Understanding the Health Beliefs of First Time Mothers Who Request An Elective Cesarean Versus Mothers Who Request A Vaginal Delivery
- Identify the health beliefs of first time mothers who are planning an elective cesarean delivery in the absence of medical indications.
- Discuss the relationship between informed consent and support in decisional satisfaction.
- Discuss the nurse’s role in supporting women who experience decisional conflict and dissatisfaction during the decision-making process and after the delivery.
Objective: Compare first time mothers who request cesarean delivery or who request vaginal delivery, to investigate differences in health beliefs, maternal outcomes, and goals for the birth experience.
Design: A prospective longitudinal study based on the Health Belief Model was conducted about first time mothers’ decision making processes and their health beliefs which led to their satisfaction with their decision about their mode of delivery.
Setting: Entire United States.
Patients/Participants: A convenience sample of 144 nulliparous women with singleton pregnancies and no medical indications requiring a cesarean delivery were recruited using the internet . Women (n = 127) planning a vaginal delivery (VDMR)represented 88.2% of the sample and women (n = 17) requesting a cesarean delivery (CDMR)represented 11.8% of the sample. Data were collected during the third trimester and six weeks after the delivery using an internet-based questionnaire.
Methods: Data were analyzed using t-tests and multiple linear regression to predict the effect of maternal health beliefs, maternal childbirth self efficacy, partner support, acceptance of the maternal role, and request group on the dependent variables of maternal perception of the delivery and maternal satisfaction with her decision.
Results: Compared to women with VDMR, women with CDMR were significantly older, less educated, perceived more risk of emergent cesarean and less ability to deliver vaginally. Hypothesis testing indicated that the model accounted for a significant amount (15.1 %) of the variance in maternal satisfaction with the decision for mode of delivery. Acceptance of the maternal role and maternal request group significantly contributed to the model indicating that women with higher acceptance of the maternal role and women with CDMR had poorer satisfaction with their decision for the mode of delivery.
Conclusion/Implications for nursing practice: The findings showed that factors influencing maternal perceptions of the delivery and satisfaction with the decision for type of delivery are different. Health beliefs had less relevance for perception of the delivery. It is possible that experiences that occur within the context of the delivery are more salient for maternal perception. Women with higher acceptance of the maternal role and who request a cesarean delivery are at risk for less satisfaction with their delivery decision and more decisional conflict and thus may need more support during decision-making processes and after delivery. Future research should examine the long-term impact of dissatisfaction with delivery decision.
Keywords: first time mothers, cesarean delivery by maternal request, satisfaction with the decision, maternal self efficacy, Health Belief Model
