Qualitative website analysis of information on birth after caesarean section.
BACKGROUND
The United Kingdom (UK) caesarean section (CS) rate is largely determined by reluctance to augment trial of labour and vaginal birth. Choice between repeat CS and attempting vaginal birth after CS (VBAC) in the next pregnancy is challenging, with neither offering clear safety advantages. Women may access online information during the decision-making process. Such information is known to vary in its support for either mode of birth when assessed quantitatively. Therefore, we sought to explore qualitatively, the content and presentation of web-based health care information on birth after caesarean section (CS) in order to identify the dominant messages being conveyed.


METHODS
The search engine Google™ was used to conduct an internet search using terms relating to birth after CS. The ten most frequently returned websites meeting relevant purposive sampling criteria were analysed. Sampling criteria were based upon funding source, authorship and intended audience. Images and written textual content together with presence of links to additional media or external web content were analysed using descriptive and thematic analyses respectively.


RESULTS
Ten websites were analysed: five funded by Government bodies or professional membership; one via charitable donations, and four funded commercially. All sites compared the advantages and disadvantages of both repeat CS and VBAC. Commercially funded websites favoured a question and answer format alongside images, 'pop-ups', social media forum links and hyperlinks to third-party sites. The relationship between the parent sites and those being linked to may not be readily apparent to users, risking perception of endorsement of either VBAC or repeat CS whether intended or otherwise. Websites affiliated with Government or health services presented referenced clinical information in a factual manner with podcasts of real life experiences. Many imply greater support for VBAC than repeat CS although this was predominantly conveyed through subtle use of words rather than overt messages, with the exception of the latter being apparent in one site.


CONCLUSIONS
Websites providing information on birth after CS appear to vary in nature of content according to their funding source. The most user-friendly, balanced and informative websites appear to be those funded by government agencies.
Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Aberdeen Maternity Hospital, Cornhill Road, Aberdeen, AB25 2ZD, UK. v.peddie@abdn.ac.uk.
Valerie L
VL
Peddie
Aberdeen Maternity Hospital, Cornhill Road, Aberdeen, UK. nataliewhitelaw1@nhs.net.
Natalie
N
Whitelaw
Department of Obstetrics & Gynaecology, NHS Grampian, Dr Gray's Hospital, Cornhill Road, Elgin, UK. grant.cumming@nhs.net.
Grant P
GP
Cumming
Division of Applied Health Sciences, University of Aberdeen, Cornhill Road, Aberdeen, UK. s.bhattacharya@abdn.ac.uk.
Siladitya
S
Bhattacharya
Division of Applied Health Sciences, School of Medicine and Dentistry, University of Aberdeen, Cornhill Road, Aberdeen, UK. mairead.black@abdn.ac.uk.
Mairead
M
Black
D017604:Cesarean Section, Repeat; D054626:Consumer Health Information; D003657:Decision Making; D005260:Female; D006801:Humans; D020407:Internet; D011247:Pregnancy; D036301:Qualitative Research; D006113:United Kingdom; D016064:Vaginal Birth after Cesarean