Decision-making around method of delivery in El Paso, Texas and Ciudad Juárez, Chihuahua Open Access
DeSisto, Carla Lucia (2013)
Abstract
Background: U.S.-Mexico border communities have high rates of cesarean births. The reasons are being studied, but no published research has yet examined cesarean birth along the U.S.-Mexico border from the perspectives of pregnant women and their doctors.
Study Question: How do low-risk, nulliparous pregnant women and their doctors in El Paso, Texas and Ciudad Juárez, Chihuahua communicate about the choice of delivery method and how do they perceive that the decision is made?
Methods: Eighteen women were recruited through obstetricians in El Paso and prenatal care providers in Ciudad Juárez in May-July, 2012. Eligible women were nulliparous, more than 8 months pregnant without medical risk factors for cesarean section, and had no plans for elective cesarean section. We observed prenatal care visits, interviewed women prenatally and postpartum, and interviewed the obstetricians of study women in El Paso. We performed qualitative data analysis on transcribed observation notes and verbatim interviews using MaxQDA software to better understand how each woman's delivery method decision was made.
Results: Women's expectations of labor and delivery were informed through multiple channels, but their most valued source of information was their female friends and relatives. The women who were most confident in their knowledge about birth and who demonstrated trust and good communication with their doctor were most involved in birthing decisions. Surgical delivery was averted by two study women by asking if they could "try harder" or "wait longer" for a vaginal delivery. Two women had unexpected cesarean deliveries because of fetal intolerance of labor and cord prolapse, respectively. Ciudad Juárez women were unable to establish rapport with delivering obstetricians because their prenatal care providers did not perform their deliveries. This also prevented us from interviewing the obstetricians of study women in Ciudad Juárez.
Conclusions: Delivery method decisions are complex and involve multiple influences, including biomedical factors, women's level of knowledge about birth, doctor-patient communication, and women's participation in decision-making. Feeling knowledgeable about the birth process may have led women to participate more with their doctors in decisions, and this may have helped women in our study avoid cesarean sections.
Table of Contents
Chapter 1: Introduction..............................................................................................................................................................................
1
Introduction and rationale......................................................................................................................................................................
1
Problem and purpose statement..............................................................................................................................................................
1
Research questions...............................................................................................................................................................................
2
Significance statement...........................................................................................................................................................................
2
Definition of terms................................................................................................................................................................................
2
Chapter 2: Comprehensive Review of the Literature........................................................................................................................................
4
Methodology.........................................................................................................................................................................................
4
Literature Review..................................................................................................................................................................................
5
--Cesarean Utilization...........................................................................................................................................................................
5
--Primary Cesarean Sections..................................................................................................................................................................
6
--Reasons for Cesareans.......................................................................................................................................................................
7
--Maternal Request for Cesarean Delivery.................................................................................................................................................
7
--Potential Problems with Cesarean Deliveries..........................................................................................................................................
9
--Cost of Cesareans..............................................................................................................................................................................
13
--Suggested Reasons for Over-Utilization.................................................................................................................................................
14
--Induction of Labor...............................................................................................................................................................................
18
--Anesthesia........................................................................................................................................................................................
19
--Breastfeeding....................................................................................................................................................................................
20
--Evidence for Reducing Cesareans...........................................................................................................................................................
21
Chapter 3: Manuscript.................................................................................................................................................................................
22
Title page.............................................................................................................................................................................................
23
Contribution of student...........................................................................................................................................................................
24
Abstract................................................................................................................................................................................................
25
Introduction..........................................................................................................................................................................................
26
Methods...............................................................................................................................................................................................
27
Results................................................................................................................................................................................................
30
Discussion............................................................................................................................................................................................
41
References...........................................................................................................................................................................................
45
Chapter 4: Additional Results, Conclusions, and Recommendations......................................................................................................................
49
Additional Results..................................................................................................................................................................................
49
Study Strengths and Limitations...............................................................................................................................................................
52
Recommendations..................................................................................................................................................................................
53
Conclusions...........................................................................................................................................................................................
55
References................................................................................................................................................................................................
56
List of Appendices
Appendix I: Prenatal care visit observation guide.......................................................................................................................................
66
Appendix IIa: In-depth interview guide for prenatal interview with women.....................................................................................................
67
Appendix IIb: In-depth interview guide for postnatal interview with women....................................................................................................
75
Appendix III: Structured interview guide for postpartum interview with obstetrician..........................................................................................
79
Appendix IV: Codebook...........................................................................................................................................................................
82
Appendix V: Cesarean section case study and evaluation...........................................................................................................................
84
Appendix VI: Thesis schedule................................................................................................................................................................
91
About this Master's Thesis
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