Reply: There is a need for a model of how to provide clinical guidance to women requesting cesarean section

Abstract

Sir, The overall aim of our paper, published in Acta No. 86 (1), was to study healthy first-time mothers with normal pregnancies requesting elective caesarean section in the absence of obstetrical or medical indication. The purpose of the article was not to advocate for or against caesarean section on a mother's request, but to describe socio-demographic background, age, health, plans concerning the size of the family, signs of postpartum depression and duration of breastfeeding, as well as expectations and experience of birth in the cohort. We totally agree that the aim should be to avoid medically unindicated caesarean section of primiparas. Our conclusions are that we should take better care of women before, during and after vaginal deliveries, in order to prevent a rising rate of caesarean section. Other researchers have found that there is a link between a history of elective or emergency caesarean section, a previous negative experience of birth, and a request for elective caesarean section (2–4). An emergency caesarean section in labour is the worst mode of delivery in terms of maternal morbidity and birth experience. To find women at risk for emergency caesarean section during late pregnancy is, therefore, of interest, as well as to appropriately discuss this matter with the patients. There is also a need for increased awareness among midwives and obstetricians of the importance of professional support during vaginal birth. This in order to reduce the increasing rate of women requesting a caesarean section in forthcoming pregnancies on the basis of previous negative birth experience. Many obstetricians and midwives have problems in adequately meeting women's requests for caesarean section, and there is indeed a need for a model of how to provide rational guidance in clinical decision-making. Psychological, social and medical factors must be taken into account when counselling women in this matter (Figure 1). Thus, in medical treatment and nursing, a cognitive approach as well as support from professionals, are important parts of the care/guidance provided. The more we know about women requesting caesarean section, the better we can counsel and guide them, and we strongly encourage a randomised study on the treatment of childbirth fear. A biopsychosocial model of how to provide rational guidance in clinical decision-making.