Clinicians' Perspectives and Experiences Regarding Maternity Care in Women With Vulvodynia.
OBJECTIVE
To assess clinicians' frequency of and comfort with provision of maternity care for women with vulvodynia, their beliefs and practices regarding delivery mode, and frequency of maternal requests for Caesarean section (CS).


METHODS
We invited physicians and midwives to complete a questionnaire assessing their frequency of contact with pregnant women with vulvodynia; their level of comfort providing antenatal, intrapartum, and postpartum care for these women; whether they believed that vulvodynia is an indication for elective CS and the frequency of making this recommendation; and the number of patients with vulvodynia who strongly requested CS.


RESULTS
Of the 140 participating clinicians, 91 were physicians and 49 were midwives. Most physicians (n = 64; 70.4%) saw patients with vulvodynia at least once per month. Clinicians who saw women with vulvodynia were most likely to see pregnant women with vulvodynia rarely (n = 54; 40.3%) or every six to 12 months (n = 29; 21.6%). Almost one third (n = 44; 31.4%) were not comfortable providing maternity care for these women, and 16.4% (n = 23) agreed that vulvodynia was an indication for elective CS. Of respondents who provided maternity care for women with vulvodynia, 15.4% (n = 18) had recommended CS; the most common reason for doing so was potential worsening of vulvar symptoms. The majority of clinicians who provided maternity care for women with vulvodynia (n = 73; 62.4%) indicated that maternal requests for CS were rare.


CONCLUSIONS
Almost one third of participating clinicians (31.4%) were not comfortable providing maternity care for women with vulvodynia. Despite infrequent maternal requests, a minority of clinicians believed that vulvodynia is an indication for CS and/or made that recommendation. Additional research and education are needed to provide optimal obstetric care for women with vulvodynia.
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Kelly B
KB
Smith
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Leslie A
LA
Sadownik
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC; Department of Psychiatry, University of British Columbia, Vancouver BC.
Rosemary
R
Basson
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Jordanna
J
Isaacson
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver BC.
Lori A
LA
Brotto
Vulvodynia; delivery; midwifery; obstetrical; physicians; pregnancy