Women's experiences of their involvement around care decisions during a subsequent pregnancy after a previous caesarean birth in Western Australia

Abstract

Background: Women who have a caesarean birth can have an experience that may impact decision-making for subsequent births. For some women this decision-making can be associated with anxiety.

Aim: To provide rich, surface level descriptions by exploring women's experiences of their involvement in decision-making during a subsequent pregnancy after a previous caesarean birth.

Methods: A descriptive qualitative study was performed between May 2018 and February 2019 using Braun and Clarke's six steps guided analysis. Pregnant women with a previous caesarean birth, receiving antenatal care at a tertiary maternity hospital in Western Australia, and self-reported low to moderate levels of anxiety were invited to participate in a telephone interview.

Findings: Women's (n = 17) experiences revealed four themes: 1) Learning from past experiences (two sub-themes loss of control and coming to terms), 2) Claiming ownership in decisions (two sub-themes challenging professional judgement and prioritising her needs, wishes and preferences), 3) Being empowered (three sub-themes getting a full picture, speaking out, and not just the baby or a number), 4) Moving forward (two sub-themes building trust in health professionals and establishing guardrails to minimise loss of control).

Discussion: Women's experiences around decision-making in a subsequent pregnancy can vary according to whether their fears and anxieties are acknowledged and addressed. Women who are informed, and receive support and respect are empowered to move forward.

Conclusion: Continuity of care may provide women with more opportunities to build trusting relationships with clinicians and be truly known as an individual with unique preferences and desires.

Keywords: Birth anxiety; Birth fear; Caesarean birth; Decision-making; Qualitative research; Women’s involvement.