Understanding Cultural Impacts and the Truth of Taiwanese Women's Request for Repeat Cesarean Delivery

Purpose:

High cesarean birth rates continue to challenge maternal care in many countries. Literature indicates that women prefer auspicious times for giving birth, contributing to a high cesarean birth rate in Chinese society. The aim of this study was to explore cultural impacts on and reasoning behind Taiwanese women’s request for repeat cesarean delivery (RCD).

Methods:

A qualitative approach was applied to conduct this research. The research comprised three stages. Stage I consisted of non-participant naturalistic observation at 33-34 weeks gestation to understand the dynamic processes of decision-making about birth choice among obstetricians and pregnant women within the antenatal clinic setting. Stage II involved interviews with pregnant women at 35-37 weeks gestation to explore the influences on their birth choice, including information accessibility, their family and friends’ attitudes, and cultural considerations. Stage III consisted of interviews with postnatal mothers, one month after birth, to reflect on their choices. Using a theoretical sampling approach, seventeen pregnant women were recruited from a private medical centre, in northern Taiwan. Data collection included in-depth interviews, observation and field notes in the Year of the Dragon, 2012. Constant comparative analytic technique and thematic analysis were employed for data analysis, and Software NVivo10 was used to organize the data.

Results:

Findings indicate that the majority of women did not intend to give birth in the Year of the Dragon, with the exception of one woman. Reasons for not wanting to give birth in the auspicious year included increasing children’s competitiveness in academic performance, running out of education resources, and encountering crowds of people (such as visiting obstetricians). Women were pregnant in the auspicious year because of an unplanned pregnancy, planned pregnancy with a 2-3 year interval, and wishing to have another baby as company for the first child.

Women’s decisions for RCD were subject to internal and external factors. Internal factors included a previous cesarean (concern about wound healing or the scar), a negative experience of natural birth (failure of trial of labour, emergency cesarean), fear of pain, evaluation of modes of birth and current pregnancy. External factors included obstetricians’ recommendations, the experience of significant others’, information retrieved from the internet and National Health Insurance (NHI) benefits.

Decision-making processes involved simply complying with the obstetrician’s recommendation or consultation. Before visiting the obstetrician, the majority of women wished for as natural a birth as possible. During the first trimester of pregnancy, some women accepted the obstetricians’ recommendations for RCD without being informed of alternatives; others made the decision at the second or early third trimester of pregnancy. The consultation process included discussion with obstetricians, respecting professional judgment, considering the condition of mother and foetus, making a decision for RCD and then selecting auspicious time. Some women chose RCD after the risk of uterine rupture was explained by obstetricians. Postnatal mothers who evaluated their birth choices after birth had emotional reactions varying between satisfaction and acceptance.

Conclusion:

The auspicious time/year to give birth did not impact on Taiwanese women’s birth choice following a primary cesarean section. However, they selected an auspicious time/day to give birth after the decision for RCD was made. Their decisions were influenced by internal and external factors. Internal factors, in particular, education about empowerment associated with natural birth is helpful in facilitating women’s confidence in natural birth. External factors such as the financial coverage for RCD from NHI, and the explanation of risk from obstetricians are also potentially modifiable. All women have the right to be informed of the alternative options for birth. Midwife-led models of care for information provision may hold promise for promoting high quality maternal care in Taiwan.