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Choice and birth method: mixed-method study of caesarean delivery for maternal request

  1. C Kingdon1,
  2. J Neilson2,
  3. V Singleton3,
  4. G Gyte4,
  5. A Hart5,
  6. M Gabbay6,
  7. T Lavender7

Article first published online: 22 APR 2009

DOI: 10.1111/j.1471-0528.2009.02119.x

Issue

BJOG: An International Journal of Obstetrics & Gynaecology

BJOG: An International Journal of Obstetrics & Gynaecology

Volume 116, Issue 7, pages 886–895, June 2009

Additional Information

How to Cite

Kingdon, C., Neilson, J., Singleton, V., Gyte, G., Hart, A., Gabbay, M. and Lavender, T. (2009), Choice and birth method: mixed-method study of caesarean delivery for maternal request. BJOG: An International Journal of Obstetrics & Gynaecology, 116: 886–895. doi: 10.1111/j.1471-0528.2009.02119.x

Author Information

  1. 1

    Department of Midwifery Studies, University of Central Lancashire, Preston, UK

  2. 2

    Department of Obstetrics & Gynaecology, School of Reproductive and Developmental Medicine, University of Liverpool, Liverpool Women’s Hospital, Liverpool, UK

  3. 3

    Department of Sociology, Lancaster University, Lancaster, UK

  4. 4

    Cochrane Pregnancy and Childbirth Group, University of Liverpool, Liverpool Women’s Hospital, Liverpool, UK

  5. 5

    Lancashire School of Health & Post Graduate Medicine, University of Central Lancashire, Preston, UK

  6. 6

    School of Population, Community and Behavioural Sciences, University of Liverpool, Liverpool, UK

  7. 7

    School of Nursing, Midwifery & Social Work, University of Manchester, Manchester, UK

* Dr C Kingdon, Research Fellow, Department Midwifery Studies, University of Central Lancashire, Preston PR1 2HE, UK. Email ckingdon@uclan.ac.uk

Publication History

  1. Issue published online: 11 MAY 2009
  2. Article first published online: 22 APR 2009
  3. Accepted 3 November 2008. Published Online 22 April 2009.

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Keywords:

  • Caesarean section;
  • choice;
  • decision-making;
  • mixed methods;
  • women’s views

Objective  To explore whether women view decision-making surrounding vaginal or caesarean birth as their choice.

Design  Longitudinal cohort study utilising quantitative (questionnaire, routinely collected data) and qualitative (in-depth interviews) methods simultaneously.

Setting  A large hospital providing National Health Service maternity care in the UK.

Sample  Four-hundred and fifty-four primigravid women.

Methods  Women completed up to three questionnaires between their antenatal booking appointment and delivery. Amongst these women, 153 were interviewed at least once during pregnancy (between 24 and 36 weeks) and/or after 12 moths after birth. Data were also obtained from women’s hospital delivery records. Descriptive statistical analysis was performed (survey and delivery data). Interview data were analysed using a seven-stage sequential form of qualitative analysis.

Results  Whilst many women supported the principle of choice, they identified how, in practice their autonomy was limited by individual circumstance and available care provision. All women felt that concerns about their baby’s or their own health should take precedence over personal preference. Moreover, expressing a preference for either vaginal or caesarean birth was inherently problematic as choice until the time of delivery was neither static nor final. Women did not have autonomous choice over their actual birth method, but neither did they necessarily want it.

Conclusions  The results of this large exploratory study suggest that choice may not be the best concept through which to approach the current arrangements for birth in the UK. Moreover, they challenge the notion of choice that currently prevails in international debates about caesarean delivery for maternal request.

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