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Objective To assess the degree and nature of women's involvement in the decision to deliver by caesarean section, and women's satisfaction with this involvement.

Design Observational study.

Setting The maternity unit in a large teaching hospital.

Sample One hundred and sixty-six women undergoing caesarean section.

Methods Interviews with the women on the third or fourth day postpartum, questionnaires sent to the women at 6 weeks and at 12 weeks postpartum, and extraction of information from the women's medical records.

Main outcome measures Women's knowledge, satisfaction, and involvement in making the decision concerning their caesarean section.

Results The majority of the women were satisfied with the information they received during pregnancy on caesarean section and with their involvement in making the decision, but the proportions were significantly higher for elective than emergency sections. For 7% of the women, maternal preference for caesarean section was a direct factor in making the decision. Just over half of the 166 women reported that they were not debriefed on the reasons for their caesarean section before their discharge from hospital. Almost a third of the women undergoing emergency caesarean section expressed negative feelings towards their delivery, compared with 13% of those undergoing elective caesarean sections.

Conclusion Women are not a homogeneous group in terms of their requirements for information, nor their desire to be involved in the decision on mode of delivery. Health professionals need to be responsive to this variability and to agree on standards for communicating with women during pregnancy about the possibility of operative delivery and for debriefing women after caesarean section. sarean section, and women's satisfaction with this involvement.