An investigation of women's involvement in the decision to deliver by caesarean section

Objective To assess the degree and nature of women's involvement in the dec ision to deliver by caesarean section, and women's satisfaction with this i nvolvement. Design Observational study. Setting The maternity unit in a large teaching hospital. Sample One hundred and sixty-six women undergoing caesarean section. Methods Interviews with the women on the third or fourth day postpartum, qu estionnaires sent to the women at 6 weeks and at 12 weeks postpartum, and e xtraction of information from the women's medical records. Main outcome measures Women's knowledge, satisfaction, and involvement in m aking the decision concerning their caesarean section. Results The majority of the women were satisfied with the information they received during pregnancy on caesarean section and with their involvement i n making the decision, but the proportions were significantly higher for el ective than emergency sections. For 7% of the women, maternal preference fo r caesarean section was a direct factor in making the decision. Just over h alf of the 166 women reported that they were not debriefed on the reasons f or their caesarean section before their discharge from hospital. Almost a t hird of the women undergoing emergency caesarean section expressed negative feelings towards their delivery, compared with 13% of those undergoing ele ctive caesarean sections. Conclusion Women are not a homogeneous group in terms of their requirements for information, nor their desire to be involved in the decision on mode o f delivery. Health professionals need to be responsive to this Variability and to agree on standards for communicating with women during pregnancy abo ut the possibility of operative delivery and for debriefing women after cae sarean section.