Issue 17: 8 Sep 2008
Source:
BJOG: An International Journal of Obstetrics and Gynaecology 2008;in press
Pregnant women are willing to accept significantly higher risks of potential complications of vaginal delivery before requesting an elective cesarean, compared with health professionals, according to the findings of a new study.
Specialists from centers in Sydney, Australia, set out to determine the risk of morbidity from vaginal delivery that pregnant women and different types of health professional were prepared to accept before opting for an elective cesarean.
The study by Turner et al, due to be published in the
BJOG: An International Journal of Obstetrics and Gynaecology, took the form of a cross-sectional survey conducted either face-to-face or through mailed questionnaires. Responses were obtained from a total of 122 nulliparas and 84 midwives from a large teaching hospital in Sydney, plus a national sample of 166 obstetricians, 12 urogynecologists, and 79 colorectal surgeons.
The pregnant women included in the study were nulliparous with a singleton uncomplicated pregnancy of less than 26 week?s gestation. The mean gestational age in this group at the time of the survey was 22 weeks; 93 percent of the women were planning to have a vaginal delivery, 2 percent were considering an elective cesarean, and 5 percent were undecided.
The respondents were asked to indicate, for each of 17 potential complications of vaginal delivery, the maximum level of risk (from 0 percent to 100 percent) that they would be willing to accept before opting for an elective cesarean. These percentages were converted to scores ranging from 0 to 1, with 0 representing the lowest threshold for that particular complication and 1 representing the highest threshold.
The 17 potential complications were: mild/moderate/severe anal incontinence, mild/moderate/severe urinary incontinence, emergency cesarean section, vaginal prolapse, forceps delivery, vacuum extraction, sexual dissatisfaction, episiotomy, prolonged labor, superficial (first or second degree) tears, deeper (third or fourth degree) tears, pain during labor, and perineal discomfort.
The researchers found that, overall, the pregnant women in the study were willing to accept significantly higher risks than health professionals. Midwives were the group closest to pregnant women in terms of perceptions of risks, being prepared to take the greatest risks, while colorectal surgeons were the group who were prepared to take the least risks.
In all groups, severe anal incontinence scored lowest, indicating that the respondents were willing to take the least risk of this complication occurring before they would opt for an elective cesarean section.
Among the pregnant women, scores ranged from 0.37 (severe anal incontinence) to 0.94 (perineal discomfort). Among the midwives, scores ranged from 0.15 to 0.89 (superficial tears). Among the obstetricians, scores ranged from 0.03 to 0.83 (superficial tears). Among the urogynecologists, scores ranged from 0.05 to 0.79 (superficial tears). Finally, among the colorectal surgeons, scores ranged from 0.02 to 0.68 (perineal discomfort).
The researchers write in their paper: ?Midwives were always prepared to take the greatest risks and colorectal surgeons the least.? They said a study is currently underway to determine whether the views of the pregnant women change after delivery.
The journal?s editor-in-chief, Professor Philip Steer, commented: ?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 cesarean section. This indicates that experiencing labor 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 labors where things have gone wrong.?
Vaginal delivery or elective cesarean?
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