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Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists

OBJECTIVE: The attempt of a woman to deliver vaginally after having had a caesarean in a previous pregnancy is increasingly common in current obstetric practice. During a trial of labour after caesarean, gynaecologists consider whether continuing vaginal birth is safe or, alternately, whether a repe...

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Autores principales: Rietveld, Anna L., de Groot, Christianne J. M., Teunissen, Pim W.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051596/
https://www.ncbi.nlm.nih.gov/pubmed/30020944
http://dx.doi.org/10.1371/journal.pone.0199887
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author Rietveld, Anna L.
de Groot, Christianne J. M.
Teunissen, Pim W.
author_facet Rietveld, Anna L.
de Groot, Christianne J. M.
Teunissen, Pim W.
author_sort Rietveld, Anna L.
collection PubMed
description OBJECTIVE: The attempt of a woman to deliver vaginally after having had a caesarean in a previous pregnancy is increasingly common in current obstetric practice. During a trial of labour after caesarean, gynaecologists consider whether continuing vaginal birth is safe or, alternately, whether a repeat caesarean is advised. There is large variation in the success rates of women with comparable medical risk factors, requiring better insight in how this assessment is made. As a window of opportunity to intervene in this unexplained variation in practice in specific, and in the globally rising caesarean rate in general, our aim was to increase understanding of gynaecologists’ decision-making during trial of labour. STUDY DESIGN: We conducted a constructivist grounded theory study, interviewing Dutch gynaecologists. Data collection and analysis were performed concurrently. Initial convenience sampling shifted to theoretical sampling as the study progressed. Data collection continued until theoretical sufficiency was reached. We applied open and axial codes to transcripts of the interviews, and then assembled the axial codes into themes that built up to an emerging theoretical framework. RESULTS: Nine gynaecologists were interviewed. Data indicated they continuously weighed the chance of a successful outcome of trial of labour against the likelihood of adversities. Patients’ opinions, aspects of progress of labour and gynaecologists’ personal stances regarding trial of labour played a role in the decision-making process; these factors are influenced by organisational affordances and culture. Variation in the assessment of individuals’ chances of success and variable thresholds for a repeat caesarean added to the complexity of the decision-making. CONCLUSION: This study pieced together patient-, delivery-, physician- and society-related factors that result in vitally important decisions during trial of labour after caesarean; it reveals the complexity as well as the repetitive patterns involved in this process. Exposing these factors offers opportunities to incorporate the decision-making process in targeted educational interventions, with the aim of modifying the underlying assumptions and concepts in order to reduce practice variation.
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spelling pubmed-60515962018-07-27 Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists Rietveld, Anna L. de Groot, Christianne J. M. Teunissen, Pim W. PLoS One Research Article OBJECTIVE: The attempt of a woman to deliver vaginally after having had a caesarean in a previous pregnancy is increasingly common in current obstetric practice. During a trial of labour after caesarean, gynaecologists consider whether continuing vaginal birth is safe or, alternately, whether a repeat caesarean is advised. There is large variation in the success rates of women with comparable medical risk factors, requiring better insight in how this assessment is made. As a window of opportunity to intervene in this unexplained variation in practice in specific, and in the globally rising caesarean rate in general, our aim was to increase understanding of gynaecologists’ decision-making during trial of labour. STUDY DESIGN: We conducted a constructivist grounded theory study, interviewing Dutch gynaecologists. Data collection and analysis were performed concurrently. Initial convenience sampling shifted to theoretical sampling as the study progressed. Data collection continued until theoretical sufficiency was reached. We applied open and axial codes to transcripts of the interviews, and then assembled the axial codes into themes that built up to an emerging theoretical framework. RESULTS: Nine gynaecologists were interviewed. Data indicated they continuously weighed the chance of a successful outcome of trial of labour against the likelihood of adversities. Patients’ opinions, aspects of progress of labour and gynaecologists’ personal stances regarding trial of labour played a role in the decision-making process; these factors are influenced by organisational affordances and culture. Variation in the assessment of individuals’ chances of success and variable thresholds for a repeat caesarean added to the complexity of the decision-making. CONCLUSION: This study pieced together patient-, delivery-, physician- and society-related factors that result in vitally important decisions during trial of labour after caesarean; it reveals the complexity as well as the repetitive patterns involved in this process. Exposing these factors offers opportunities to incorporate the decision-making process in targeted educational interventions, with the aim of modifying the underlying assumptions and concepts in order to reduce practice variation. Public Library of Science 2018-07-18 /pmc/articles/PMC6051596/ /pubmed/30020944 http://dx.doi.org/10.1371/journal.pone.0199887 Text en © 2018 Rietveld et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Rietveld, Anna L.
de Groot, Christianne J. M.
Teunissen, Pim W.
Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists
title Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists
title_full Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists
title_fullStr Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists
title_full_unstemmed Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists
title_short Decision-making during trial of labour after caesarean; a qualitative study with gynaecologists
title_sort decision-making during trial of labour after caesarean; a qualitative study with gynaecologists
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051596/
https://www.ncbi.nlm.nih.gov/pubmed/30020944
http://dx.doi.org/10.1371/journal.pone.0199887
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