Skip to main content
SpringerLink
Log in

Bioethics and Birth

Insights on Risk Decision-Making for an Elective Caesarean after a Prior Caesarean Delivery

  • Articles
  • Published:
Monash Bioethics Review Aims and scope Submit manuscript

Abstract

This article presents the findings of qualitative research which explored, from the mothers’ perspective, the process of decision-making about mode of delivery for a subsequent birth after a previous Caesarean Section. In contradiction to the clinical literature, the majority of mothers in this study were strongly of the opinion that a vaginal birth after caesarean (VBAC) posed a higher risk than an elective caesarean (EC). From the mothers’ perspective, risk discussions were primarily valuable for gaining support for their pre-determined choice, rather than obtaining information. The findings posit ethical concerns with regards to informed consent and professional obstetric practice at a time when there is a documented and worrying trend towards an increase in births by caesarean section (CS).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Alderson, P. 1991. Abstract bioethics ignores human emotions. Bulletin of Medical Ethics 68(May) 13–21.

    Google Scholar 

  • American College of Obstetricians and Gynecologists. 1999. ACOG Practice Bulletin: vaginal birth after previous cesarean delivery. Clinical Management Guidelines. International Journal of Gynecology and Obstetrics 66(2): 197–204.

    Article  Google Scholar 

  • Australian Institute of Health and Welfare. 2004. Australia’s Health 2004. Canberra: AIHW.

    Google Scholar 

  • Bauman, Z. 1993. Postmodern Ethics. Oxford: Blackwell.

    Google Scholar 

  • Clouser, K. & Gert, B. 1990. A critique of Principlism. Journal of Medicine and Philosophy 15: 219–236.

    Article  Google Scholar 

  • De Grazia, D. 1992. Moving forward in bioethical theory: Theories, cases and specified principlism. Journal of Medicine and Philosophy 17: 511–539.

    Article  Google Scholar 

  • Declercq, E.; Sakala, C., et al. 2006. Listening to Mothers II: The Second National U.S. Survey of Women’s Childbearing Experiences, [internet]. New York: Childbirth Connection. Accessed 31 July 2008. Available from: http://www.childbirthconnection.org/listeningtomothers.

    Google Scholar 

  • Dodd, J.; Crowther, C, et al. 2004. Planned elective repeat caesarean section versus planned vaginal birth for women with a previous caesarean birth (Review). Cochrane Database Systematic Review: 4.

  • Eden, K.; Hashima, J., et al. 2004. Childbirth preferences after Cesarean birth: A review of the evidence. Birth 31(1): 49–60.

    Article  Google Scholar 

  • Fenwick., J.; Gamble, J., et al. 2007. Believing in birth — choosing VBAC: The childbirth expectations of a self-selected cohort of Australian women. Journal of Clinical Nursing 16: 1561–1570.

    Article  Google Scholar 

  • Gamble, J.; Health, M., et al. 2000. Women’s request for a cesarean section: A critique of the literature. Birth 27:256–263.

    Article  Google Scholar 

  • Gamble, J.; Health, M., et al. 2001. Women’s preference for a cesarean section: Incidence and associated factors. Birth 28: 101–110.

    Article  Google Scholar 

  • Gamble, J. and Creedy, D. 2001. Women’s preference for caesarean section: Incidence and associated factors. Birth 28(2): 101–10.

    Article  Google Scholar 

  • Gilliam, M. 2006. Cesarean delivery on request: Reproductive consequences. Seminars in Perinatology 30: 257–260.

    Article  Google Scholar 

  • Gilligan, C. 1982. In a different voice: Psychological Theory and Women’s Development. Cambridge, Mass.: Harvard University Press.

    Google Scholar 

  • Hamilton, B.; Martin, J., et al. 2007. Births: Preliminary Data for 2006. Centers for Disease Control and Prevention Division of Vital Statistics. National Vital Statistics Report 57 (7).

  • Hildingsson, I.; Radestad, I., et al. 2002. Few women wish to be delivered by caesarean section. BJOG: International Journal of Obstetrics and Gynaecology 109: 618–623.

    Article  Google Scholar 

  • Holloway, I. 2008. A–Z of Qualitative Research in Healthcare. 2nd ed. Oxford: Blackwell.

    Google Scholar 

  • Horey, D.; Weaver, J., et al. 2008. Information for pregnant women about caesarean birth (Review). Cochrane Library Systematic Review: 3.

  • Johnstone, M-J. 2004. Bioethics: A Nursing Perspective. Sydney: Churchill Livingston.

    Google Scholar 

  • Landon, M.; Hauth, J., et al. 2004. Maternal and perinatal outcomes associated with a trial of labor after prior cesarean delivery. The New England Journal of Medicine 351(25): 2581–2589.

    Article  Google Scholar 

  • Lovat, T. & Mitchell, K. 1991. Bioethics for Medical and Health Professionals. New South Wales: Social Science Press, New South Wales.

    Google Scholar 

  • Macones. G.; Peipert. J., et al., 2005. Maternal complications with vaginal birth after cesarean delivery: A multicenter study. American Journal of Obstetrics & Gynecology 193: 1656–1652.

