CR38P VAGINAL DELIVERY COMPARED WITH ELECTIVE CAESAREAN SECTION: THE VIEWS OF PREGNANT WOMEN AND CLINICIANS

Abstract

Purpose: Concern about maternal morbidity associated with vaginal delivery (VD) may be driving the increasing trend for elective caesarean section (CS). This study aimed to quantify the risk of morbidity from VD that pregnant women would be prepared to accept before requesting an elective CS, and to compare these views with those of clinicians.Methodology: Participants completed a questionnaire to ascertain the maximum level of risk they would be prepared to accept before opting for an elective CS. Utility scores for each complication were calculated, with higher scores (closer to 1) indicating a preference towards VD.Results: 122 pregnant women, 84 midwives, 166 obstetricians, 12 urogynaecologists and 79 colorectal surgeons participated. For the evaluated 18 potential complications of VD pregnant women were willing to accept higher risks than clinicians. Pregnant women were least accepting of risks of severe anal incontinence (mean utility score 0.32), emergency CS (0.51), moderate anal incontinence (0.56), severe urinary incontinence (0.56), fourth degree tears (0.59), and third degree tears (0.72) The views of midwives were closest to those of pregnant women. Urogynaecologists and colorectal surgeons were the most risk averse, with 42% and 41% respectively stating they would request an elective CS for themselves or their partners.Conclusions: Pregnant women were able to quantify the level of risk they are prepared to accept from a VD before opting for an elective CS being aware of the potential complications of elective CS, and these risks were significantly higher than those accepted by the clinicians involved in their care. Their views are more closely aligned to midwives than to specialist clinicians.