Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians

Authors

  • CE Turner,

    1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    2. Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia
    Search for more papers by this author
  • JM Young,

    1. Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service, Sydney, New South Wales, Australia
    2. School of Public Health, University of Sydney, Sydney, New South Wales, Australia
    Search for more papers by this author
  • MJ Solomon,

    Corresponding author
    1. Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    2. Discipline of Surgery, University of Sydney, Sydney, New South Wales, Australia
    3. Surgical Outcomes Research Centre (SOuRCe), Sydney South West Area Health Service, Sydney, New South Wales, Australia
      Prof MJ Solomon, Surgical Outcomes Research Centre, PO Box M157, Missenden Road, Sydney, NSW 2050, Australia. Email msolomon@med.usyd.edu.au
    Search for more papers by this author
  • J Ludlow,

    1. Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    Search for more papers by this author
  • C Benness,

    1. Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    Search for more papers by this author
  • H Phipps

    1. Department of Obstetrics and Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
    Search for more papers by this author

Prof MJ Solomon, Surgical Outcomes Research Centre, PO Box M157, Missenden Road, Sydney, NSW 2050, Australia. Email msolomon@med.usyd.edu.au

Abstract

Objective  To quantify the risk of morbidity from vaginal delivery (VD) that pregnant women would be prepared to accept before requesting an elective caesarean section and to compare these views with those of clinicians.

Design  Cross-sectional survey.

Setting  Major teaching hospital (nulliparas and midwives) and national samples of medical specialists.

Sample  Nulliparas (n = 122), midwives (n = 84), obstetricians (n = 166), urogynaecologists (n = 12) and colorectal surgeons (n = 79).

Methods  Face-to-face interviews (nulliparas) and mailed questionnaire (clinicians).

Main outcome measures  Maximum level of risk participants would be prepared to accept before opting for an elective caesarean section for each of 17 potential complications of VD. Utility scores for each complication were calculated with higher scores (closer to 1) indicating a greater acceptance of risk.

Results  Pregnant women were willing to accept higher risks than clinicians for all 17 potential complications. They were least accepting of the risks of severe anal incontinence (mean utility score 0.32), emergency caesarean section (0.51), moderate anal incontinence (0.56), severe urinary incontinence (0.56), fourth-degree tears (0.59) and third-degree tears (0.72). The views of midwives were closest to those of pregnant women. Urogynaecologists and colorectal surgeons were the most risk averse, with 42 and 41%, respectively, stating that they would request an elective caesarean for themselves or their partners.

Conclusions  Pregnant women were willing to accept significantly higher risks of potential complications of VD than clinicians involved in their care. Pregnant women’s views were more closely aligned to midwives than to medical specialists.

Ancillary