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Al-Rifai RH, Elbarazi I, Ali N, Loney T, Oulhaj A, Ahmed LA. Knowledge and Preference Towards Mode of Delivery among Pregnant Women in the United Arab Emirates: The Mutaba'ah Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E36. [PMID: 33374611 PMCID: PMC7793149 DOI: 10.3390/ijerph18010036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 12/11/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND The rate of cesarean section (CS) is growing in the United Arab Emirates (UAE). Pregnant women's knowledge on the mode of delivery, factors associated with lack of adequate knowledge, and preference towards CS delivery were investigated. METHODS Baseline cross-sectional data from 1617 pregnant women who participated in the Mutaba'ah Study between September 2018 and March 2020 were analyzed. A self-administered questionnaire inquiring about demographic and maternal characteristics, ten knowledge-based statements about mode of delivery, and one question about preference towards mode of delivery was used. Knowledge on the mode of delivery was categorized into "adequate (total score 6-10)" or "lack of adequate (total score 0-5)" knowledge. Crude and multivariable models were used to identify factors associated with "lack of adequate" knowledge on the mode of delivery and factors associated with CS preference. RESULTS A total of 1303 (80.6%) pregnant women (mean age 30.6 ± 5.8 years) completed the questionnaire. The majority (57.1%) were ≥30 years old, in their third trimester (54.5%), and had at least one child (76.6%). In total, 20.8% underwent CS delivery in the previous pregnancy, and 9.4% preferred CS delivery for the current pregnancy. A total of 78.4% of pregnant women lacked adequate knowledge on the mode of delivery. The level of those who lacked adequate knowledge was similar across women in different pregnancy trimesters. Young women (18-24 years) (adjusted odds ratios (aOR), 3.07, 95% confidence interval (CI), 1.07-8.86) and women who had CS delivery in the previous pregnancy (aOR, 1.90, 95% CI, 1.06-3.40) were more likely to be classified with a lack of adequate knowledge. Age (aOR, 1.08, 95% CI, 1.02-1.14), employment (aOR, 1.96, 95% CI, 1.13-3.40), or previous CS delivery (aOR, 31.10, 95% CI, 17.71-55.73) were associated with a preference towards CS delivery. CONCLUSION This study showed that pregnant women may not fully appreciate the health risks associated with different modes of delivery. Therefore, antenatal care appointments should include a balanced discussion on the potential benefits and harms associated with different delivery modes.
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Affiliation(s)
- Rami H. Al-Rifai
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Iffat Elbarazi
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Nasloon Ali
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
| | - Tom Loney
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai P.O. Box 505055, UAE;
| | - Abderrahim Oulhaj
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
| | - Luai A. Ahmed
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE; (I.E.); (N.A.); (A.O.); (L.A.A.)
- Zayed Centre for Health Sciences, United Arab Emirates University, Al Ain P.O. Box 17666, UAE
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Loke AY, Davies L, Mak YW. Is it the decision of women to choose a cesarean section as the mode of birth? A review of literature on the views of stakeholders. BMC Pregnancy Childbirth 2019; 19:286. [PMID: 31399072 PMCID: PMC6688235 DOI: 10.1186/s12884-019-2440-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 07/29/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND A debate on the decision of women to choose a cesarean section as the mode of birth in uncomplicated pregnancies from the views of relevant stakeholders. MAIN TEXT Using five electronic databases, a literature search was conducted for studies published from January 2003 to December 2016. Studies on a woman's right to request or to choose a cesarean section as the mode of birth in uncomplicated pregnancies were included. Fifty-five articles were identified (39 research studies and 16 opinion-based articles). Among health professionals, obstetricians were the most supportive of this right. It is argued that although women reported wanting to choose the mode of birth, with the safety of their babies as the priority, they also relied on the advice of their maternity care provider and considered it the responsibility of their obstetrician to make the decision. A higher proportion of the general public in countries with well-developed private healthcare accepted that a woman should have the freedom to choose the mode of birth. CONCLUSIONS This review provided a debate on the choice of pregnant women in uncomplicated pregnancies on the mode of birth from various stakeholders. Further research is required to explore what the meanings of autonomy of pregnant women to choose the mode of birth, and the process that they go through when making this decision.
