Maternal Request For Caesarean Section Research Articles

Maternal request for caesarean section after a negative birth experience: A systematic review

Maternal request for caesarean section after a negative birth experience: A systematic review

Non-medical reasons affecting cesarean section rate in teaching hospitals in Anbar province, Iraq

Background: Globally, there is an increment in the cesarean section rate. Although the cesarean section is a lifesaving surgery in some cases, it is not safer than vaginal delivery and associated with higher maternal and perinatal complications. Many cesarean sections nowadays are performed for non-medical reasons, and decision-making is affected by social factors and the health standards of the community. Objectives: The objective of this study is to assess the non-medical reasons for cesarean sections. Method: This cross-sectional descriptive study was conducted in two teaching hospitals in Anbar province/Iraq. Women who underwent planned cesarean section at term were included. The inclusion criteria were cephalic fetal presentation, normally sited placenta, and no previous uterine scar. A questionnaire was set regarding the medical causes of planned cesarean section and any non-medical reasons that affect the decision-making. Seniors in obstetrics and gynecology in these hospitals responsible for these women were asked to fill in these questionnaires. Results: Out of 82 women included in the study, 11% were aged 35 years or more and 65.9% were nullipara. About 43.9% of the cesarean sections were performed for a purely medical cause and 34.1% had a medical cause for terminating the pregnancy. Still, decision-making was affected by non-medical reasons, and in 22% of the cases, cesarean sections were done without medical causes. A maternal request for cesarean section was the most common reason for those who underwent cesarean section without a medical cause. Conclusion: Proper maternal counseling about the potential risks of cesarean section and improving health care in the labor room can help in decreasing the cesarean section rate and its associated mortality and morbidity.

Changes in caesarean section rates in China during the period of transition from the one-child to two-child policy era: cross-sectional National Household Health Services Surveys

ObjectivesSince 2009, China has introduced policies, principally targeting health professionals, to reduce caesarean section (CS) overuse. In 2016, China endorsed a universal two-child policy. Advanced maternal age and previous CS...

ETHICAL DILEMMA OF CESAREAN SECTION ON MATERNAL REQUEST (CSMR)

Objective: To study the demographic characteristics of pregnant ladies and factors contributing towards rise in cesarean section on maternal request to aid the obstetricians in decision making.
 Study Design: Cross sectional analytical survey.
 Place and Duration: Gynecology Department of Pak Emirates Military Hospital, Rawalpindi, from Nov 2019 to Mar 2020.
 Methodology: One hundred and fifteen women of child bearing age requesting cesarean section were included in the study. Demographic details were noted. A study proforma was filled for determinants of primary and secondary tocophobia and factors that may be improved for vaginal delivery.Results: A total of 115 patients with mean age of 27.99 years were included. Amongst them, 88 (76.5%) were Punjabi with 92 (80%) living in rural area. Primigravida were 11 (9.6%), 83 (72.2%) had previous lower segment cesarean section and 3 (2.6%) had vaginal delivery. For primary tocophobia, 22 ( 24.4%) experienced anxiety. Fear of labor pains was seen in 20 (19.2%) and lack of control in 27 (26%). For secondary tocophobia, 15 (37.5%) were fearful of prolonged labor and 5 (22.5%) of sub optimal birth outcome. In women with previous one cesarean section, 13 (14.8%) correlated negatively with birth experience and 20 (22.7%) found timed cesarean section convenient. For vaginal delivery, pain relief was preferred by 19 (20.2%) and 31 (33%)wanted pain relief and attendant.
 Conclusion: Better understanding of fears behind maternal request for cesarean section can lead to improved attitudes towards vaginal delivery. The negative perceptions of pregnant ladies should be addressed in antenatal.........

The effect of the systematic birth preparation program on fear of vaginal delivery and quality of life.

