Purpose: This qualitative research study aimed to explore women’s choice of cesarean delivery and the findings uncovered have clear applications to nursing practice. Namely, in the role of a nurse advocate with potential applications to emerging roles such as a cesarean case manager.
Methods: Four women who had chosen to have their first child by cesarean in the absence of medical indication were interviewed between September 2014 to January 2015. These participants generated data to provide rich new understandings. I used a type of purposive sampling referred to as criterion sampling, where you search for individuals who meet a set of criteria. The main criterion was women who have chosen cesarean deliveries for their first child as they were identified as having had the unique experience of never-before having a child and so previous delivery experiences could not impact their choice for cesarean delivery. Semi-structured interviews lasting 45-90 minutes were used to generate data. The interviews were audio-taped and transcribed. The interpretation followed the qualitative, dialogic approach of Gadamerian Hermeneutics.
Results: The final interpretations revealed 1) the complexities of choice, 2) the impact of allowing choice, and 3) nurses are in the unique role to act as an advocate for women choosing cesarean deliveries to promote positive birth experiences and healthy developmental environments for their newborns. 1) Choice is complex and is influenced by history, society, and the personal values of the individual. Women’s rights movements, industrialization, health care commodification, and the medicalization of childbirth have all contributed to the occurrence of choice for cesarean deliveries. Women who choose cesarean deliveries are likely to have the perspective of vaginal birth being inherently risky and are more likely to take on the risks of surgery than attempt a planned vaginal birth. Women who choose cesarean deliveries may have underlying anxiety around the birth of their child and want to have a sense of control, predictability, and safety, which they may feel in a planned surgical delivery. 2) Allowing for choice can promote a positive physiological response in the women and create mental well-being in the post-partum period. Alternatively, feelings of losing control during delivery have been implicated in post-traumatic stress disorder (PTSD) and post-partum depression (PPD). The psychological impact on mothers who experience traumatic deliveries can be detrimental to the child as well. PPD can deprive an infant of essential maternal interactions. Early deprivation is correlated to childhood behavioral disorders. Alternatively, a perceived sense of control can have a positive effect on birth satisfaction. 3) Nurses can act as an advocate to best care for women choosing cesarean deliveries by promoting individualized care, advocating for patient autonomy, and by exploring new ways to serve this population.
Conclusion: Throughout history, women have gained more control to make choices that impact their lives and health; choice in government, choice in parturition, and now, choice in delivery. Women are making a choice to have cesarean deliveries. It is a choice that is situated in broad shifting social contexts and also one that is made by each woman for their individual context. As with other shifts in health care, now maternity care providers are faced with the responsibility of responding to this choice. When caring for women who chose a cesarean delivery, maternity nurses have a unique opportunity to inquire and reflect on the woman’s perception of safety and the underlying factors in her choice as well as how they can best care for this woman in order to promote a positive birth experience and healthy developmental environments for their newborns.