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Affiliation(s)
- Alice Yuen Loke
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong.
| | - Louise Davies
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yim-Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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Farrell RM, Metcalfe JS, McGowan ML, Weise KL, Agatisa PK, Berg J. Emerging ethical issues in reproductive medicine: are bioethics educators ready? Hastings Cent Rep 2018; 44:21-9. [PMID: 25231658 DOI: 10.1002/hast.354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Advocates for the professionalization of clinical bioethics argue that bioethics professionals play an important role in contemporary medicine and patient care, especially when addressing complex ethical questions that arise in the delivery of reproductive medicine. For bioethics consultants to serve effectively, they need adequate training in the medical and ethical issues that patients and clinicians will face, and they need skills to facilitate effective dialog among all parties. Because clinical ethics consultation is a "high-stakes endeavor" that can acutely affect patient care, efforts are under way to ensure that bioethics consultants have the competence to provide such guidance. Yet to date, no studies have examined whether the training of bioethics consultants meets the needs of health care professionals who are on the front lines of such issues. In fact, limited information is available on the reproductive health issues that bioethics training programs address or the degree to which these programs meet the needs of patients confronting reproductive health decisions and their clinicians. It is therefore important to answer this key question: What are the primary ethical issues encountered in reproductive medicine that currently affect patient care? Equally important, are bioethics training programs prepared to address those issues? To begin to answer these questions, we conducted parallel surveys of directors of graduate bioethics training programs and obstetrician-gynecologists. The goal of this project is to lay the groundwork to establish a working partnership between bioethics educators and reproductive medicine practitioners to address the often troubling and frequently complex ethical issues in reproductive medicine.
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Rivo JC, Amyx M, Pingray V, Casale RA, Fiorillo AE, Krupitzki HB, Malamud JD, Mendilaharzu M, Medina ML, del Pino AB, Ribola L, Schvartzman JA, Tartalo GM, Trasmonte M, Varela S, Althabe F, Belizán JM. Obstetrical providers' preferred mode of delivery and attitude towards non-medically indicated caesarean sections: a cross-sectional study. BJOG 2018; 125:1294-1302. [PMID: 29325216 PMCID: PMC6041183 DOI: 10.1111/1471-0528.15122] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To describe obstetrical providers' delivery preferences and attitudes towards caesarean section without medical indication, including on maternal request, and to examine the association between provider characteristics and preferences/attitudes. DESIGN Cross-sectional study. SETTING Two public and two private hospitals in Argentina. POPULATION Obstetrician-gynaecologists and midwives who provide prenatal care and/or labour/delivery services. METHODS Providers in hospitals with at least 1000 births per year completed a self-administered, anonymous survey. MAIN OUTCOME MEASURES Provider delivery preference for low-risk women, perception of women's preferred delivery method, support for a woman's right to choose her delivery method and willingness to perform caesarean section on maternal request. RESULTS 168 providers participated (89.8% coverage rate). Providers (93.2%) preferred a vaginal delivery for their patients in the absence of a medical indication for caesarean section. Whereas 74.4% of providers supported their patient's right to choose a delivery method in the absence of a medical indication for caesarean section and 66.7% would perform a caesarean section upon maternal request, only 30.4% would consider a non-medically indicated caesarean section for their own personal delivery or that of their partner. In multivariate adjusted analysis, providers in the private sector [odds ratio (OR) 4.70, 95% CI 1.19-18.62] and obstetrician-gynaecologists (OR 4.37, 95% CI 1.58-12.09) were more willing than either providers working in the public/both settings or midwives to perform a caesarean section on maternal request. CONCLUSIONS Despite the ethical debate surrounding non-medically indicated caesarean sections, we observe very high levels of support, especially by providers in the private sector and obstetrician-gynaecologists, as aligned with the high caesarean section rates in Argentina. TWEETABLE ABSTRACT Non-medically indicated c-section? 74% of sampled Argentine OB providers support women's right to choose.
