PERSPECTIVES AND DECISION MAKING REGARDING THE MODE OF DELIVERY IN PREGNANT WOMEN WITH A PREVIOUS C-SECTION IN A GENERAL HOSPITAL IN LIMA, PERU

Purpose:

To evaluate factors leading to a decision making regarding to the mode of delivery during pregnancy and perspectives of the final mode of delivery in women with a previous caesarian-section (C-section) for a non-recurrent cause in a large national hospital in Lima, Peru. 

Method:

Qualitative study using a semi-structured interview among pregnant women with a previous C-section for a non-recurrent cause attending the obstetrics clinic of a general hospital during the months of May and June, 2013. Adult patients with 36 or more weeks of gestation were invited to participate. Interviews were performed at recruitment and after delivery. Recorded data was analyzed using the Framework approach and 4 main themes were selected: i) Perspectives about the previous C-section experience ii) Factors affecting decision making regarding the mode of delivery for current pregnancy iii)Involvement in the decision making process and iv) Perspectives of the final delivery mode. 

Results:

17 participants completed both interviews and were analyzed. At recruitment, all of them had chosen an intended mode of delivery but 8 out of 17 ended up having a different final delivery mode. Regarding previous C-section experiences, most acknowledged to have received information about the need of a C-section by their physician. Women´s postures about getting a C-section were diverse and concerns were easier to handle for those who felt physician and family support. Decision making was influenced by their own previous experience and information shared by friends and relatives. There was a lack of knowledge about benefits and risks of vaginal delivery and C-section. Most participants were involved in the decision making process and recognized to have stated to their physicians the main reason for their personal choice. The most common reason to choose a vaginal delivery was the short recovery period that allow women to nurse their children while C-section was usually selected to avoid the extreme pain during labor. Finally, despite the high frequency of discordance between intended and final delivery mode, most participants were pleased with the final mode of delivery as long as the child was born without problems.

Conclusion:

Pregnant women are involved in the decision making process. However, their decisions are based on personal and shared experiences rather than facts about benefits and risks of procedures.