Communicating the health risks and benefits of repeat caesareans or VBAC

Communicating the health risks and benefits of repeat caesareans or VBAC
The study surveyed 21 women from 2 city hospitals in Bristol and Dundee. Uncertainty in decision making, information provision and decision-making roles were examined by researchers, as these were considered to be the main factors behind women opting for a repeat caesarean section or vaginal birth after caesarean (VBAC).

Women who chose to have a caesarean section did so because they were afraid of vaginal birth or were convinced that a vaginal birth was not for them, or wanted to have control over the birth. Women choosing VBAC did so because they were influenced by the shorter recovery time after birth, wanted the experience of a natural delivery or feared having to go through another caesarean section. Uncertainty and anxiety in choosing the method of delivery was a result of conflicting opinions between women and their partners, or among their health professionals.

The information these women received about caesarean sections was mostly about procedural issues rather than the health risks and benefits of the different methods of delivery. Many women felt that it would be helpful to receive information after the first caesarean section.

In terms of decision-making roles, the majority of women felt that their doctors allowed them the choice of delivery, unless complications developed and intervention was required, and favoured this ‘hands-off' approach. Some women however, would have liked more guidance from their obstetricians.

Clare Emmett, lead researcher of the study said, “ The study explored the experiences of women with previous caesarean section making the decision about mode of delivery in a subsequent pregnancy. Most of the women interviewed felt able to make their own choice between vaginal birth after caesarean or repeat elective caesarean section and healthcare professionals were generally found to be supportive of that choice.

However, it seemed that the women were not always provided with comprehensive and balanced information about the risks and benefits of the delivery options to support their decision-making.”

Phil Steer, editor of BJOG said, “This study is unique as it places the obstetrician at the centre of expert information provision for women who are unsure about whether to have a repeat caesarean or VBAC. The ‘consumerist' approach towards decision making means that women are encouraged to make their own decisions instead of relying solely on their doctor's recommendations.

Obstetricians need to adopt more flexibility by tailoring the information they provide to women. The research shows that they need to talk about safety issues alongside information about procedures and statistics. If handled well, women should feel more confident to make informed choices.”

ENDS

For more information on this release, and to request a pdf of the paper, please contact Gerald Chan at gchan@rcog.org.uk . To speak to Professor Phil Steer, call 020 8846 7892, or email p.steer@imperial.ac.uk . To speak to Clare Emmett, call 0117 3313830 (Tue and Wed only) or email clare.emmett@bristol.ac.uk .

Notes

Emmett C, Shaw A, Montgomery A, Murphy D on behalf of the DiAMOND study group. Women's experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks. BJOG 2006; 113:1438-1445.
Date published: 22/11/2006 - 01:00Published by: Simon KempNo of comments: 0
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