The aim of this study was to assess the impact of systematic birth preparation program on fear of vaginal delivery and quality of life (QoL) in pregnant women who request elective cesarean delivery without any obstetric indication. This study was conducted prospectively. A total of 100 women who requested elective cesarean delivery due to psychosocial reasons were included into the study. Women were divided into two groups according to their desire to participate in the systematic birth preparation program. Group A: case group (n = 50) consisted of women who participated in the systematic birth preparation program. Group B: control group (n = 50) received usual antenatal care. All patients were interviewed with questionnaires including the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF) and Edinburgh Postnatal Depression Scale (EPDS) at postpartum 6th week. Type of delivery, maternal request for cesarean section, scores for QoL, and postpartum depression were compared between the two groups. Vaginal delivery rate was significantly higher in among the patients who received the systematic birth preparation program (group A: 78%, group B: 56%). Maternal request for elective cesarean section significantly decreased after the systematic birth preparation program (group A: 8%, group B: 28%). In group A, the WHOQOL-BREF-TR mean scores (SD) for physical domain, psychological domain, and environmental domain were significantly higher than the values exhibited in group B. In scores of the postpartum depression scale, there were no significant differences between the two groups (p = 0.075). The current study indicates that systematic birth preparation program may decrease the rate of elective cesarean delivery by reducing fear of vaginal delivery and improve the quality of life at postpartum period.

Effects of spouses’ involvement in pregnancy on fear of childbirth in nulliparous women

Background: Maternal request for caesarean section due to fear of normal vaginal delivery is one of the main reasons for the high rate of caesarean section. Objective: The aim of this study was to examine the effect of the presence of spouse in preparation class of delivery on fear of parturition in the nulliparous women. Methods: This controlled randomized trial was conducted in 152 pregnant women nulliparous referred to delivery preparation class in Qazvin. We received informed consent from participants. The samples were randomly assigned to intervention (n=76) and control groups (n=76). Eight sessions of the childbirth preparation classes were held for the intervention and control groups with or without the spouse respectively. Data collection tools were demographic characteristics and childbirth attitude questionnaire. Statistical testes such as T-test, and repeated measure were used for analysis. Findings: The mean age of the mothers participating in the study was 25.85±4.42 years. The decrease in mean of fear scores in the intervention group was significantly higher than the control group (28.58±6.47 and 32.82±5.79, respectively) (P<0.001). A significant difference was also observed between two groups in the rate of selection of normal vaginal delivery (P<0.001). Conclusion: The results of the study showed that the presence of a spouse in preparation class of delivery reduces the amount of childbirth fear and is suggested as one of the methods of implementing pregnant women's education program. Keywords: Nulliparous women, Childbirth, Pregnancy, Men's participation

Factors associated with women’s intention to request caesarean delivery in Dar es Salaam, Tanzania

Background. In the past decade, the rate of caesarean section (CS) has increased dramatically in many parts of the world. At Muhimbili National Hospital (MNH) there has been a dramatic rise in the caesarean section rate over the past decade. Objective . To determine the incidence of maternal request for CS and factors associated with intention to request caesarean section at the MNH antenatal clinic. Methods . We conducted a cross-sectional study from August to October 2014. A structured questionnaire gathered participants’ background and obstetric information, perceptions and opinions regarding a request for caesarean section, and the respective reasons for the request. Confidence intervals were calculated and a p- value <0.05 was considered significant. Results . The incidence of CS on maternal request was about 6%. The intention to request for CS in the index pregnancy was 8%. Higher-level education and formal-sector employment had higher odds for requesting CS ( p =0.01 and p =0.05, respectively). Half of the participants agreed that maternal request for CS should be allowed; more private patients agreed that it could affect the doctor-patient relationship ( p =0.02); more private patients agreed that request for CS was due to fear of losing a child ( p =0.03). Previous history of CS was an independent predictor of maternal request for caesarean section (OR 1.7; 95% CI 1.7 - 15.4) and (OR 5.8; 95% CI 1.6 - 20.1), respectively. Conclusion . Maternal requests for CS exist at the national referral hospital in Tanzania. This was associated with factors other than women’s preferences, including perceived fear of child loss and events associated with previous CS.