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Affiliation(s)
- JC Rivo
- Duke University School of Medicine, Duke University, Duke University Medical Center Greenspace, Durham, NC, USA
| | - M Amyx
- Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - V Pingray
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - RA Casale
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - AE Fiorillo
- Centro de Educación Médica e Investigaciones Clínicas, ‘Norberto Quirno’ (CEMIC), Autonomous City, Buenos Aires, Argentina
| | - HB Krupitzki
- Centro de Educación Médica e Investigaciones Clínicas, ‘Norberto Quirno’ (CEMIC), Autonomous City, Buenos Aires, Argentina
| | - JD Malamud
- Sanatorio de la Mujer, Rosario, Santa Fe Province, Argentina
| | - M Mendilaharzu
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán Province, Argentina
| | - ML Medina
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán Province, Argentina
| | - AB del Pino
- Sanatorio de la Mujer, Rosario, Santa Fe Province, Argentina
| | - L Ribola
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - JA Schvartzman
- Centro de Educación Médica e Investigaciones Clínicas, ‘Norberto Quirno’ (CEMIC), Autonomous City, Buenos Aires, Argentina
| | - GM Tartalo
- Instituto de Maternidad y Ginecología Nuestra Señora de las Mercedes, San Miguel de Tucumán, Tucumán Province, Argentina
| | - M Trasmonte
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - S Varela
- Hospital Nacional A. Posadas, El Palomar, Buenos Aires Province, Argentina
| | - F Althabe
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
| | - JM Belizán
- Mother and Child Health Research Department, Institute for Clinical Effectiveness and Health Policy (IECS-CONICET), Buenos Aires, Argentina
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Brione R. To What Extent Does or Should a Woman's Autonomy Overrule the Interests of Her Baby? A Study of Autonomy-related Issues in the Context of Caesarean Section. New Bioeth 2018; 21:71-86. [PMID: 29384346 DOI: 10.1179/2050287715z.00000000058] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Approaches to supporting autonomy in medicine need to be able to support complex and sensitive decision-making, incorporating reflection on the patient's values and goals. This should involve deliberation in partnership between physician and patient, allowing the patient to take responsibility for her decision. Nowhere is this truer than in decisions around pregnancy and Caesarean section where maternal autonomy can seem to directly conflict with foetal interests. Medical and societal expectations and norms such as the expectations of a ‘mother’, constraints of making decisions in an emergency, and the role of technology in viewing the foetus as a separate patient and surgery as a guarantor of results can all act to limit a woman's autonomy. In considering decisions about Caesarean section, maternal interests in bodily integrity can be dismissed as being less important than the foetus's own interests and the mother's duties to it, despite the inherent risks and impacts of such a major surgical procedure. Maternal autonomy must be respected through support for informed deliberation, incorporating patients' own values and risk tolerance, with the aim of minimizing the effect of those factors that would tend to limit autonomy.
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Ralston SJ, Farrell RM. The Ethics of Access: Who Is Offered a Cesarean Delivery, and Why? Hastings Cent Rep 2015. [PMID: 26215717 DOI: 10.1002/hast.476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Selinger H. Maternal request for caesarean section: an ethical consideration. JOURNAL OF MEDICAL ETHICS 2014; 40:857-860. [PMID: 24248807 DOI: 10.1136/medethics-2013-101558] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Caesarean section (CS) is a method of delivering a baby through a surgical incision into the abdominal wall. Until recently in the UK, it was preserved as a procedure which was only carried out in certain circumstances. These included if the fetus lay in a breech position or was showing signs of distress leading to a requirement for rapid delivery. CS is perceived as a safe method of delivery due to the recommendation by the National Institute for Health and Care Excellence (NICE) in these situations. As a result, the opportunity for maternal request for CS arose, whereby the mother requests the operation despite no medical indication. There are risks associated with CS, as with all surgery, however, these risks in current and future pregnancies may not be fully understood by the mother. The ethics of exposing mothers to these risks, as well as performing surgery on what is otherwise a healthy patient, become entangled with the demand for patient choice, as well as the increasing financial strain on our healthcare system. The main question to be examined in this essay is whether it is ethical to allow women to choose a CS in the absence of obstetric indication, taking into account the increased risk to the mother and her future offspring in order to potentially decrease the risk to the current baby. Alongside a case report, this analysis will apply Beauchamp and Childress' four principles of biomedical ethics and an exploration of the scientific literature.
