Women’s experiences of unplanned and emergency caesarean section within New Zealand’s maternity system. (2020)
Type of ContentTheses / Dissertations
Thesis DisciplineHealth Sciences
Degree NameDoctor of Philosophy
PublisherUniversity of Canterbury
Background: In New Zealand, normal birth has been at the core of the maternity philosophy, particularly among midwives. The midwifery model provides continuity of care during pregnancy, childbirth, and up to six weeks postnatally - women who experience continuity of care report greater satisfaction with their maternity provider. Yet, caesarean section rates continue to rise globally, and the current rate in NZ is estimated at 25-30%. Unplanned and emergency caesarean section (CS) complicates a woman’s care journey as care is transferred from a Lead Maternity Carer (LMC). A transfer of care to a hospital-based obstetric specialist may take place in what are often unanticipated and challenging circumstances. Women who undergo CS commonly report increased negative birth experiences, specifically, more extended maternal recovery periods, lower breastfeeding rates, and increased risk of post- traumatic stress disorder. The research sought to understand the participants’ experiences and the nature of care for women during and after unplanned/emergency CS in Canterbury, New Zealand, adopting a post-structuralist feminist perspective.
Method: This qualitative study explored the experiences of 30 women who had undergone unplanned and emergency caesarean section and the accounts of 11 lead maternity carers’ (LMCs). Data were collected using in-depth semi-structured interviews. The data were analysed using the Framework approach described by Ritchie and Spencer, and thematic- discourse analysis was used to identify and describe meaningful concepts in the data.
Findings: Analysis of the interviews with new mothers revealed an overarching theme - ‘the mixed emotions of becoming a mother from an unplanned/emergency caesarean birth’ - from which nine key themes emerged. Collectively, the themes highlight the conflicting feelings participants experienced in their connection to their lead maternity carer (LMC) but disconnection to their experience of emergency caesarean section. Mixed emotional reactions from the caesarean delivery revealed that despite the relief of a live birth, the mothers experienced emotions that included a lingering sense of failure, disappointment, and loss of agency. These findings are linked to the incongruity of women’s birth expectations and outcomes. Triangulation with findings from the interviews with the care providers identifies opportunities for health system strengthening.
Conclusion and implications for practice: Drawing on Foucault’s discussion of knowledge and power to apply analyses of governmentality surrounding birth discourses within the context of a midwifery dominated health system. This thesis contributes an understanding that while the techniques of governmentality remain constant, the sense of individual responsibility that accompanies natural birth discourses elicited emotions of guilt and disappointment among women. The research makes visible the contested nature of the discourses of natural birth among women who experience operative deliveries, thereby highlighting the need for more nuanced antenatal education and wrap-around support post- CS.
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