Patient Preference the Leading Indication for Elective Caesarean Section in Public Patients—Results of a 2-Year Prospective Audit in a Teaching Hospital

Abstract

Because the rate of cesarean delivery has grown markedly in recent decades and recent research indicates that patient requests may be one of the strongest indications, a prospective study was undertaken to audit indications for operative delivery. A total of 9138 deliveries at an Australian teaching hospital in a 2-year period were reviewed. The cesarean delivery rate was 17.8 percent, and of the 1624 caesarean deliveries, 39 percent were elective. More than one fourth of elective cesarean deliveries (27 percent) were done solely because of the mother’s request, and this was the leading indication for elective surgery. In 103 of 170 cases, the woman had previously had a cesarean delivery, but the current pregnancy was otherwise suitable for a trial of labor. All 56 women with breech presentation also were otherwise suitable for attempted vaginal birth. Only five women presented no particular reason for requesting elective delivery. The most common medical indication for elective cesarean delivery was more than one previous cesarean delivery. Other medical indications included a previous complicated cesarean delivery, a term breech presentation in which a trial of labor was considered inadvisable, placenta previa, severe intrauterine growth retardation with abnormal placental function, transverse and unstable fetal lie, suspected cephalopelvic disproportion, and preeclampsia. Preterm breech presentation, active herpes simplex, multiple gestation, and abruptio placenta were other indications. Nonelective cesarean deliveries were most often done because of suspected fetal distress or failure to progress in labor. The investigators believe that current maternal decision-making may well be influenced by the modern emphasis on patient advocacy and consumer choice. Attempts to lower the cesarean delivery rate should focus on promoting a trial of vaginal delivery in cases of a history of past cesarean delivery and also in cases of breech presentation. It also would help to develop better means of detecting fetal acidosis during labor. Aust NZ J Obstet Gynaecol 1999;39:207–214