Need for Innovations.

Among the greatest challenges in obstetrics today are the high cesarean section rates. For a number of years, the AKF Working Group on Women’s Health in Medicine, Psychotherapy, and Society has raised awareness on this issue (www.kaiserschnittkampagne.de). Its commitment to promoting women’s health on a political level across disciplines has significantly contributed to getting an S3 guideline on indications for cesarean section underway. Apart from high-quality guidelines capable of improving the quality of the practical work in the delivery rooms, it is essential to address the structural, organizational and economic conditions which have contributed to the decline in normal births. The following innovations would contribute to the development of modern, safe, women- and family-centered obstetrics: Early and routine integration of midwives in prenatal care could lessen the focus on risk and technology which dominates today’s obstetric care; Nationwide implementation of one-on-one care in delivery rooms is a prerequisite for a relationship-centered and progressive culture of giving birth; Making the topic of physiology of birth an integral part of the medical training curriculum would promote a deeper understanding of the normal process of giving birth; Establishing regular, joint reflection rounds of the delivery room staff as well as planned basic and advanced training events addressing special obstetric situations would enhance the ability of doctors and midwifes to handle special and emergency situations; and the removal of the wrong financial incentives existing under the DRG system, which discourage natural birth, would alleviate economic pressure. Maternal request for cesarean section in the absence of medical indications, mainly driven by fear of giving birth (1), represents a particular challenge. It is known that many pregnant women change their mind after in-depth advice and retrospectively rate their decision to have a normal birth as good (2). This highlights the high importance of comprehensive advice and a trustful relationship. Obstetric care in Germany could be advanced a step further by developing, applying and evaluating structured and quality-assured consulting concepts.

Maternal request for caesarean section: Audit of a care pathway

This report is based on an audit of the delivery outcome of a specific care pathway for women who had made a maternal request for caesarean section (MRCS). The study took place in a UK inner city National Health Service maternity unit with 6,000 births per year. All 31 multiparous and 16 nulliparous women on the pathway were included. All of the former group had delivered vaginally, all reported having experienced their previous birth as traumatic, and all subsequently delivered vaginally. Of the 16 nulliparous women, six delivered by planned caesarean section; four delivered vaginally; four had an instrumental delivery and two had an emergency caesarean section. A designated multidisciplinary care pathway that incorporates education and support may have the potential to help more women to achieve a normal delivery. More research is needed to assess its potential for reducing unnecessary caesarean deliveries and for improving user experience.

“Too Posh to Push”: The Rise and Rise of a Catchphrase

The phrase "too posh to push" was coined over 14years ago to describe maternal request for cesarean section in the absence of clinical indications. The phrase was readily taken up and used by the United Kingdom media despite limited evidence that many women request cesarean sections or have an aversion to vaginal birth. The objectives of this study were to explore the way in which the phrase was used; the context and themes associated with it. To better understand the part the news media might play in public and health care professionals' perceptions, all articles using the phrase in eight UK national weekday newspapers from 1999 to 2011 (n=335) were subjected to content analysis. Key themes have changed over the years but some themes, such as celebrity cesareans, the risks of cesarean section, and the rising cesarean rate, have remained. Four different definitions of the term "too posh to push" were identified. Levels of usage of these terms changed over time. Misinterpretation of the National Sentinel Cesarean Section Audit results and a tendency to confuse elective cesarean section with maternal request for a cesarean have suggested that more "too posh to push" cesareans occurred than is probably the case. The phrase seems to have become well established. It is likely that press handling of the topic has continued to contribute to the impression that cesarean purely for maternal request is common. The association with celebrity continues to fuel press interest in the topic.

Maternal request for caesarean section: an ethical consideration

Caesarean section (CS) is a method of delivering a baby through a surgical incision into the abdominal wall. Until recently in the UK, it was preserved as a procedure which...