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Kekewich MA. Market liberalism in health care: a dysfunctional view of respecting "consumer" autonomy. JOURNAL OF BIOETHICAL INQUIRY 2014; 11:21-29. [PMID: 24363176 DOI: 10.1007/s11673-013-9492-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2012] [Accepted: 04/24/2013] [Indexed: 06/03/2023]
Abstract
The unfortunately vast history of paternalism in both medicine and clinical research has resulted in perpetually increasing respect for patient autonomy and free choice in Western health care systems. Beginning with the negative right to informed consent, the principle of respect for autonomy has for many patients evolved into a positive right to request treatments and expect accommodation. This evolution of patient autonomy has mirrored a more general social attitude of market liberalism where increasing numbers of patients have come to embody the role of the "consumer." This paper explores this transformation and critiques the current way in which respect for patient autonomy is put into practice. Ultimately, this paper concludes that the consumer view of patient autonomy is dysfunctional. Moreover, this paper argues that, based on the inherent goals of medicine, some form of paternalism is required in any meaningfully therapeutic relationship.
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Affiliation(s)
- Michael A Kekewich
- Department of Clinical and Organizational Ethics, The Ottawa Hospital, Civic Campus, 1053 Carling Avenue, Ottawa, ON, K1Y 4E9, Canada,
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Ethical concerns and career satisfaction in obstetrics and gynecology: a review of recent findings from the Collaborative Ambulatory Research Network. Obstet Gynecol Surv 2011; 66:572-9. [PMID: 22088234 DOI: 10.1097/ogx.0b013e3182391240] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
UNLABELLED Obstetricians-gynecologists (ob-gyns) are frequently confronted with situations that have ethical implications (e.g., whether to accept gifts or samples from drug companies or disclosing medical errors to patients). Additionally, various factors, including specific job-related tasks, costs, and benefits, may impact ob-gyns' career satisfaction. Ethical concerns and career satisfaction can play a role in the quality of women's health care. This article summarizes the studies published between 2005 and 2009 by the Research Department of the American College of Obstetricians and Gynecologists, which encompass ethical concerns regarding interactions with pharmaceutical representatives and patient safety/medical error reporting, as well as ob-gyn career satisfaction. Additionally, a brief discussion regarding ethical concerns in the ob-gyn field, in general, highlights key topics for the last 30 years. Ethical dilemmas continue to be of concern for ob-gyns. Familiarity with guidelines on appropriate interactions with industry is associated with lower percentages of potentially problematic relationships with pharmaceutical industries. Physicians report that the expense of patient safety initiatives is one of the top barriers for improving patient safety, followed by fear of liability. Overall, respondents reported being satisfied with their careers. However, half of the respondents reported that they were extremely concerned about the impact of professional liability costs on the duration of their careers. Increased familiarity with guidelines may lead to a decreased ob-gyn reliance on pharmaceutical representatives and free samples, whereas specific and practical tools may help them implement patient safety techniques. The easing of malpractice insurance and threat of litigation may enhance career satisfaction among ob-gyns. This article will discuss related findings in recent years. TARGET AUDIENCE Obstetricians & Gynecologists and Family Physicians. LEARNING OBJECTIVES After the completing the CME activity, physicians should be better able to analyze how interactions with pharmaceutical industry may pose ethical dilemmas, examine current barriers to implementing patient safety initiatives, and evaluate the factors that influence career satisfaction among obstetrician-gynecologists.
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Danerek M, Maršál K, Cuttini M, Lingman G, Nilstun T, Dykes AK. Attitudes of midwives in Sweden toward a woman's refusal of an emergency cesarean section or a cesarean section on request. Birth 2011; 38:71-9. [PMID: 21332777 DOI: 10.1111/j.1523-536x.2010.00440.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND A woman's refusal or request for a cesarean section can be a problem for midwives and obstetricians working in maternity units. The objective of this study was to describe the attitudes of midwives in Sweden toward the obstetrician's decision making in relation to a woman's refusal of an emergency cesarean section and to a woman's request for a cesarean section without a medical indication. METHODS The study has a cross-sectional multicenter design and used an anonymous, structured, and standardized questionnaire for data collection. The study group comprised midwives who had experience working at a delivery ward at 13 maternity units with neonatal intensive care units in Sweden (n = 259). RESULTS In the case of a woman's refusal to undergo an emergency cesarean section for fetal reasons, most midwives (89%) thought that the obstetrician should try to persuade the woman to agree. Concerning a woman's request for a cesarean section without any medical indications, most midwives thought that the obstetrician should agree if the woman had previous maternal or fetal complications. The reason was to support the woman's decision out of respect for her autonomy; the midwives at six university hospitals were less willing to accept the woman's autonomy in this situation. If the only reason was "her own choice," 77 percent of the midwives responded that the obstetrician should not comply. CONCLUSIONS The main focus of midwives seems to be the baby's health, and therefore they do not always agree with respect to a woman's refusal or request for a cesarean section. The midwives prefer to continue to explain the situation and persuade the woman to agree with the recommendation of the obstetrician.
