Giving birth after caesarean: Identifying shared preferences among pregnant women using Q methodology |
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| Institution: | 1. Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands;2. Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands;3. Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, The Netherlands;4. Centre for Psychological Wellbeing and Pregnancy, Amsterdam, The Netherlands;5. School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands;1. Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia;2. Mater Mothers’ Hospital, Mater Health Services, South Brisbane, Queensland, Australia;3. School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia;4. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia;1. Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany;2. Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany;3. Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Germany;4. Clinic for Gynecology and Obstetrics, HELIOS University Clinic, Wuppertal, University Witten/Herdecke, Germany;1. Division of Determinants and Challenges of Health Systems, Centre for Health Systems Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico;2. Division of Reproductive Health, Centre for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico;1. Intergenerational Health, Murdoch Children’s Research Institute, 50 Flemington Road, Parkville, Victoria, Australia;2. General Practice and Primary Health Care Academic Centre, University of Melbourne, 200 Berkeley Street, Carlton, Victoria, Australia;3. Victorian Foundation for Survivors of Torture, 4 Gardiner Street, Brunswick, Victoria, Australia;4. Departments of Paediatrics, The University of Melbourne, 50 Flemington Road, Parkville, Victoria 3052, Australia |
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| Abstract: | BackgroundCaesarean rates are rising worldwide, the main contributor being the elective repeat caesarean. During the past decades, rates of vaginal birth after caesarean dropped considerably. This requires insight in women’s preferences regarding giving birth following a previous caesarean.AimTo gain a better understanding of women’s values and preferences regarding the upcoming birth following a previous caesarean. Using Q methodology, this study systematically explores and categorises their preferences.MethodsQ methodology is an innovative research approach to explore and compare a variety of viewpoints on a certain subject. Thirty-one statements on birth after caesarean were developed based on the health belief model. Thirty-six purposively sampled pregnant women with a history of caesarean ranked these statements from least to most important. By-person factor analysis was used to identify patterns which, supplemented with interview data, were interpreted as preferences.FindingsThree distinct preferences for giving birth after a caesarean were found; (a) “Minimise the risks for me and my child”, giving priority to professional advice and risk of adverse events, (b) “Seek the benefits of normal birth”, desiring to give birth as normal as possible for both emotional and practical reasons, (c) “Opt for repeat caesarean”, expressing the belief that a planned caesarean brings comfort.ConclusionsPreferences for birth after caesarean vary considerably among pregnant women. The findings help to understand the different types of information valued by women who need to decide on their mode of birth after a first caesarean. |
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| Keywords: | Caesarean Trial of labour Q methodology Patient preferences Counseling |
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