PL.78 Maternal Request for a Caesarean Section in the Absence of Medical Indications

IntroductionCS rates are rising worldwide. In the UK, 25% of women have a CS and 6–8% of women express a preference.1 2NICE recently updated guidelines stating that women can request...

Vaginal birth after caesarean section: a practical evidence-based approach

In the UK, around 10–15% of the obstetric population have experienced prior caesarean delivery. This article provides a practical evidence-based approach to the antenatal and intrapartum management of such women. This review is primarily sourced from data presented in guidelines produced by UK (RCOG, NICE) and USA (ACOG, NIH) professional bodies. Antenatal counselling should incorporate an individualized assessment of the risks and benefits of ERCS (elective repeat caesarean section) and planned VBAC (vaginal birth after caesarean) modes of delivery. Planned VBAC is associated with slightly (0.25%) increased perinatal risk than planned ERCS, although absolute risks are low for both modes of delivery. This information, coupled with high rates of VBAC success (70%) and very low-risk of uterine scar rupture (0.5%), indicates planned VBAC is an appropriate option for the vast majority of multiparous women with previous caesarean delivery and is cost effective for the healthcare provider. Of significance, recent guidance from NICE (UK) adds a further dimension to decision making as it has stated that maternal request for caesarean section is permissible in certain circumstances.

Intervention for Fear of Childbirth: HypnoBirthing

Fear of childbirth was a common problem among pregnant women. Fear of childbirth cause both many important problems at childbirth and maternal request for cesarean section and gradually increase in cesarean section rate. It was known that childbirth education classses were effective way in order to decrease fear. HypnoBirthing, which was one of the methods used at childbirth education classes, was effective approach for decreasing childbirth fear. As in the world, in Turkey, widespreading education classses used HypnoBirthing method with other methods, can increase achievement of that classses’ lessen fear of childbirth.

Does planned caesarean section following a previous traumatic birth improve women's satisfaction?

BackgroundA proportion of women requesting Caesarean section (CS) do so due to a previous traumatic birth experience with the expectation that a CS will improve their next birth experience. Obstetricians...

P247 Maternal request for caesarean section due to previous traumatic birth experience – Quantifying an increasing obstetric care problem

P247 Maternal request for caesarean section due to previous traumatic birth experience – Quantifying an increasing obstetric care problem

A survey of women's experiences following instrumental vaginal delivery

SummaryThere is little published data on women's experiences of having had an instrumental vaginal delivery (IVD). We conducted a postal survey of women who had IVD at our centre between November 2007 and January 2008, using a semi-structured questionnaire to ascertain perceptions. The response rate was 63% (58/92). Eleven (19%) felt that the risks and benefits of an IVD were explained to them. Although 46/58 (79%) needed an episiotomy, only 17(37%) recalled an explanation. Increased fear of childbirth following IVD was reported by 16/58 (27.5%); 14 of the 58 women (24%) preferred a caesarean section if they were to need operative delivery, rather than having an IVD in a further pregnancy. Clear information about the risks and benefits of IVD and debriefing following the procedure are desirable to women having IVD. These measures may reduce fear of childbirth and also reduce maternal request for caesarean section in future pregnancies.

The obstetrician's perspective on cesarean section on maternal request

AbstractPercentages of cesarean section world‐wide have increased substantially over the past two decades. Maternal request for abdominal delivery may have contributed to this development. The wish to be delivered by C‐section for personal reasons without medical indication should be discussed from the medical point of view as well as from the legal perspectives of mother and child. Today, mortality in primarily indicated and performed cesarean section is not substantially higher than in vaginal delivery. The consequences of cesarean section are important for succeeding pregnancies. Besides the risk of scar rupture, the drastic increase in the incidences of placental detachment (placenta accreta/increta/percreta) and placenta previa in succeeding pregnancies are of relevance. However, this risk should be weighed against fetal risk in vaginal delivery, especially intrauterine death and encephalopathy caused by intrapartum hypoxia as well as cerebral palsy amounting to 1/500. Pelvic floor damage after vaginal delivery can probably be reduced but not necessarily avoided by primary cesarean section. In summary, advantages and disadvantages of vaginal and abdominal delivery have to be weighed up carefully. Cesarean section performed by an experienced team with optimal equipment is accompanied by rather low risk. The obstetrician has to consider possible unlawfulness in cases of maternal request for cesarean section.

