ROLE OF HEALTH PROFESSIONALS

Women's Experience of Decision Making about Mode of Delivery after a Previous Caesarean Section: The Role of Health Professionals and Information about Health Risks

Women's Experience of Decision Making about Mode of Delivery after a Previous Caesarean Section: The Role of Health Professionals and Information about Health Risks

Introduction

A new study published in the December 2006 edition of BJOG: An International Journal of Obstetrics and Gynaecology, reveals the reasons for the type of delivery women want after a previous caesarean section. The study surveyed 21 women from 2 city hospitals in Bristol and Dundee. Uncertainty in decision making, information provision and decision-making roles were examined by researchers, as these were considered to be the main factors behind women opting for a repeat caesarean section or vaginal birth after caesarean (VBAC). Women who chose to have a caesarean section did so because they were afraid of vaginal birth or were convinced that a vaginal birth was not for them, or wanted to have control over the birth. Women choosing VBAC did so because they were influenced by the shorter recovery time after birth, wanted the experience of a natural delivery or feared having to go through another caesarean section. Uncertainty and anxiety in choosing the method of delivery was a result of conflicting opinions between women and their partners, or among their health professionals. The information these women received about caesarean sections was mostly about procedural issues rather than the health risks and benefits of the different methods of delivery. Many women felt that it would be helpful to receive information after the first caesarean section (Gamble, 2000).

In terms of decision-making roles, the majority of women felt that their doctors allowed them the choice of delivery, unless complications developed and intervention was required, and favoured this 'hands-off' approach. Some women however, would have liked more guidance from their obstetricians.

A metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis.

Discussion

The women who were interviewed for this website were also participants in a large randomised clinical trial, the DiAMOND trial. DiAMOND stands for 'Decision Aids for Mode of Next Delivery' and the aim of the trial was to evaluate two decision aids designed to support women in their decision-making about how to give birth to their next child after a previous caesarean. Previous research had found a lack of readily available information for women in this situation. It suggested that many women would find it helpful to have access to information about the risks and benefits of different ways of giving birth when making the decision about whether to have a planned caesarean or a vaginal birth after caesarean (VBAC). The trial was conducted at three hospitals located in two cities in the UK between May 2004 and January 2006. Women were invited to take part during their first hospital ...