title: [The Decision-Making Processes in Taiwanese Women With Repeat Caesarean Deliveries].
abstract: BACKGROUND
  Repeat caesarean delivery (RCD) ranks as the top reason for the high caesarean rates in Taiwan. More than 90% of Taiwanese women who have had a previous caesarean delivery chose RCD following their next pregnancy.
  
  
  OBJECTIVE
  To explore the decision-making processes regarding RCD in Taiwanese women.
  
  
  METHODS
  A qualitative approach with grounded theory was used to conduct this research. Participants were recruited from a private medical centre in northern Taiwan. Methods of data collection include in-depth interviews, observation, and field notes. Constant comparative analytical techniques were employed for data analysis.
  
  
  RESULTS
  A total of 16 women chose RCD. Ensuring the well-being of mother and fetus was the core theme. Women's decisions were influenced by both internal factors (previous negative experience of birth, concern about uterine rupture, fixing the scar of previous caesarean and current pregnancy situation) and external factors (obstetrician's recommendation, the experience of female significant others, an inaccurate information from internet and the unconditional financial coverage from Health National Insurance). Decision-making processes involved searching information regarding mode of birth, evaluating vaginal birth risk, trusting obstetricians' professional judgment, and a lack of progress during the course of labour.
  
  
  CONCLUSIONS
  The well-being of mother and fetus is the major concern affecting mothers' decisions regarding RCD. The majority of Taiwanese women participate passively in the decision-making process regarding their options for mode of birth. In the present study, women choices were primarily guided by reducing the risk of uterine rupture. Hospitals should reduce unnecessary induction interventions. Obstetricians should inform women of the risks and benefits of various birth modes. The government could establish a website that provides a clear explanation of the criteria for the government to financially cover the costs of RCD in order to assist women to make optimal birth choices.
authors.affiliation: PhD, RN, Lecturer, Department of Nursing, Chang Gung University of Science and Technology, Taiwan, ROC. swchen@mail.cgust.edu.tw.
authors.forename: Shu-Wen
authors.initials: SW
authors.lastname: Chen
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat; D003657:Decision Making; D005260:Female; D006801:Humans; D008875:Middle Aged; D011247:Pregnancy; D036301:Qualitative Research
keywords:  decision-making process ;  grounded theory ;  qualitative research ;  repeat caesarean delivery (RCD);  risk evaluation 