Are pregnant women's obstetric care preferences contemplated in a provider-dominated maternity care system?

Abstract

Pregnant women are demonstrating increasing interest and personal involvement in the decision-making process associated with their health care. Birth route preferences occupy a predominant place in this regard. MacFarlane et al. conducted a large retrospective analysis of routinely collected data in 31 European countries and reported on delivery route in nulliparous and multiparous women (BJOG 2016;123:559–568). A very large variation was shown both in caesarean deliveries (14.8–52.2%) and operative vaginal deliveries (0.5–16.4%) across the continent. Our commentary should offer an observation and avoid reinterpretation of the authors’ conclusions. A recent survey of pregnant women conducted in Eastern Europe demonstrated that 88.4% of respondents prefer a vaginal delivery (Dweik et al. Acta Obstet Gynecol Scand 2014;93:408–15). A previous obstetric experience including a caesarean delivery, along with certain maternal beliefs and cultural issues associated with medical care drives the pregnant women's preference. An aspect that needs further study within the data from the Euro-Peristat group is the relationship between the obstetric provider cognitive traits and the type of delivery. Providers with better adaptive decision-making traits during the labour process may offer a lower risk of obstetric intervention. We suggest that obstetric training, however standardised and driven by evidence-based care, may not result in standardised practices. The authors labelled their database as ‘European’; however, the lack of inverse association between the intervention rates appears to indicate that there is no international or multi-institutional consensus in spite of published policies and guidelines. The use of agreed upon clinical definitions within the Euro-Peristat system does not appear to translate in best practice agreements. The burning question will be whether equal variables and data points are used by each country within the Eurosystem. The reported differences in intervention rates between public versus private clinical units is a frequently reported event in other regions of the world where there are significant differences in the levels of provider compensation for ‘surgical’ interventions. At what level of maternity care medicalisation during labour and delivery will the obstetric community establish the line for best practice? Globalisation is the frequent term used to indicate a universal agreement for certain life events. Economic globalisation has not affected all world areas equally. Complex variables beyond clinical parameters are involved in the practice of obstetrics. The educated women's views, in association with their maternity care based on strong qualitative research and supported by well-trained obstetric providers, will have a significant impact on their care. The author has no financial disclosures to declare.