A study published in the current issue of the journal Birth examined the number of nursing hand-offs (switches in the nurse responsible for a patient’s care) for women giving birth to determine whether this was associated with a greater risk of having a c-section.
The “Green Journal” has a lot of interesting articles for January 2007. Among them:
Bettes BA, Coleman VH, Zinberg S, Spong CY, Portnoy B, DeVoto E, Schulkin J. Cesarean delivery on maternal request: obstetrician-gynecologists’ knowledge, perception, and practice patterns. Obstet Gynecol. 2007 Jan; 109(1):57-66.
ACOG Fellows (practicing OB/GYNs who are part of a national obstetrics and gynecology organization) were interviewed by mailed questionnaire about elective c-sections. Their findings:
-92.2% reported that their department or practice has no policy on maternal request cesareans. Of those with a policy, 72.2% stated the policy is to support maternal requests.
-53% reported having done c-sections in response to maternal request, “with the majority of those performing them once or twice per month or more rarely”
-58.4% reported an increase in maternal requests for c-sections in the past year.
-When asked about what they would choose if they or their spouse were pregnant (for a term, uncomplicated, head first, single delivery), “Fewer than 20% (n=102, 17.8%) of respondents reported that they would choose or recommend a cesarean delivery on maternal request in this situation, due to concerns for the mother’s (64.8%) or the neonate’s (19.4%) well-being; 15.7% would choose cesarean delivery on maternal request for convenience.”
-54.6% believe a woman has the right to c-section on request without any medical indication, and 57.4% would perform one. Those who believed it was a right/appropriate were more likely to say they would perform one.
-The clinicians were asked to agree or disagree with 14 risks and 14 benefits. 0.8% endorsed none of the risks, while 11.8% endorsed none of the benefits.
-”The most frequently endorsed benefit was the reduced risk of perineal damage (76.2%), followed by risk of dystocia or birth trauma (63.4%), pelvic organ prolapse (56.8%), long-term incontinence (54.8%), lacerations (53.9%), and complications from labor (49.6%). ”
-”The most frequently endorsed risk was intraoperative risks to the mother such as bleeding and damage to internal organs (93.7%). ”
-Female respondants were more negative about the procedure on maternal request than were male respondants.
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