Which mode of delivery? a mixed-method investigation into decision-making by women with one previous caesarean section

Objective To delineate the influencing factors on a woman's decision-making process concerning mode of delivery after one previous caesarean section. Design This mixed-method study comprised a quantitative audit and a qualitative questionnaire, set within a tertiary unit centre. The main outcome measures were to determine provision of and satisfaction of women with the information given regarding potential mode of delivery. Methods Women who had delivered between 10 January 2010 and 18 August 2010 with any number of previous caesarean sections were identified from the birth register. Those with one previous caesarean section were contacted to be interviewed. Women giving birth between 1 July 2010 and 18 August 2010 were interviewed in person while still in hospital; women delivering from 10 January 2010 to 30 June 2010 were interviewed retrospectively by telephone. Notes were examined for documented discussions concerning mode of delivery. Results The full audit cohort included 384 women. The qualitative questionnaire included 79 women interviewed by telephone, and 44 women in person. Within the cohort interviewed, doctors were perceived as having had the greatest influence in a woman's decision-making concerning mode of delivery. The post-partum period after the first caesarean section was regarded as the best time to talk to a woman about future deliveries. Discussions regarding mode of delivery in the current pregnancy were not always fully documented in antenatal notes. Conclusions Doctors should talk to women after their first caesarean section about future mode of delivery. Provision of information to aid decision-making in the next pregnancy should be provided early, be consistent and should clearly documented by both midwives and obstetricians.