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‘Mentalizing possibilities’ - a grounded theory of antenatal women’s decision making of their birth choices in pregnancy following a previous caesarean section (CS)
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Date
2019
Authors
Monis, Malitha Veera
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Publisher
University College Cork
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Abstract
Aim: To develop a grounded theory of antenatal women’s decision making of their birth choices in pregnancy following a previous CS. Rationale for theory: Reports identify a lack of choice for pregnant women including women’s choice of vaginal birth after a previous caesarean section (VBAC) (HIQA, 2016; DOH, 2016). VBAC is a safe choice for most women (RCOG, 2015; HSE, 2011). Women’s experience of decision making about VBAC has been described as ‘groping through the fog’, where decision making and information during pregnancy and the birth is unclear and contrasting (Lundgren et al, 2012, p3). To date, no theory has explained how women make decisions with their birth choices in pregnancy following a previous CS. Method: Classic grounded theory based on Glaser and Strauss (1967). Pregnant women who had experienced a previous CS (elective or emergency) were recruited through antental clinics, 15 formal and 15 informal interviews and 2 non-participant observations were conducted. Ethical approval was obtained. Findings: The theory of mentalizing possibilities is a substantive theory which explains pregnant women’s decision making about their birth choices after a previous CS. Women’s main concern is to achieve a positive experience. Mentalizing possibilities explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process. Women use different behavioural strategies based on their self-determination; accordingly, they are classified into four different types-uncertainty acceptors, innocent modifiers, slippery slopers and comfort seekers. There are internal and external factors which influence their self-determination enabling women to develop awareness. Cognitive strategies go through three stages. They are possibility seeking in early pregnancy, probability distancing in mid pregnancy and reality re-seeking in late pregnancy. Conclusion: Women want a positive birth experience in pregnancy after a previous CS. These women require support and continuity in decision making in order to help them decide the optimal birth choice for their current pregnancy. To provide a positive birth experience for individual women, healthcare professionals should engage with women in pregnancy and listen to their concerns.
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Keywords
Decision making , Women's experiences , Grounded theory , Birth choices , Pregnancy , (VBAC) , CS , VBAC , (CS) , Previous caesarean section
Citation
Monis, M. V. 2019. ‘Mentalizing possibilities’ - a grounded theory of antenatal women’s decision making of their birth choices in pregnancy following a previous caesarean section (CS). PhD Thesis, University College Cork.