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J Midwifery Womens Health. 2009 Sep-Oct;54(5):373-379. doi: 10.1016/j.jmwh.2008.12.014.

Decision making in patient-initiated elective cesarean delivery: the influence of birth stories.

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Sarah Munro, MA, is Editorial Manager at the Centre for Rural Health Research and is a graduate of the University of British Columbia, Vancouver, Canada. She is a doula and breastfeeding consultant and also provides research support for the Centre.Jude Kornelsen, PhD, is Co-Director of the Centre for Rural Health Research, and is Assistant Professor, Department of Family Practice, University of British Columbia, Vancouver, Canada. She is supported by the Canadian Institutes of Health Research New Investigator and Michael Smith Foundation for Health Research Scholar Award Programs. The Centre is also supported by Vancouver Coastal Health Research Institute and the Child and Family Research Institute of British Columbia, Canada.Eileen Hutton, PhD, is Director of the Midwifery Education Program and Assistant Dean in the Faculty of Health Sciences at McMaster University in Hamilton, Ontario, where she is an Associate Professor in the Department of Obstetrics and Gynecology. She is supported by the Canadian Institutes of Health Research New Investigator Award program.


Patient-initiated elective cesarean delivery is emerging as an urgent issue for practitioners, hospitals, and policy makers and for pregnant women. This exploratory qualitative study looks at the birth stories and cultural knowledge that women use to inform the decision about an elective cesarean without medical indication. Data collection consisted of exploratory qualitative in-depth interviews with 17 primiparous women in British Columbia, Canada. Interviews revealed the influence of socially circulated birth stories and cultural narratives on their attitudes towards mode of delivery. Participants included in their decision making process both medical information and informal birth stories that were technologically inclined and confirmed their preference for cesarean delivery. Results indicate that women who participated in this study drew heavily from social and cultural knowledge in forming their decision to give birth by patient-initiated elective cesarean delivery. Although the numbers of women who request a cesarean delivery for social reasons is still small, the persuasive influence on parturient women of positive cesarean stories and negative vaginal stories must be considered. Care providers and childbirth educators need to become familiar with the social influences impacting women's decisions for mode of delivery so that truly informed choice discussions can be undertaken.

[Indexed for MEDLINE]

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