The context of women's childbirth decisions regarding vaginal birth after cesarean section

Abstract

The purpose of this study was to investigate the influences, both internal and external, identified by women in their choice of vaginal birth after a previous cesarean section (VBAC) or repeat cesarean section (RCS). The rate of cesarean section (C/S) is currently approximately one in four to five births in the United States. Thus the stakes in obstetrical decision making both financially and philosophically, have become enormous (Keeler & Brodie, 1993). The method for this descriptive study combined 6 focus group interviews (n=19) with development and pilot-testing of the Cesarean Decision Making Questionnaire (C/S DMQ) to measure influences on method of delivery choice (N=31). Women who chose VBAC or RCS comprised the focus group sample. An additional 12 women were recruited to complete the questionnaires by mail. Factors identified in the literature and supported by clinical experience as influencing the decision making process constituted dimensions and items of the C/S DMQ developed for this study and served as the initial framework for content analysis of the focus groups. It was evident from the qualitative data that childbirth model and influence of health care providers (primarily physicians), along with perceptions of risk to baby, followed by risk to self, most influenced women's decisions regarding their method of delivery. Desire for control of decisions and childbirth practices was very important for the women who chose VBAC as compared to women who chose RCS. The C/S DMQ pilot results contained several dimensions or aspects with respectable internal consistencies. These included Childbirth Models, Desire for Control, Health Care Providers, and Social Support. Other dimensions with less internal consistency were Perceptions of Risk and Vulnerability, Uncertainty, and Demographics. The concepts of Risk and Uncertainty require further conceptualization for adequate instrumentation. Low internal consistency of Demographics may reflect the variety of demographic variables measured. The difference between women who chose VBAC and RCS was reflected in the dimension of Childbirth Models as a mediating variable for risk, supporting the social model for women who choose VBAC.