Table 3.

Patient and provider themes. Themes were identified by semi-structured interviews with patients whoexperienced cesarean delivery, and providers who provide cesarean delivery clinical care. More complete example quotations can be found in Appendix 2.

Patient Perspectives
Theme	Code	Example Quotation
Effective communication, education, and respect	Desire to understand back-up plan or alternatives	“I’m a planner, I need to understand… I need to know what you’re going to do so I’m prepared for it mentally.”
	Importance of tailored education	“The things the providers say should be accessible to everyone.”
	Comfort from real-time updates	“Nurses were keeping me informed, calming me down… it was just more of a pleasant experience…”
	Perceived discrimination	“My weight… added complications… some doctors looked at me a little bit different…
Emotional support by care team	Effect of being awake during a major surgery	“Mentally, I think it’s a little bit more tough… you’re going into a surgery and you’re wide awake.”
	Importance of mutual respect	“Mutual respect is everything… [without it] I wouldn’t feel like you’re handling my concerns.”
	Comforting environment created by care team	“They just boosted me up… gave me the strength to go for the operation…”
Intraoperative pain or discomfort	Patient discomfort (but not in pain) during cesarean delivery	“It was just the tugging… it was getting too much…”
	Patient felt pain during cesarean delivery	“I was in a lot of pain… I felt every single amount of pain…”
	Inadequate intraoperative pain management	“They gave me more… but it was too late.”
	Lack of pain management discussion	“I don’t think they… talked to me about options. They told me I would be given this. I was under the assumption that’s exactly what is given.
	Fear of intraoperative pain	“It was a fear that what if the spinal doesn’t work.”
	Anesthesiologist addressing pain concerns	“I actually did experience pain… they were very like, if you’re feeling anything, tell us.”
Varying acceptability around pain therapies	Patient aversion to opioids	“I didn’t want any [opioids]… I don’t want to be taking care of a baby while I’m on a narcotic.”
	Concerns about anesthesia side effects	“When I hear side effects, I get more concerned…”
	Preference for general anesthesia	“I didn’t expect to feel all that amount of pain… I would’ve felt better being put under.”
	Prioritizing baby’s needs over pain management	“I would want whatever was best for my son to happen…”
Stigma surrounding cesarean delivery	Efforts or desire to mirror vaginal birth	“They were able to accommodate… what I had hoped for.”
	Social judgment around birth	““Women will make comparisons… both of those are real births…”
Provider Perspectives
Theme	Code	Quotation
Complexity of pain responses	Recognition of pain complexity	“Pain is not just about the medicines we’re giving… it’s very subjective.”
	Importance of individualized pain management	“One treatment does not fit all… you have to individualize your approach.”
Multiple pain control strategies	Patient education on pain management	“When patients have reasons for going beyond our standard therapy…”
	Importance of multimodal pain management.	“The patient is getting everything from that multimodal arsenal.”
Effective communication during emergency cesarean delivery	Desire for better intraoperative pain education	“In an emergency c-section… they might not be quite as well informed…”
	Reducing patient anxiety through education	“A lot of people are anxious because of the unknown… being informed on step by step…”
	Balancing provider opinion with patient autonomy	“Almost always there’s more than one option… support whatever informed decision they make.”
Patient psychological well-being during cesarean delivery	Priority for respectful communication	“Patients may have had a traumatic past birth… just being respectful…”
	Recognition of patient trauma with general anesthesia	“…now there’s a time in their life, maybe arguably one of the most important times in their life, and they can’t remember it. That’s some real trauma.”
Barriers to observing the patients’ birth plans	Desire for flexibility in protocols	“Certain providers actually didn’t mind turning off the lights…”
	Bonding with newborn	“In some cases, a patient desires skin-to-skin contact during a c-section but may be vomiting throughout the procedure. This makes it challenging to facilitate that bonding moment, which is difficult for me as I want them to have the best experience possible.”
	Recognizing “beauty of birth” beyond medical aspects	“[our hospital] is very efficient… but for this patient, it’s their whole world. They’re birthing a child… So just be cognizant that you’re in a monumental moment in their life and act accordingly.”
	Challenges in accommodating birth preferences	“…Sometimes it can be a little bit frustrating because we don’t have the same values or views on those issues, and you’re in the tough spot…But being able to go beyond what your views are and saying, hey how can you try to make it happen? … Let’s try to respect those wishes.”
	Views on healthcare system stress	“People sometimes are… fixated on just getting through the day… they forget that that’s important.”

Patient Themes