Decision-Making Process for Choosing an Elective Cesarean Delivery Among Primiparas in Taiwan

A significant proportion of cesarean deliveries in Taiwan were without medical indications and/or on maternal request. The
purpose of this study was to understand the decision-making process of choosing an elective cesarean delivery (ELCD) among
primiparas in Taiwan. This qualitative exploratory study was guided by grounded theory. Data were collected through in-depth
interviews with 20 primiparous women, 15 of whom chose ELCD. Verbatim transcriptions were analyzed using constant comparative
analysis and methods of open, axial, and selective coding. The core category that describes the process of ELCD decision making
among primiparas is “controlling risks of childbirth and ensuring well-being.” The decision process can be divided into three
phases: (1) Pre-decision: risk perception, including two subcategories, negative pre-existing ideas about normal spontaneous
delivery (NSD) caused worry, and desire for ELCD as the solution; (2) In-decision: risk assessment. Women proactively collected
information about NSD and cesarean delivery, and then weighed the personal risk between NSD and ELCD. Risk assessment focused
on seven dimensions including safety, health, comfort, efficiency, feminine charms, time and economy; (3) Post-decision: marching
onward fearlessly, including two subcategories, belief in ELCD and stress relief, and persuading stakeholders to agree and
gaining the required resources for ELCD. At different phases of decision-making, women revealed different concerns, though
the sequence of phases was not necessarily unidirectional. Health care providers should be aware of the decision phase and
intervene at appropriate times. It is difficult to change a women’s decision to have ELCD in the post-decision phase.