All Hail Cesarean Sections?

Pregnant women lack knowledge about birth delivery methods following a previous C section

(RxWiki News) Women who have had one child by cesarean section have to decide for their next pregnancy how they'll give birth: another C section or attempt a vaginal delivery?

Most of the time, it's their doctor who has the biggest sway over which method they choose.

"Learn the risks and benefits of vaginal versus cesarean birth."

A new study reveals that women who have already had one C section don't know much about the risks and benefits of the two options and therefore may not be making an informed decision about their method of giving birth.

Lead author Dr. Sarah Bernstein, of St. Luke's-Roosevelt Hospital Center in New York, said less than 10 percent of women attempt a VBAC (vaginal birth after cesarean) even though they have a success rate of 60 to 80 percent.

Bernstein and her colleagues assessed 155 women who came to St. Luke's-Roosevelt hospital to give birth between November 2010 and July 2011 and had at least one prior birth by C section.

The women in the study did not have any risk factors that would make attempting labor and a vaginal delivery unsafe.

No significant differences existed between the women who chose another C section and those who chose a VBAC in terms of age, education level, ethnicity and health insurance status.

The researchers found that 87 women chose to attempt labor and a vaginal delivery, compared to 68 who chose an elective cesarean again.

The women in both groups - and especially in the repeat C section group - showed little knowledge about the risks and benefits of both delivery methods.

Only 4 percent of the C section patients and 13 percent of the laboring patients knew how likely a VBAC was to be successful.

About a third of the women understood the risks of uterine rupture during labor and the increased risk for multiple cesareans, and 52 percent did not know which delivery method had a faster recovery.

"When patients perceived that their doctor preferred a repeat cesarean, very few chose to undergo trial of labor, whereas the majority chose trial of labor if that was their doctor's preference," Bernstein said.

Only 4 percent of those women whose doctor appeared to prefer a cesarean actually went with a VBAC, compared to 43 percent who opted for labor when they believe that was their doctor's preference.

According to Dr. Jennifer Mushtaler, M.D., an obstetrician in Austin, Texas, among the barriers to wide adoption of VBACs are liability concerns, immediate availability and low compensation.

"I suspect that until fears of lawsuits are assuaged and physicians are compensated commensurate with the hours of care required to offer a VBAC, there will continue to be a lower percentage of acceptance in communities at large," she said.

The study was presented February 9 at the Society for Maternal-Fetal Medicine's annual meeting, The Pregnancy Meeting, in Dallas, TX. No information was available regarding the study's funding or financial disclosures of the authors.

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Review Date: 
February 8, 2012