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Purpose/Aim

To explore women's values and expectations about birth after cesarean during decision making to better inform the design of strategies to support women to achieve consistency between their values, birth expectations, and birth experiences.

Research Questions

What reasons underpin the choices women make about method of birth after cesarean? What do women value and expect from their birth choices after cesarean? What factors influence consistency between choice and outcome?

Significance/Background

Shared decision making around birth after cesarean necessitates shared understanding of individual values and expectations of women. Reduction in dissonance between providers and women is needed to achieve high-quality health decisions and outcomes.

Methods

One hundred and eighty-seven women participating in a decision-aid trial for birth after cesarean wrote about their choices for birth at 36 to 38 weeks’ gestation. At 6 to 8 weeks after the birth, 168 also wrote about their experiences of birth, satisfaction with the decision process, and health after the birth. Narrative analysis identified values and expectations underpinning birth decisions and the extent to which these were realized.

Findings

Decision making was difficult for many women, and emotions such as fear and anxiety were expressed as women explained their different birth choices. Avoidance of the previous cesarean experience, an expectation of a “better” or “faster” recovery, and issues around “safety” for the baby, were common reasons given for trial of labor as well as for elective repeat cesarean. Provider preferences were influential, and women's need for information about their options underpinned levels of confidence and certainty during decision making. Satisfaction with the birth experience and adherence to choice largely depended on practice patterns of the birth setting, commitment by providers to support choice, and women's strength of preference or commitment to their birth choice.

Discussion

Women do not always choose the mode of birth that providers expect them to. Greater understanding and support of individual values and expectations of women is needed to effectively support shared decision making for birth after cesarean.