Caesarean Delivery on Maternal Request - a Collective Case Study

Student thesis: Master Thesis and HD Thesis

  • Cari Parsberg Laursen
  • Mette Løvholm
  • Michelle Juhl Borup Pedersen
4. term, Public Health, Master (Master Programme)
ABSTRACT Background: A child born by cesarean delivery has an increased risk of developing a number of diseases compared to vaginally born children. As for the mother complications can occur both during and after cesarean delivery, as in future pregnancies, when compared to vaginal birth. Since 2002 the registration of maternal request, a term that defines a situation where a woman wish for cesarean delivery without the midwife or obstetrician finds a medical or obstetric reason to grant the wish, has been available. In Denmark a woman does not have the legal right to demand cesarean delivery as this decision is based upon the assessment made by the obstetrician. Between respecting the woman’s autonomy and practicing evidence based medicine an ethical cross field arises. Aim: The aim of this thesis was to explore the woman’s experience of the dialogue with antenatal care team when she wishes for cesarean delivery and to determine how to best balance the woman’s autonomy and the professional assessment. This was done with the purpose of minimizing cesarean delivery on maternal request for multiparous women. Methods: A collective case study with two cases was carried out: a critical case and an online focus group. The critical case was based on informants from a maternity ward where minimizing the total amounts of cesarean deliveries was pursued. The online focus group were recruited and carried out on Facebook. A total of three semi-structured interviews were carried out and a total of 22 women participated in the focus group. The material was analyzed using Dahlager & Fredlund’s philosophical hermeneutic analysis approach and the analysis programme NVivo 10. A systematic literature search contributed to interpret and discuss the findings and inspired to the development of specific interventions. Findings: Three main themes were found: Recognition, Trust and Explanatory Models. Inconsistencies remain as to how multiparous women experience the dialogue with antenatal care team. The team’s recognition of the reasons for her to make the wish appears to be a strong indicator for the women’s overall satisfaction with the dialogue. As there are inconsistencies in the procedures of maternal request nationally the satisfaction of the dialogue depends also on the procedure of the individual maternity ward. We estimate that trust is found to be an element of meaning for the women’s experiences and the present practice of maternal request and previous birth experiences are sources of mistrust between the woman and the antenatal care team. Based on the women’s feeling of recognition, trust in the antenatal care team and the women’s personal characteristics the dialogue can either take on a battling or negotiating kind. Conclusion: In order to balance the woman’s autonomy and the professional assessment and reduce cesarean delivery on maternal request we recommend a specific intervention which includes three parts; a clarifying, a negotiating and a decision-making phase in which a minimum of two meetings with a consultant midwife in which the use of an Option Grid and techniques of motivational interviewing is applied.
Publication date1 Jun 2016
Number of pages141
ID: 234455016