What if something goes wrong? A grounded theory study of parents' decision-making processes around mode of breech birth at term gestation

Objective: To explore factors that influence parents' decision-making for mode of breech birth at term gestation. Design: A grounded theory study conducted using a constructivist approach. Semi-structured telephone interviews were recorded and transcribed verbatim and analysed using the software NVivo for Mac version 11.4.0. Setting: England, UK. Participants: Twelve parents with breech presentation confirmed by ultrasound at >= 36+0 weeks gestation were recruited from several UK social media forums. Findings: Two core themes impacting on a parent's decision-making process for term breech birth were identified. Firstly, a framework of potential influences including partner and relationship, family and friends, health professionals, own birth culture, self, shared experiences and the time available for decision-making. Secondly, mortality salience, or parental focus on risk of potential injury or death associated with birth, was found to be central to every participant's narrative. Key conclusions: This study highlights the individuality and wider framework of parent's decision-making influences for term breech birth, and demonstrates to care providers the conflicted emotions that may be experienced. The findings of this study may guide midwives and other professionals in providing person-centered, non-judgmental, balanced and evidence-based mode of term breech birth counselling. Implications for practice: Health professionals should adopt a parentcentred approach to counselling for mode of term breech birth, considering parents' wider influences in their decision-making and the fear of injury or death surrounding both vaginal breech birth and caesarean section. They can also facilitate parents to understand the influences that might be guiding their own decision-making. (C) 2019 Elsevier Ltd. All rights reserved.