Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 17;18(1):377.
doi: 10.1186/s12884-018-2007-7.

Factors influencing decision-making for caesarean section in Sweden - a qualitative study

Sunita Panda  1 , Deirdre Daly  2 , Cecily Begley  2   3 , Annika Karlström  4 , Birgitta Larsson  4 , Lena Bäck  4 , Ingegerd Hildingsson  4   5
Affiliations

Factors influencing decision-making for caesarean section in Sweden - a qualitative study

Sunita Panda et al. BMC Pregnancy Childbirth. .

Abstract

Background: Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden.

Methods: A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin.

Results: The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes.

Conclusion: Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.

Keywords: Caesarean section; Decision-making; Midwife-led care; Midwives; Normal birth; Nulliparous; Obstetricians; Qualitative.

PubMed Disclaimer

Conflict of interest statement

Authors’ information

SP is a PhD student, DD is an Assistant Professor of Midwifery and CB is the Chair of Nursing and Midwifery in School of Nursing and Midwifery, Trinity College Dublin. IH is a Professor of Midwifery, in Uppsala University and Mid Sweden University, Sundsvall, AK is a Senior Lecturer, LB and BL are PhD students at Mid Sweden University, Sundsvall, Sweden.

Ethics approval and consent to participate

Approval was granted by the research ethics committee of School of Nursing and Midwifery, Trinity College Dublin, in July 2015. Confirmation of Sweden’s legislative processes exempting the conduct of research with clinicians from requiring ethics committee approval was obtained from the Central Ethical Review Board and Data Protection Authority, Sweden. Written consent was obtained from the participants prior to conducting the focus group interviews. https://www.datainspektionen.se/other-lang/in-english/the-general-data-protection-regulation-gdpr/

Consent for publication

Not applicable

Competing interests

There are no competing interests associated with this article. Cecily Begley, a co-author in this manuscript is a member of the editorial board and a Section Editor of this journal.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Diagram representing Swedish clinicians’ perspectives of factors influencing decision-making for CS in Sweden
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Betran AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional and National Estimates: 1990-2014. PLoS One. 2016;11(2):e0148343. doi: 10.1371/journal.pone.0148343. - DOI - PMC - PubMed
    1. Betran AP, Torloni MR, Zhang J, Ye J, Mikolajczyk R, Deneux-Tharaux C, Oladapo OT, et al. What is the optimal rate of cesarean section at population level? A systematic review of ecologic studies. Reprod Health. 2015;12:57. doi: 10.1186/s12978-015-0043-6. - DOI - PMC - PubMed
    1. Declercq E, Cabral H, Ecker J. The plateauing of cesarean rates in industrialized countries. Am J Obstet Gynecol. 2017;216(3):322–323. doi: 10.1016/j.ajog.2016.11.1038. - DOI - PubMed
    1. Villar J, Carroli G, Zavaleta N, Donner A, Wojdyla D, Faundes A, et al. Maternal and neonatal individual risks and benefits associated with cesarean delivery: multicentre prospective study. Bmj. 2007;335:1025–1029. doi: 10.1136/bmj.39363.706956.55. - DOI - PMC - PubMed
    1. Panda S, Begley C, Daly D. Readmission following caesarean section: reasons for readmission and outcomes for women in one large Irish maternity hospital. Br J Midwifery. 2016;24(5):2–8. doi: 10.12968/bjom.2016.24.5.322. - DOI