ANZJOG as an international journal

One of the interesting aspects of the editor's role is to receive and read manuscripts from all over the world. It is remarkable how diverse are the sources from which articles are submitted. While the journal is still predominantly exhibiting an Australian and New Zealand flavour with about half the published articles originating from these two countries, no less than 20 different countries from all of the continents of the world have made up the balance since I started as Editor. It is also interesting to see that the same clinical problems are being faced and studied across the globe. In this issue I have included an article on rising caesarean section rates in northern Greece, which shows a similar pattern and concerns as have been expressed by many in this country. I was recently asked to comment on the new American College of Obstetricians and Gynecologists statement on maternal request for caesarean section. This is an excellent document that clearly summarises the current evidence about the benefits and harm of caesarean section. It is well-balanced and makes some important conclusions. While neither endorsing nor arguing against maternal choice as a valid reason, the point is made that this should not be done in women who are planning to have ‘several’ children because of the increasing risks of bleeding and hysterectomy after multiple caesarean sections. Over the next few months there will be a number of articles dealing with various aspects of this issue, including maternal satisfaction with their choices. I trust these articles will stimulate debate and look forward to many Letters to the Editor. I have chosen as the lead article the opinion piece (written by three midwives) about the importance of maternal death review. Maternal mortality reports in Australia have gone through a number of evolutions over the 40 years or so since they started. At present, the national report is entirely reliant on the information provided to the National Perinatal Statistics Unit by individual jurisdictions. While the process is robust in some states, there is concern about the veracity and completeness of the information provided in some cases and whether there is complete ascertainment. Without this, it is impossible to know how well or badly we perform in relation to international comparisons. It seems hard to believe that there are no national regulations or even guidelines that stipulate such things as the need for coronial referral and/or autopsy in the case of direct maternal deaths. Even in many indirect cases, the exact cause of death may be unclear and therefore an understanding of avoidable factors may be incomplete. The four case reports chosen for this issue are all about important clinical lessons. While the messages in two are quite simple they may lead to avoidance of significant morbidity. There is also an interesting exchange of letters about the question of mesh erosion after infracocygeal sacrocolpopexy. I would encourage any further comments on this important question. Finally, we are publishing a short series of cases of laparoscopic cervico-isthmic cerclage. Personally, I do not doubt that this type of procedure is superior to the traditional cerclage performed vaginally at the end of the first trimester for those who have true cervical incompetence. The important questions are when and how to do it. Is it time for the exponents of the two operations to combine to do a randomised trial?

Obstetrician gender and the likelihood of performing a maternal request for a cesarean delivery

Objective To examine the relationship between obstetrician gender and the likelihood of maternal request for cesarean section (CS) within different healthcare institutions (medical centers, regional hospitals, district hospitals, and obstetric and gynecology clinics). Study design Five years of population-based data from Taiwan covering 857,920 singleton deliveries without a clinical indication for a CS were subjected to a multiple logistic regression to examine the association between obstetrician gender and the likelihood of maternal request for a CS. Results After adjusting for physician and institutional characteristics, it was found that male obstetricians were more likely to perform a requested CS than female obstetricians in district hospitals (OR = 1.53) and clinics (OR = 2.26), while obstetrician gender had no discernible associations with the likelihood of a CS upon maternal request in medical centers and regional hospitals. Conclusions While obstetrician gender had the greatest association with delivery mode decisions in the lowest obstetric care units, those associations were diluted in higher-level healthcare institutions.