Frances Handley-Derry. (2013). Repeat elective caesarean: decision-making for women with a previous caesarean section. McGill Family Medicine Studies Online, 08: e02.

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Abstract

Context: Among women with a prior caesarean section, 82.2% will have another caesarean delivery. The Society of Obstetrics and Gynaecology of Canada (SOGC) recommends that physicians offer medically eligible women with a previous caesarean section a trial of labour, to attempt a vaginal delivery. With greater inclusion of the patient in medical decision-making, it is important to understand women’s part in this decision-making process.

Objectives: To describe women’s decision-making by looking at: 1) whether the decision was reported as primarily physician- or patient-driven 2) women’s reasons for repeat caesarean section, 3) women’s main information sources.

Methods: For one year women booked for a repeat elective caesarean section, who were eligible for a trial of labour according to the 2005 guidelines of the SOGC, were approached with the survey in hospital post-partum, and invited to participate in the study. Chart review was used to determine eligibility, and obtain other medical characteristics.

Results: Most of the women (77 %) reported being involved in the decision about their caesarean section. However, almost a quarter reported wholly physician-driven decisions (23 %). The main reasons women selected for a caesarean section related to their previous birth experience, and the physician’s recommendation. Women born outside of Canada, with less education or who were allophones, were less likely to report using certain information sources, such as the Internet, and to find the information in the hospital-provided pamphlet useful. All in all, the women who received less information were more likely to report solely physician-driven decisions.

Conclusion: Although patient involvement in decision-making is the norm, some decisions for caesarean section are made without the patient. Women’s concerns, such as fear of a failed vaginal delivery, play an important role in this decision-making. Overall, immigrant women may understand less about their birth options than their Canadian peers. Addressing these concerns during pre-natal counselling may aid more fully informed consent, help assuage women’s fears of vaginal birth and may increase the number of women at tempting a trial of labour.