Women's perceptions of caesarean birth: A roy international study

Jacqueline Fawcett; Cynthia Aber; Susan Haussler; Marianne Weiss; Sheila Taylor Myers; Jaye L. Hall; V. Lynn Waters; Charlette King; Marja Terttu Tarkka; Anja Rantanen; Paivi Astedt-Kurki; Jennifer Newton; Virginia Silva

doi:10.1177/0894318411419211

Women's perceptions of caesarean birth: A roy international study

Jacqueline Fawcett, Cynthia Aber, Susan Haussler, Marianne Weiss, Sheila Taylor Myers, Jaye L. Hall, V. Lynn Waters, Charlette King, Marja Terttu Tarkka, Anja Rantanen, Paivi Astedt-Kurki, Jennifer Newton, Virginia Silva

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

Abstract

The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.

Original language	English
Pages (from-to)	352-362
Number of pages	11
Journal	Nursing Science Quarterly
Volume	24
Issue number	4
DOIs	https://doi.org/10.1177/0894318411419211
Publication status	Published - Oct 2011
Externally published	Yes

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10.1177/0894318411419211

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@article{a7788f759c1644f2993b6591c3d9fdb7,

title = "Women's perceptions of caesarean birth: A roy international study",

abstract = "The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.",

keywords = "caesarean birth perceptions, caesarean birth responses, mixed method research, Roy adaptation model",

author = "Jacqueline Fawcett and Cynthia Aber and Susan Haussler and Marianne Weiss and Myers, {Sheila Taylor} and Hall, {Jaye L.} and Waters, {V. Lynn} and Charlette King and Tarkka, {Marja Terttu} and Anja Rantanen and Paivi Astedt-Kurki and Jennifer Newton and Virginia Silva",

note = "Funding Information: The study findings do not support the empirical adequacy of the theory of perceptions of and responses to caesarean birth. As can be seen in Table 3 and by comparing Figures 3 and 5 , a more parsimonious theory emerged from the path analysis. Lack of support for theory propositions B, F, and I indicates that number of caesarean births was not a relevant contextual stimulus in this study. Theory propositions A and H were not supported, which suggests that type of caesarean birth was not the RAM focal stimulus for perception of the birth experience; instead, the support found for theory propositions C, G, and J suggests that preparation for caesarean birth is the focal stimulus for perception of the birth experience. Lack of support for theory proposition A conflicts with Marut and Mercer{\textquoteright}s (1979) finding of less positive perceptions of the birth experience by women who had unplanned caesarean births. Support for theory propositions E and G is consistent with the RAM proposition advanced by Fawcett (2003) that stimuli are directly related to the modes of adaptation. Comparison of the path coefficients for theory propositions E (0.28) and G (0.18) indicates that type of caesarean birth is the focal stimulus for responses, and that preparation for caesarean birth is the contextual stimulus for responses. This conclusion also is supported by the finding of a slightly greater total effect for type of caesarean birth (0.28) than for preparation for caesarean birth (0.26) on responses to caesarean birth. The positive path coefficient for the relation between type of caesarean birth and responses conflicts with the findings of a negative relation in earlier studies. The change in the direction of the relation may be explained by the present study findings for numbers of adaptive and ineffective responses. More specifically, the results for responses to caesarean birth, as measured by the number of adaptive and ineffective responses to the CBEQ, conflict with findings of studies of women{\textquoteright}s responses to caesarean birth that were conducted in the 1970s, 1980s, and 1990s ( Fawcett, 1981 ; Fawcett & Burritt, 1985 ; Fawcett & Weiss, 1993 ; Reichert et al., 1993 ). The women in this study had more adaptive than ineffective responses, whereas women in earlier studies had more ineffective than adaptive responses, especially if they had unplanned caesarean births. These findings underscore Shearer{\textquoteright}s (1989) speculation that caesarean birth has become normalized, perhaps even more so with the constantly increasing caesarean birth rate during in the early years of the 21 st century. Support for theory proposition D is consistent with the RAM proposition of a relation between the cognator subsystem and the modes of adaptation Overall, the study findings support the soundness of the RAM, in that some theory propositions (C, D, E, G, J) linking stimuli with the cognator subsystem or with modes of adaptation and theory proposition D linking the cognator subsystem with modes of adaptation were supported. Inspection of R 2 values indicates that type of caesarean birth, preparation for caesarean birth, and perception of the birth experience accounted 31% of the variance in responses for caesarean birth, which is considered a large effect size ( Cohen, 1988 ). Comparison of the path coefficients indicates that the relation between perception of the birth experience and responses to caesarean birth (0.33) is stronger than the relation of either type of caesarean birth (0.28) or preparation for caesarean birth (0.18) to responses. This finding suggests that the link between the cognator subsystem and the modes of adaptation is stronger than the link between stimuli and modes. Continued inspection of R 2 values indicates that the link between stimuli and the cognator subsystem is weak, inasmuch as preparation for caesarean birth accounted for only 5% of the variance in perception of the birth experience and the path coefficient was 0.23, which is considered a small effect size ( Cohen, 1988 ). Continued investigation of the relative strength of these relations is warranted. The results of this study also support the continued utility of the RAM as a guide for the content analysis of responses to the CBEQ questions ( Fawcett, 2006 ). All of the women{\textquoteright}s responses to the CBEQ could be categorized within the four RAM modes of adaptation, which indicates that the four modes provide a comprehensive frame of reference for examination of women{\textquoteright}s responses to the entire caesarean birth experience. The findings of no differences in perception of the birth experience and in responses to caesarean birth for women from the three countries suggest that the experience of caesarean birth is similar across international boundaries. Inspection of the scores for perception of the birth experience and responses to caesarean birth indicate that on average, the women had essentially neutral perceptions and responses, findings that are similar to earlier studies ( Cranley et al., 1983 ; Fawcett et al., 1992 ; Marut & Mercer, 1979 ). However, the ranges for those scores indicate that some women had somewhat negative or somewhat positive perceptions and some had extremely negative or extremely positive responses ( Table 2 ). Systematic assessment of women{\textquoteright}s perceptions and responses is needed to allow those women who have negative perceptions and responses to tell the story of their birth experience, which may help them to find meaning in the experience ( Affonso, 1977 ) and reduce postpartum psychosocial morbidity, including depression ( Lavender & Walkinshaw, 1998 ). The findings that a greater percentage of Finnish women had a repeat caesarean than their United States and Australian counterparts may explain why a greater percentage of the Finish women also felt more prepared for the caesarean. Although associations were found between the theory concepts representing the focal stimulus—type of caesarean birth–and the contextual stimuli—number of caesarean births and preparation for caesarean birth—the interaction terms were not related to perceptions of or responses to caesarean birth in the regression analyses. The authors are indebted to all those persons who participated in various ways in this study. Many women in this study felt prepared for the caesarean birth, yet few attended preparation for childbirth classes. Perhaps healthcare providers and other women who have had caesarean births conveyed sufficient details about this method of delivery to meet the women{\textquoteright}s informational needs. Future studies should address the sources and quality of information about caesarean birth accessed by women. The results of this study indicate that nursing and midwifery students and staff nurses can play a very important role in practice by systematically recording the results of their assessments of women who experience caesarean birth. The instruments used in this study can easily be used in nursing practice, or other practice tools that capture women{\textquoteright}s perceptions of and responses to caesarean birth could be developed. The present study findings can be used as the basis for comprehensive assessments and add to the already available data needed to develop evidence-based nursing interventions that will foster positive perceptions of and responses to caesarean birth. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article. ",

