Misrecognition of need: Women's experiences of and explanations for undergoing cesarean delivery

Abstract

International rates of operative delivery are consistently higher than the World Health Organization determined is appropriate. This suggests that factors other than clinical indications contribute to cesarean section. Data presented here are from interviews with 115 mothers on the postnatal ward of a hospital in Northeast England during February 2006 to March 2009 after the women underwent either unscheduled or scheduled cesarean childbirth. Using thematic content analysis, we found women’s accounts of their experiences largely portrayed cesarean section as everything that they had wanted to avoid, but necessary given their situations. Contrary to popular suggestion, the data did not indicate impersonalized medical practice, or that cesareans were being performed ‘on request.’ The categorization of cesareans into ‘emergency’ and ‘elective’ did not reflect maternal experiences. Rather, many unscheduled cesareans were conducted without indications of fetal distress and most scheduled cesareans were not booked because of ‘choice.’ The authoritative knowledge that influenced maternal perceptions of the need to undergo operative delivery included moving forward from ‘prolonged’ labor and scheduling cesarean as a prophylactic to avoid anticipated psychological or physical harm. In spontaneously defending themselves against stigma from the ‘too posh to push’ label that is currently common in the media, women portrayed debate on the appropriateness of cesarean childbirth as a social critique instead of a health issue. The findings suggest the ‘need’ for some cesareans is due to misrecognition of indications by all involved. The factors underlying many cesareans may actually be modifiable, but informed choice and healthful outcomes are impeded by lack of awareness regarding the benefits of labor on the fetal transition to extrauterine life, the maternal desire for predictability in their parturition and recovery experiences, and possibly lack of sufficient experience for providers in a variety of vaginal delivery scenarios (non-progressive labor, breech presentation, and/or after previous cesarean).

Why do women request an elective cesarean delivery for non‐medical reasons? A systematic review of the qualitative literature

“…The PRISMA diagram outlines the number of papers included or excluded at each stage of the search process (Figure ). A total of 16 articles are included in this review . The characteristics of each study are summarized in Table , with an in‐depth analysis and critique included in the supplementary material (Appendix S4—available online).…”

“…The selected studies included women aged between 16 and 43 years old, with the exception of one study where age was not stated . Only two studies reported ethnicity, where the significant majority of women were Caucasian (85% and 97%, respectively) …”

“…Six studies enrolled only primipara, four enrolled only multipara, while six included primipara and multipara . Eleven studies included the views of pregnant women in their third trimester (weeks 29‐40), with two including women from week 20 and 26 .…”

Diminished Control and Unmet Expectations: Testing a Model of Adjustment to Unplanned Cesarean Delivery

“…Many women consider childbirth to be a landmark event that colors the rest of their lives (Callister, ; Lobel, ). The majority of American women hope for and prefer vaginal rather than surgical (cesarean) delivery (Pevzner, Preslicka, Bush, & Chan, ; Tully & Ball, ). However, approximately one‐third of all births are surgical deliveries, reflecting a 60% increase since 1996 (Martin, Hamilton, & Ventura et al., ).…”

Association Between Obstetric Mode of Delivery and Autism Spectrum Disorder

“…The prevalence of birth by CS is estimated to be 15% worldwide and is more than 20% in developed countries. 12 Because the prevalence of ASD is increasing worldwide, for a variety of reasons, 13,14 it is becoming increasingly important to fully understand any possible longterm effects of birth by CS.…”