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.


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


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


METHODS
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.


METHODS
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.
Kamal
Pallavi
P
Department of Health Sciences, University of Leicester, UK.
Dixon-Woods
Mary
M
Kurinczuk
Jennifer J
JJ
Oppenheimer
Christina
C
Squire
Patricia
P
Waugh
Jason
J
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D017604:Cesarean Section, Repeat / Q000523:psychology / Q000706:statistics & numerical data*; D003657:Decision Making; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D008880:Midwifery / Q000379:methods*; D009774:Obstetrics / Q000379:methods*; D011247:Pregnancy; D011295:Prenatal Care / Q000458:organization & administration; D011364:Professional Practice / Q000458:organization & administration*; D011369:Professional-Patient Relations