    Article  Google Scholar 

  • McCourt, C.; Weaver, J., et al., 2007. Elective caesarean section and decision making: A critical review of the literature. Birth 34(1): 65–79.

    Article  Google Scholar 

  • McGrath, P. 1998. Autonomy, discourse, and power: A postmodern reflection on principlism and bioethics. The Journal of Medicine and Philosophy, 23(5): 516–532.

    Article  Google Scholar 

  • McGrath, P. 2000. Informed consent to peripheral blood stem cell transplantation. Cancer Strategy 2: 44–50.

    Google Scholar 

  • McGrath, P. and Ray-Barreul, G. 2009. The easy option? Australian findings on mothers’ perception of Elective Caesar as a birth choice after a prior Caesarean Section. International Journal of Nursing Practice 15(4): 271–279.

    Article  Google Scholar 

  • McGrath P.; Phillips E. (2009). The breast or bottle? Women’s infant feedings choices in a subsequent birth after a previous Caesarean Section. Australian Journal of Advanced Nursing 27(1): 37–47.

    Google Scholar 

  • McGrath, P.; Henderson, D.; Holewa, H. 2006. Patient-centred care: Qualitative findings on health professionals’ understanding of ethics in acute medicine. Journal of Bioethcial Inquiry 3(3): 149–60.

    Article  Google Scholar 

  • McGrath P.; Phillips E.; Vaughan G. 2009 [in press]. Speaking out! Qualitative insights on the experience of mothers who wanted a vaginal birth after a birth by Caesarean Section The Patient: Patient-Centered Outcomes Research.

  • Menacker, F.; Declercq, E., et al. 2006. Cesarean delivery: Background, trends, and epidemiology. Seminars in Perinatology 30:235–241.

    Article  Google Scholar 

  • Minkoff, H. & Chervenak, F. 2003. Elective primary cesarean delivery. The New England Journal of Medicine 348(10): 946–950.

    Article  Google Scholar 

  • Nicholson, R. 1994. Limitations of the four principles. In R. Gillon (ed.). Principles of Health Care Ethics (pp. 267–275). Chichester: Wiley.

    Google Scholar 

  • Phillips E.; McGrath P.; Vaughan G. 2009 [in press]. ‘I wanted desperately to have a natural birth’: Mothers’ insights on VBAC. Contemporary Nurse.

  • Shorten, A.; Chamberlain, M., et al. 2004. Making choices for childbirth: Development and testing of a decision-aid for women who have experienced previous caesarean. Patient Education and Counseling 52: 307–313.

    Article  Google Scholar 

  • Shorten, A.; Shorten, B., et al. 2005. Making choices for childbirth: A randomized controlled trial of a decision-aid for informed birth after cesarean. Birth 32(4): 252–261.

    Article  Google Scholar 

  • Smith, G. 2009. Rise in caesarean section. The Health Report, Australian Broadcasting Commission, Radio National http://www.abc.net.au/rn/healthreport/stories/2009/2708388.htm#transcript. Accessed 20th October 2009.

  • Smith, GCS., et al. 2008. The effect of delaying childbirth on primary caesarean section rates. PLoS Medicine 5(7): e144.

    Article  Google Scholar 

  • Sorrell, J.; Redmond, G. 1995. Interviews in qualitative nursing research: Differing approaches for ethnographic and phenomenological studies. Journal of Advanced Nursing 21:1117–1122.

    Article  Google Scholar 

  • Spiegelberg, H. 1975. Doing Phenomenology. The Hague: Nijhoff.

    Book  Google Scholar 

  • Streubert, J.; Carpenter, D. 1995. Qualitative Research in Nursing: Advancing the Humanistic Imperative. New York: Lippincott.

    Google Scholar 

  • Thomas, J.; Paranjothy, S., et al. 2001. National Sentinel Caesarean Section Audit Report. London: Royal College of Obstetricians and Gynaecologists Press.

    Google Scholar 

  • Tong, R. 1996. Feminist approaches to bioethics. In S. Wolf (ed.)., Feminism and Bioethics: Beyond reproduction (pp. 67–94) Oxford: Oxford University Press.

    Google Scholar 

  • Van Manen, M. 1990. Researching Lived Experience. Ontario: State University of New York Press.

    Google Scholar 

  • Walker, R.; Turnbull, D., et al. 2005. The development and process evaluation of an information-based intervention for pregnant women aimed at addressing rates of caesarean section. BJOG: International Journal of Obstetrics and Gynaecology 112:1605–1614.

    Article  Google Scholar 

  • Weaver, J.; Statham, H., et al. 2007. Are there “unnecessary” cesarean sections? Perceptions of women and obstetricians about cesarean sections for nonclinical indications. Birth 34(1): 32–41.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. CQ University, Australia

    Pam McGrath & Emma Phillips

Authors
  1. Pam McGrath
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emma Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

McGrath, P., Phillips, E. Bioethics and Birth. Monash Bioethics Review 28, 27–45 (2009). https://doi.org/10.1007/BF03351315

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF03351315

Keywords

Search

Navigation