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Suffragettes for Caesareans: "Every Woman Should Have a Choice"

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Suffragettes for Caesareans: University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2016 Suffragettes for Caesareans: "Every woman should have a choice" Imanoff, Julia Imanoff, J. (2016). Suffragettes for Caesareans: "Every woman should have a choice" (Unpublished master's thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/27934 http://hdl.handle.net/11023/3286 master thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Suffragettes for Caesareans: “Every woman should have a choice” by Julia B. Imanoff A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF NURSING GRADUATE PROGRAM IN NURSING CALGARY, ALBERTA SEPTEMBER, 2016 © Julia B. Imanoff 2016 Abstract Patient choice for caesarean delivery (CD) is complex. This choice poses a challenge to Health Care Providers (HCPs) in terms of resource allocation, economics, and surgical risks. Yet, women’s understanding of choice is poorly understood. This study answers the question: how HCPs might understand women’s choice for CD? Four primiparous women who chose a CD were recruited. Semi-structured interviews were used to generate data. The interpretation followed a hermeneutic approach. The interpretations emphasized the complexities of choice, HCPs’ role in birth experiences, and how the woman in this study understood vaginal deliveries as risky and unpredictable and caesarean deliveries as safe and controlled. These findings question how HCP’s understandings of choice can shape patient care. HCPs have the opportunity to recognize the meaning of the choice for each woman and how it is situated in a broader historical context, and how they can promote positive birth experiences in their practice. ii Preface This thesis is the original work by the author, J. Imanoff. The recruitment and data generation described in Chapters 4 and 5 were approved by the University of Calgary Ethics Board (ID # REB13-1183). The discussion on fear of adverse outcomes in Chapter 6 includes ideas that are based on a concept analysis that has been published as Imanoff, J.B. & Mannion, C. (2015). The Great Caesarean Debate: The concept of fear of childbirth as a potential indication for caesarean birth. Proceedings of the 20th World Congress on Controversies in Obstetrics, Gynecology, and Infertility (COGI), France, 117-123. doi: 10.12894/COGI/201412/16. J. Imanoff was responsible for the concept analysis as well as the manuscript composition. C. Mannion contributed to manuscript edits. iii Acknowledgements Firstly, I would like to express my sincere gratitude to my supervisors, Drs. Cynthia Mannion and Graham McCaffrey, for their support of my thesis work; for their patience, motivation, and expertise. With their guidance, I have been able to develop my capacity for research as a novice researcher. The rich discussions during the analysis and interpretation phases were stimulating and extremely motivating. Reflecting fondly on our time together, I could not have imagined having better advisors and mentors. I would like to thank the rest of my thesis committee: Drs. Deb White and Debbie McNeil, for their insightful comments and encouragement, but also for the challenging questions which helped broaden my perspective and shaped the way I view my work. Their contributions and support are greatly appreciated. I profoundly thank the institutions and organizations which have awarded funding to me during this degree: The Faculty of Nursing at the University of Calgary, the Faculty of Graduate Studies at the University of Calgary, the Government of Alberta, the Canadian Nurses Foundation. My sincere thanks also goes to the obstetricians and clinic staff, who helped me recruit participants for my study. Without their support, it would not have been possible to conduct this research. I would also like to thank the women who participated in this study for welcoming me into their homes and sharing their personal choice and birth experience with me. I thank my colleagues for the long conversations, encouragement, and support. A special thanks to Morgan Yates for being there every step of the way and to Irene Boldt, for the stimulating discussions, the long phone conversations, and final edits. iv Last but not the least, I would like to thank my family: my parents for cheering me on and helping to shape the way I see the world (which ultimately led me to hermeneutics); my husband for being my partner in all things, understanding and supporting my perpetual desire to further my education; and my son whose birth had a profound impact on the way in which I have come to understand caesarean deliveries. v Dedication This thesis is dedicated to all mothers who constantly face the challenge of choosing their own path. vi Table of Contents Abstract ............................................................................................................................................ i Preface............................................................................................................................................ iii Acknowledgements ........................................................................................................................ iv Dedication ...................................................................................................................................... vi Table of Contents .......................................................................................................................... vii List of Tables .................................................................................................................................. x List of Figures and Illustrations ..................................................................................................... xi List of Symbols, Abbreviations, Nomenclatures .......................................................................... xii Chapter 1: A Brief History of Caesarean Deliveries ...................................................................... 1 1.1 Introduction ..................................................................................................................... 1 1.2 The History of Caesarean Deliveries .............................................................................. 1 1.3 The Trend in Caesarean Deliveries ................................................................................. 3 Chapter 2: Literature Review ........................................................................................................ 11 2.1 Review of the Literature ............................................................................................... 11 2.1.1 Prevalence. ................................................................................................................ 15 2.1.2 Demographics. .......................................................................................................... 15 2.1.3 Expectations. ............................................................................................................. 16 2.1.4 Experiences. .............................................................................................................. 17 2.1.5 Choice. ...................................................................................................................... 18 2.1.6 Rationale. .................................................................................................................. 19 2.1.7 Birth Satisfaction. ..................................................................................................... 22 2.2 Summary of the Literature ............................................................................................ 23 Chapter 3: Methodology ............................................................................................................... 24 3.1 Philosophical Underpinnings ........................................................................................ 24 3.2 The Address of the Topic .............................................................................................. 27 3.3 Research Question ........................................................................................................ 28 3.4 Ethics............................................................................................................................. 28 Chapter 4: Sampling and Recruitment .......................................................................................... 29 4.1 Sample size ................................................................................................................... 29 vii 4.1.1 Inclusion/exclusion criteria. ...................................................................................... 29 4.1.2 Recruitment. .............................................................................................................. 30 4.2 Data Generation ............................................................................................................ 31 4.3 Interpretation ................................................................................................................
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