Abstract
BackgroundRising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians’ and midwives’ perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden.MethodsA qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin.ResultsThe thematic analysis resulted in three main themes; ‘Belief in normal birth – a cultural perspective’; ‘Clarity and consistency – a system perspective’ and ‘Obstetrician makes the final decision, but...’, and each theme contained a number of subthemes. However, ‘Belief in normal birth’ emerged as the core central theme, overarching the other two themes.ConclusionFindings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a ‘team approach’ helped them achieve their goal and keep their CS rate low.
Highlights
Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates
The thematic analysis resulted in three main themes, each containing a number of subthemes
Promoting normal birth Midwives and obstetricians shared the belief that normal birth is best for women and babies, and offers the best possible outcomes
Summary
Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Birth choice UK (2002) has defined “normal birth” as one which starts naturally and does not involve any medical or technological intervention [9] This working definition of normal birth includes spontaneous onset of labour, spontaneous progress of labour and spontaneous birth, and excludes induction of labour, epidural or spinal or general anaesthetic, forceps or ventouse, caesarean section, or episiotomy. Exploring the multifactorial and complex reasons behind the rising trend in CS, and the declining rates in normal birth, has become an important goal for health professionals. Asking midwives and obstetricians about their perceptions of the factors that influence the decision to perform a CS is one way of exploring the decision-making process, and conducting this research in Sweden, a country with low CS rates, offered a unique research opportunity to achieve this goal
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