year = "2011",

month = oct,

doi = "10.1177/0894318411419211",

language = "English",

volume = "24",

pages = "352--362",

journal = "Nursing Science Quarterly",

issn = "0894-3184",

publisher = "SAGE Publications Ltd",

number = "4",

}

TY - JOUR

T1 - Women's perceptions of caesarean birth

T2 - A roy international study

AU - Fawcett, Jacqueline

AU - Aber, Cynthia

AU - Haussler, Susan

AU - Weiss, Marianne

AU - Myers, Sheila Taylor

AU - Hall, Jaye L.

AU - Waters, V. Lynn

AU - King, Charlette

AU - Tarkka, Marja Terttu

AU - Rantanen, Anja

AU - Astedt-Kurki, Paivi

AU - Newton, Jennifer

AU - Silva, Virginia

N1 - Funding Information: The study findings do not support the empirical adequacy of the theory of perceptions of and responses to caesarean birth. As can be seen in Table 3 and by comparing Figures 3 and 5 , a more parsimonious theory emerged from the path analysis. Lack of support for theory propositions B, F, and I indicates that number of caesarean births was not a relevant contextual stimulus in this study. Theory propositions A and H were not supported, which suggests that type of caesarean birth was not the RAM focal stimulus for perception of the birth experience; instead, the support found for theory propositions C, G, and J suggests that preparation for caesarean birth is the focal stimulus for perception of the birth experience. Lack of support for theory proposition A conflicts with Marut and Mercer’s (1979) finding of less positive perceptions of the birth experience by women who had unplanned caesarean births. Support for theory propositions E and G is consistent with the RAM proposition advanced by Fawcett (2003) that stimuli are directly related to the modes of adaptation. Comparison of the path coefficients for theory propositions E (0.28) and G (0.18) indicates that type of caesarean birth is the focal stimulus for responses, and that preparation for caesarean birth is the contextual stimulus for responses. This conclusion also is supported by the finding of a slightly greater total effect for type of caesarean birth (0.28) than for preparation for caesarean birth (0.26) on responses to caesarean birth. The positive path coefficient for the relation between type of caesarean birth and responses conflicts with the findings of a negative relation in earlier studies. The change in the direction of the relation may be explained by the present study findings for numbers of adaptive and ineffective responses. More specifically, the results for responses to caesarean birth, as measured by the number of adaptive and ineffective responses to the CBEQ, conflict with findings of studies of women’s responses to caesarean birth that were conducted in the 1970s, 1980s, and 1990s ( Fawcett, 1981 ; Fawcett & Burritt, 1985 ; Fawcett & Weiss, 1993 ; Reichert et al., 1993 ). The women in this study had more adaptive than ineffective responses, whereas women in earlier studies had more ineffective than adaptive responses, especially if they had unplanned caesarean births. These findings underscore Shearer’s (1989) speculation that caesarean birth has become normalized, perhaps even more so with the constantly increasing caesarean birth rate during in the early years of the 21 st century. Support for theory proposition D is consistent with the RAM proposition of a relation between the cognator subsystem and the modes of adaptation Overall, the study findings support the soundness of the RAM, in that some theory propositions (C, D, E, G, J) linking stimuli with the cognator subsystem or with modes of adaptation and theory proposition D linking the cognator subsystem with modes of adaptation were supported. Inspection of R 2 values indicates that type of caesarean birth, preparation for caesarean birth, and perception of the birth experience accounted 31% of the variance in responses for caesarean birth, which is considered a large effect size ( Cohen, 1988 ). Comparison of the path coefficients indicates that the relation between perception of the birth experience and responses to caesarean birth (0.33) is stronger than the relation of either type of caesarean birth (0.28) or preparation for caesarean birth (0.18) to responses. This finding suggests that the link between the cognator subsystem and the modes of adaptation is stronger than the link between stimuli and modes. Continued inspection of R 2 values indicates that the link between stimuli and the cognator subsystem is weak, inasmuch as preparation for caesarean birth accounted for only 5% of the variance in perception of the birth experience and the path coefficient was 0.23, which is considered a small effect size ( Cohen, 1988 ). Continued investigation of the