Does Education Level Influence the Decision to Undergo Elective Repeat Caesarean Section Among Women With a Previous Caesarean Section?

Abstract

ObjectivePatient education level has been shown to affect health care outcomes in a variety of clinical contexts. The aim of this study was to evaluate whether maternal education level influences women to plan elective repeat Caesarean section rather than attempt a vaginal birth after Caesarean. MethodsWe conducted a retrospective cohort study of women with a previous Caesarean section who delivered at the Royal Victoria Hospital between 2001 and 2006. Education level was stratified as follows: ≤ 11 years (up to and including a high school diploma), 12 to 15 years (some college or university education), and ≥ 16 years (university degree). We used unconditional logistic regression to calculate age-adjusted estimates of the risk of having a planned Caesarean section. ResultsAmong 18 673 deliveries in our cohort, 1915 were in women with a previous Caesarean section. Of these, 12.6% had a high school degree or less, 38.3% had some college or university education, and 49.1% had a university degree. Compared with women whose maximum education was a high school diploma, there was a higher rate of planned Caesarean section in women with some college or university education (OR 1.38; 95% CI 1.00 to 1.89, P = 0.047) and in women with a university degree (OR 1.42; 95% CI 1.04 to 1.94, P = 0.03). ConclusionHigher education appears to be associated with an increased rate of elective repeat Caesarean section. Whether this is due to patient differences or physician bias, physicians should be aware of this disparity and should attempt to provide unbiased informed consent for all women regardless of their level of education.