BJOG release: Vaginal delivery vs elective caesarean section - what do women and doctors think? The study, from the Royal Prince Alfred Hospital Sydn

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The study, from the Royal Prince Alfred Hospital Sydney, University of Sydney and Surgical Outcomes Research Centre (SOuRCE), Sydney South West Area Health Service is the first published paper to evaluate scores for the potential risks of vaginal delivery, to compare women’s and clinicians’ views and to quantify the particular factors which would prompt women to request a primary elective caesarean section.

In total 102 pregnant women, 84 midwives, 166 obstetricians, 12 urogynaecologists and 79 colorectal surgeons were included in the research. Participants were asked to rank 17 complications of vaginal delivery, including severe anal incontinence, severe urinary incontinence, vaginal prolapse and emergency caesarean section, in order to ascertain the maximum level of risk they would be prepared to accept before opting for an elective caesarean.

The results showed significant variation between the groups with only 2% of pregnant women preferring elective caesarean compared to 11% of midwives, 21% of obstetricians, 44% of colorectal surgeons and 50% of urogynaecologists.

All the groups ranked pelvic floor problems the highest as a motive for requesting elective caesarean over vaginal delivery. Emergency caesarean was ranked at four by pregnant women but between nine and 11 by clinicians. Pregnant women were also much more willing to experience pain in labour and perineal discomfort.

There was also a statistically significant link between the type of delivery planned and the type of antenatal care women were receiving. Pregnant women who were seeing a private obstetrician were more willing to experience a prolonged labour than those who were attending public antenatal clinics.

Miss Catherine Turner, co-author and currently Resident Surgical Officer at St Mark’s Hospital, London, said: "Our study found that pregnant women were more likely to aim for a vaginal delivery, and they accept a higher threshold of risks from vaginal delivery when compared to clinicians. Midwives views were more closely aligned to those of pregnant women, while urogynaecologists and colorectal surgeons were prepared to take very low risks before they would opt for an elective caesarean section. Pelvic floor problems ranked highest in all groups as the reason to request elective caesarean section over vaginal delivery.

"This paper reveals what women consider to be the important issues when deciding on a vaginal delivery or an elective caesarean section for their first born child and more importantly, the divergence these issues have compared with their treating health professionals".

Professor Philip Steer, BJOG Editor-in-Chief said: “This study shows that women who are pregnant with their first baby are prepared to take greater risks than clinicians when deciding between a vaginal delivery or an elective caesarean section. This indicates that experiencing labour and attempting a normal birth are two very important priorities in women's decision making. It may also indicate that doctors are biased by their inevitable involvement in complex cases, or labours where things have gone wrong.

“It is important to ensure that women are provided with good quality information by their midwife and/or doctor so that they can make an informed decision with relevant medical advice about the type of birth that is best for them and their baby. It is also important to remember that childbirth can be unpredictable and therefore any birth plan should be flexible enough to allow for unexpected complications.”

Ends

Notes
BJOG: An International Journal of Obstetrics and Gynaecology is owned by the Royal College of Obstetricians and Gynaecologists (RCOG) but is editorially independent and published monthly by Wiley-Blackwell. The journal features original, peer-reviewed, high-quality medical research in all areas of obstetrics and gynaecology worldwide. Please quote ‘BJOG' or ‘BJOG: An International Journal of Obstetrics and Gynaecology' when referring to the journal.

To speak to Miss Catherine Turner, please call 020 7772 6357 or email scturner@idx.com.au
To speak to Professor Philip Steer, please call 020 7772 6357 or email p.steer@imperial.ac.uk

Reference
Turner C, Young J, Solomon M, Ludlow J, Benness C, Phipps H. Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians. BJOG 2008; DOI: 10.1111/j.1471-0528.2008.01892.x.

Date published: 26/08/2008 - 01:00Published by: Simon KempNo of comments: 0
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