relative strength of these relations is warranted. The results of this study also support the continued utility of the RAM as a guide for the content analysis of responses to the CBEQ questions ( Fawcett, 2006 ). All of the women’s responses to the CBEQ could be categorized within the four RAM modes of adaptation, which indicates that the four modes provide a comprehensive frame of reference for examination of women’s responses to the entire caesarean birth experience. The findings of no differences in perception of the birth experience and in responses to caesarean birth for women from the three countries suggest that the experience of caesarean birth is similar across international boundaries. Inspection of the scores for perception of the birth experience and responses to caesarean birth indicate that on average, the women had essentially neutral perceptions and responses, findings that are similar to earlier studies ( Cranley et al., 1983 ; Fawcett et al., 1992 ; Marut & Mercer, 1979 ). However, the ranges for those scores indicate that some women had somewhat negative or somewhat positive perceptions and some had extremely negative or extremely positive responses ( Table 2 ). Systematic assessment of women’s perceptions and responses is needed to allow those women who have negative perceptions and responses to tell the story of their birth experience, which may help them to find meaning in the experience ( Affonso, 1977 ) and reduce postpartum psychosocial morbidity, including depression ( Lavender & Walkinshaw, 1998 ). The findings that a greater percentage of Finnish women had a repeat caesarean than their United States and Australian counterparts may explain why a greater percentage of the Finish women also felt more prepared for the caesarean. Although associations were found between the theory concepts representing the focal stimulus—type of caesarean birth–and the contextual stimuli—number of caesarean births and preparation for caesarean birth—the interaction terms were not related to perceptions of or responses to caesarean birth in the regression analyses. The authors are indebted to all those persons who participated in various ways in this study. Many women in this study felt prepared for the caesarean birth, yet few attended preparation for childbirth classes. Perhaps healthcare providers and other women who have had caesarean births conveyed sufficient details about this method of delivery to meet the women’s informational needs. Future studies should address the sources and quality of information about caesarean birth accessed by women. The results of this study indicate that nursing and midwifery students and staff nurses can play a very important role in practice by systematically recording the results of their assessments of women who experience caesarean birth. The instruments used in this study can easily be used in nursing practice, or other practice tools that capture women’s perceptions of and responses to caesarean birth could be developed. The present study findings can be used as the basis for comprehensive assessments and add to the already available data needed to develop evidence-based nursing interventions that will foster positive perceptions of and responses to caesarean birth. The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. The author(s) received no financial support for the research, authorship, and/or publication of this article.

PY - 2011/10

Y1 - 2011/10

N2 - The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.

AB - The purpose of this Roy adaptation model-based multi-site international mixed method study was to examine the relations of type of caesarean birth (unplanned/planned), number of caesarean births (primary/repeat), and preparation for caesarean birth to women's perceptions of and responses to caesarean birth. The sample included 488 women from the United States (n = 253), Finland (n = 213), and Australia (n = 22). Path analysis revealed direct effects for type of and preparation for caesarean birth on responses to caesarean birth, and an indirect effect for preparation on responses to caesarean birth through perception of birth the experience.

KW - caesarean birth perceptions

KW - caesarean birth responses

KW - mixed method research

KW - Roy adaptation model

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U2 - 10.1177/0894318411419211

DO - 10.1177/0894318411419211

M3 - Article

C2 - 21975484

AN - SCOPUS:80053601939

SN - 0894-3184

VL - 24

SP - 352

EP - 362

JO - Nursing Science Quarterly

JF - Nursing Science Quarterly

IS - 4

ER -

Women's perceptions of caesarean birth: A roy international study

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