Becoming Redundant: women’s experience of unwanted scheduled caesarean section - a grounded theory study

Abstract

Currently, one third of Australian childbearing women per annum have a caesarean section. Evidence strongly indicates, however, that most women enter into pregnancy expecting and wanting to give birth naturally. While a body of research exists that accounts for some aspects of how women experience caesarean section, the phenomenon has not previously been described in depth. The purpose of this study was to uncover and theorise how women processed and experienced a first caesarean recommended in pregnancy for a health reason.This Western Australian investigation was conducted using the Glaserian version of Grounded Theory methodology. Twenty-eight pregnant women who had been anticipating giving birth naturally, but were advised during pregnancy that they would need to give birth by caesarean section, agreed to participate in the study. Five sets of data were collected. The first comprised semi-structured in depth interviews with the 28 women both before and after the birth of their baby. Non-participant observations of women’s behaviours and interactions whilst they were in the operating theatre, including situation maps, written notes and pencil sketches, formed the second data set. The third and fourth sets of data consisted of semi-structured interviews held with participating women’s partners and with maternity health care professionals. Field notes formed the final set.The Grounded Theory that emerged was labelled Becoming Redundant. The theory comprises the core problem that anticipating and experiencing a scheduled caesarean section posed for women, namely Being Made Redundant, and the psychosocial process they undertook to manage it, labelled Regrouping. In total, eight major categories were identified. The four categories that contributed to the core problem were labelled Being robbed, Becoming a ‘persona non grata’, Off everyone’s radar and Left wanting. The categories in the regrouping process were labelled Trying to make it feel real, Travelling a new path blindly, Striving to be included whilst trying to behave and Treading water. In addition, four factors emerged from the data that moderated, or limited, women’s regrouping endeavours. These were titled Expecting birth would be natural, Hurtling towards ‘D-day’, The green drape and Caesarean section is hospital not women’s business.For 25 of the 28 women, needing and having a caesarean section was frightening, disempowering, distressing and in complete contrast with how they had expected and wanted their baby’s birth to be. The childbirth expectations of these 25 women were shattered as the hospital effectively took over their baby’s birth, and they were left with feelings of loss, grief and, in some cases, symptoms of emotional trauma. In response, women set about trying to accommodate the personal losses they incurred, and to transition to their ‘new reality’. The effect of the moderating factors, however, was to thwart women’s adaptation efforts. Consequently, when they were interviewed between 10 and 14 weeks after their caesarean section, these 25 women reported feeling cognitively and emotionally ‘stuck’ in their childbearing experience. They also described spending considerable energy and attention on trying to work out what had happened to them rather than focusing on their new baby.The remaining three women either experienced or responded to their scheduled caesarean section differently to the other 25; this was because of the absence of one or more of the moderating factors. Ultimately, however, only one of the women was left feeling positive, emotionally on a ‘high’ and free of regret after her baby’s birth.This Western Australian research highlights significant new findings about women who require a caesarean section for a health reason. The work makes an important and original contribution not only to the maternity literature, but to the body of knowledge concerning grief, traumatic stress and dissociation, and change transition. The theory of Becoming Redundant provides maternity care professionals, academics and consumers with previously unknown information about how women might experience, manage and be affected by unforeseen and unwelcome change during the childbearing episode, and has direct and important implications for the care of childbearing women. The disappointment, grief and/or traumatic stress that is likely to arise for a woman when her childbearing expectations can no longer be fulfilled must be anticipated, recognised, acknowledged and forestalled where possible. For women to integrate and move on from their childbirth experience and become fully engaged in motherhood, those who have had to ‘change track’ must be afforded the time, space and support to explore the meaning of the change, to fully mourn what they lose because of it, and to recapture their losses to the greatest extent possible.