Decision-making process for choosing an elective cesarean delivery among primiparas in Taiwan

Shiou Yun Huang, Shuh Jen Sheu, Chen Jei Tai, Ching Ping Chiang, Li Yin Chien*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

21 Scopus citations


A significant proportion of cesarean deliveries in Taiwan were without medical indications and/or on maternal request. The purpose of this study was to understand the decision-making process of choosing an elective cesarean delivery (ELCD) among primiparas in Taiwan. This qualitative exploratory study was guided by grounded theory. Data were collected through in-depth interviews with 20 primiparous women, 15 of whom chose ELCD. Verbatim transcriptions were analyzed using constant comparative analysis and methods of open, axial, and selective coding. The core category that describes the process of ELCD decision making among primiparas is "controlling risks of childbirth and ensuring well-being." The decision process can be divided into three phases: (1) Pre-decision: risk perception, including two subcategories, negative pre-existing ideas about normal spontaneous delivery (NSD) caused worry, and desire for ELCD as the solution; (2) In-decision: risk assessment. Women proactively collected information about NSD and cesarean delivery, and then weighed the personal risk between NSD and ELCD. Risk assessment focused on seven dimensions including safety, health, comfort, efficiency, feminine charms, time and economy; (3) Post-decision: marching onward fearlessly, including two subcategories, belief in ELCD and stress relief, and persuading stakeholders to agree and gaining the required resources for ELCD. At different phases of decision-making, women revealed different concerns, though the sequence of phases was not necessarily unidirectional. Health care providers should be aware of the decision phase and intervene at appropriate times. It is difficult to change a women's decision to have ELCD in the post-decision phase.

Original languageEnglish
Pages (from-to)842-851
Number of pages10
JournalMaternal and Child Health Journal
Issue number5
StatePublished - Jul 2013


  • Childbirth
  • Decision making
  • Elective cesarean delivery
  • Pregnancy
  • Primiparas
  • Risk perception


Dive into the research topics of 'Decision-making process for choosing an elective cesarean delivery among primiparas in Taiwan'. Together they form a unique fingerprint.

Cite this