choice
17-22: I had labour induction for eight hours. After nine hours, [the contractions] were getting faster. I was three centimetres in nearly nine hours, but afterwards, [they became] faster, and I was fully dilated in half an hour. (VBAC.)
14-23: The doctor scheduled the operation for me and then performed a caesarean section directly. Last time, I did not feel anything; I was entirely asleep. But this time, I could feel pain and it felt quite terrible. (RCS.)
Reflections on factors influencing decisions
19-47 The doctor! I was that kind of person! What the doctor told me, that method, I just followed what he said. (RCS.)
10-47 The doctor was too busy. When you asked him questions, he just briefly understated it, telling you in just a few words. He could not answer all your doubts. (RCS.)
08-58: I felt that the information was insufficient! (Woman attempted a VBAC that resulted in a RCS.)
Refection on outcomes of decisions
02-39: I still felt weak but it was much better [than after the previous birth]. This birth was much better than the previous birth. (Women had a RCS.)
17-03: My physical strength was really different! Body recovery was pretty good. One month after birth, I felt good. My physical strength and vigour were good. (Women had a VBAC.).