Complexities of choice after prior cesarean: a narrative analysis.
BACKGROUND
High rates of primary cesarean internationally continue to create decision dilemmas for women and practitioners about birth in subsequent pregnancies. This article explores values and expectations that guide women during decision making about the next birth after cesarean and identifies factors that influence consistency between women's choices and actual birth experiences.


METHODS
Narrative analysis was used to identify key themes in decision-making experiences of women who were facing a choice about mode of birth after cesarean. A sample of 187 women provided qualitative data about their choices for birth at 36-38 weeks. At 6-8 weeks after the birth, 168 also wrote about their experiences of birth and the process of making the decision.


RESULTS
Decision making about birth after cesarean was complex and difficult for many women; strong emotions were expressed as they weighed birth options. Fear and anxiety were articulated as women explained their choices and expectations. Avoidance of the previous cesarean experience, an expectation of a "better" or "faster" recovery, and issues around "safety" for the baby were common reasons given for wanting either vaginal or cesarean birth. Practitioner preferences were influential and women's need for information about their options underpinned their confidence or certainty about their decision.


CONCLUSIONS
Strategies are needed to support practitioners to expand discussions beyond clinical algorithms about physical risks and benefits of birth options and to actively integrate women's values and preferences into decisions about birth.
Yale University School of Nursing, West Haven, Connecticut, USA.
Allison
A
Shorten
Brett
B
Shorten
Holly Powell
HP
Kennedy
D000328:Adult; D002585:Cesarean Section / Q000523:psychology*; D002755:Choice Behavior; D005260:Female; D006801:Humans; D033262:Narration; D057240:Patient Preference / Q000523:psychology*; D011247:Pregnancy; D011369:Professional-Patient Relations; D036301:Qualitative Research; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean / Q000523:psychology*
birth choices; choice complexity; narrative analysis; previous cesarean; trial of labor (TOL); vaginal birth after cesarean (VBAC)