Information for women after CS: are they getting enough?
Of the factors known to influence rising caesarean section (CS) rates in Scotland, it is without doubt the practice of repeat elective CS that is the major determinant. Accounting for a national rate of 30%, the high incidence of CS performed in women after one previous caesarean birth does not reflect the evidence underpinning a trial of labour as preferred practice (Expert Advisory Group on Caesarean Section in Scotland, 2001). Indeed, several factors are considered to influence the practice of trial of vaginal delivery after CS. These include the durability of the uterine incision performed at the primary CS, prolonged pregnancy and individual obstetrician and women's preferences (Enkin et al, 1995). However, in relation to the latter, few studies have addressed the views of women and their choice of mode of delivery in a subsequent pregnancy following previous caesarean birth. The evidence available suggests there is still a considerable number of women who have experienced a lack of involvement and information in relation to their childbirth experience (Churchill et al, 2000; Fleissig, 1993). A small exploratory, descriptive study was designed to examine women's role in choosing a repeat elective CS or trial of vaginal delivery following previous caesarean birth. Due to time constraints, a survey approach was adopted, as surveys tend to be less time-consuming than other methods (Parahoo, 1997). For ethical reasons, eligibility was considered only after the medical decision for proposed mode of delivery had been made. Therefore, recruitment did not take place before 36-weeks' gestation. Using a self-administered questionnaire, data was collected from 38 respondents over an eight-week period. Results demonstrated that 23 women (60%) reported involvement in the decision-making process. Of those women, 16 were having a trial of vaginal delivery and seven were having a repeat elective CS. Few women (n=9, 39%) addressed medical factors for their decision, compared to the majority of women (n=16, 69%) who addressed non-clinical and personal issues.
Lucas
Angela
A
Bell College, NHS Lanarkshire.
D000328:Adult; D002585:Cesarean Section / Q000451:nursing* / Q000523:psychology / Q000706:statistics & numerical data*; D017604:Cesarean Section, Repeat / Q000706:statistics & numerical data; D002755:Choice Behavior; D005260:Female; D006801:Humans; D008425:Maternal Behavior; D009035:Mothers / Q000193:education* / Q000523:psychology; D007744:Obstetric Labor Complications / Q000453:epidemiology / Q000451:nursing; D010358:Patient Participation / Q000706:statistics & numerical data; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D012606:Scotland; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016064:Vaginal Birth after Cesarean / Q000451:nursing* / Q000523:psychology / Q000706:statistics & numerical data*