Objective  To explore the views of health professionals on the factors influencing repeat caesarean section. Design  Qualitative study involving semi‐structured interviews with professionals who care for women in pregnancy and labour. Setting  Acute hospital trust with two maternity units and community midwifery service, Leicestershire, UK. Sample  Twenty‐five midwives and doctors. Methods  Interviews with professionals were undertaken using a prompt guide. All interviews were audiotaped and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software. Main outcome measures  Identification of factors influencing professional decision making about repeat caesarean section. Results  Decision making in relation to repeat caesarean is a complex process involving several parties. Professionals identify the relevance of evidence for decision making for repeat caesarean. However, professionals feel that following strict protocols is of limited value because of the perceived substandard quality of evidence in this area, other external pressures and the contingent, unique and often unanticipated features of each case. Professionals also perceive that the organisation of care plays an important role in rates of repeat caesarean. Conclusions  Decision making for repeat caesarean is a social practice where standardised protocols may have limited value. Attention needs to be given to the multiple parties involved in the decision‐making process. Reflective practice, opinion leadership and role modelling may offer ways forward but will require evaluation.

Objective To explore women's views on being referred to and attending a specialist antenatal hypertension clinic.Design Qualitative interview study.Setting A pregnancy hypertension clinic in a large teaching hospital in the East Midlands.Population Twenty-one women (aged 18 years and above) attending the pregnancy hypertension clinic for the first time during their current pregnancy.Methods Women who had been referred to and attended a specialist antenatal clinic participated in semi-structured interviews. Data analysis was based on the constant comparative method.Main outcome measures Women's experiences and perceptions of being referred to and attending a specialist antenatal clinic.Results Being referred to the clinic conferred an 'at risk' status on women. Some women welcomed the referral but others experienced it as unsettling. Many were unclear about why they had been identified as being at risk or had difficulties in accepting the legitimacy of the reason for referral. Women were often inadequately informed about why they were referred to the clinic, what they could expect and the benefits of attending the clinic over management in the community. Although attendance at the clinic was cited as a source of reassurance, the reassurance was often made necessary by concern raised by the initial referral.Conclusions Women's accounts suggest that the interface between community and secondary antenatal services needs improvement to minimise possible adverse effects from identifying women as being 'at risk' during pregnancy.Keywords Antenatal clinic, qualitative, women's views.Please cite this paper as: Jackson C, Bosio P, Habiba M, Waugh J, Kamal P, Dixon-Woods M. Referral and attendance at a specialist antenatal clinic: qualitative study of women 's views. BJOG 2006; 113:909-913.

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