Factors influencing repeat caesarean section: qualitative exploratory study of obstetricians' and midwives' accounts.

OBJECTIVE

To explore the views of health professionals on the factors influencing repeat caesarean section.

DESIGN

Qualitative study involving semi-structured interviews with professionals who care for women in pregnancy and labour.

SETTING

Acute hospital trust with two maternity units and community midwifery service, Leicestershire, UK.

SAMPLE: Twenty-five midwives and doctors.

METHODS

Interviews with professionals were undertaken using a prompt guide. All interviews were audiotaped and transcribed verbatim. Analysis was based on the constant comparative method, assisted by QSR N5 software.

MAIN OUTCOME MEASURES: Identification of factors influencing professional decision making about repeat caesarean section.

RESULTS

Decision making in relation to repeat caesarean is a complex process involving several parties. Professionals identify the relevance of evidence for decision making for repeat caesarean. However, professionals feel that following strict protocols is of limited value because of the perceived substandard quality of evidence in this area, other external pressures and the contingent, unique and often unanticipated features of each case. Professionals also perceive that the organisation of care plays an important role in rates of repeat caesarean.

CONCLUSIONS

Decision making for repeat caesarean is a social practice where standardised protocols may have limited value. Attention needs to be given to the multiple parties involved in the decision-making process. Reflective practice, opinion leadership and role modelling may offer ways forward but will require evaluation.