BJOG. 2009 Apr 22. [Epub ahead of print]
Choice and birth method: mixed-method study of caesarean delivery for maternal
request.
Kingdon C, Neilson J, Singleton V, Gyte G, Hart A, Gabbay M, Lavender T.
Department of Midwifery Studies, University of Central Lancashire, Preston, UK.
Objective To explore whether women view decision-making surrounding vaginal or
caesarean birth as their choice. Design Longitudinal cohort study utilising
quantitative (questionnaire, routinely collected data) and qualitative (in-depth
interviews) methods simultaneously. Setting A large hospital providing National
Health Service maternity care in the UK. Sample Four-hundred and fifty-four
primigravid women. Methods Women completed up to three questionnaires between
their antenatal booking appointment and delivery. Amongst these women, 153 were
interviewed at least once during pregnancy (between 24 and 36 weeks) and/or
after 12 moths after birth. Data were also obtained from women's hospital
delivery records. Descriptive statistical analysis was performed (survey and
delivery data). Interview data were analysed using a seven-stage sequential form
of qualitative analysis. Results Whilst many women supported the principle of
choice, they identified how, in practice their autonomy was limited by
individual circumstance and available care provision. All women felt that
concerns about their baby's or their own health should take precedence over
personal preference. Moreover, expressing a preference for either vaginal or
caesarean birth was inherently problematic as choice until the time of delivery
was neither static nor final. Women did not have autonomous choice over their
actual birth method, but neither did they necessarily want it. Conclusions The
results of this large exploratory study suggest that choice may not be the best
concept through which to approach the current arrangements for birth in the UK.
Moreover, they challenge the notion of choice that currently prevails in
international debates about caesarean delivery for maternal request.