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Affiliation(s)
- Margaretha Danerek
- Department of Health Sciences, Faculty of Medicine, University Lund, Lund, Sweden
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Abstract
In its brief tenure evidence-based medicine (EBM) has proven to be a powerful magnet for criticism, while at the same time it has demonstrated impressive resilience. Located within the ongoing critical discourse surrounding the strengths and weaknesses of an EBM approach is the persistent question of the proper place of the social sciences relative to other disciplinary perspectives. This article considers one way the social sciences might usefully illuminate EBM-mediated human interactions to influence policy. We focus on the ethical nexus of the human impulse for unlimited consumption of health care resources in those situations where there exist competing clinical management options and suggest strategies for resource-preserving shared decision making. We conclude that a frugal default option is a fruitful avenue for future exploration in such situations.
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Affiliation(s)
- Elizabeth Libby Bogdan-Lovis
- Center for Ethics and Humanities in the Life Sciences, Michigan State University, East Lansing, Michigan 48824, USA.
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Abstract
PURPOSE OF REVIEW A complicated but relevant and timely concept, cesarean delivery on maternal request (CDMR) is defined as a cesarean delivery for a singleton pregnancy on maternal request at term in the absence of medical or obstetrical indications. RECENT FINDINGS Multiple potential risks and benefits exist with both vaginal and cesarean deliveries. A CDMR performed prior to the onset of labor for a mother planning on only one or two children may be reasonable after informed consent and counseling. However, the most concerning complications from cesareans are the neonatal respiratory morbidity and the impact on a mother's future reproductive health, including the risk of abnormal placentation such as placenta previa or accreta. The literature on CDMR is limited and is derived primarily from observational or extrapolated studies. A well designed prospective study does not currently exist but is needed comparing the optimal groups of planned vaginal delivery and planned CDMR. SUMMARY Discussions regarding CDMR should be individualized. Until there are more data on CDMR and guidelines implemented, an explicitly executed informed consent should form the framework of any decision regarding mode of delivery.
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Lee YM, D'Alton ME. Cesarean delivery on maternal request: the impact on mother and newborn. Clin Perinatol 2008; 35:505-18, x. [PMID: 18952018 DOI: 10.1016/j.clp.2008.07.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Mothers should be counseled that the most concerning risks related to maternal request cesarean delivery are neonatal respiratory morbidity and those that may affect the mother's future reproductive health, including life-threatening conditions, such as placenta accreta. The literature suggests that overall risks of maternal complications with cesarean delivery on maternal request are slightly lower than a trial of vaginal delivery and are primarily driven by the avoidance of unplanned or emergent cesarean deliveries and their associated increased rate of complications. When addressing risks and benefits with patients, there are three areas of importance. First, the risks for neonatal respiratory morbidity and abnormal placentation with future pregnancies should be emphasized. Secondly, there are many areas on which studies are lacking. Finally, numerous factors can alter the risks and benefits--such as culture, maternal obesity, and provider background--and should be acknowledged.
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Affiliation(s)
- Young Mi Lee
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA.
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Rooks JP. Use of nitrous oxide in midwifery practice--complementary, synergistic, and needed in the United States. J Midwifery Womens Health 2007; 52:186-9. [PMID: 17467584 DOI: 10.1016/j.jmwh.2007.02.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Smith GN, Pakenham S, Chamberlain S. Women's views of elective primary caesarean section. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2007; 29:214-215. [PMID: 17346487 DOI: 10.1016/s1701-2163(16)32406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Graeme N Smith
- Department of Obstetrics and Gynaecology, Queen's University, Kingston ON
| | - Susie Pakenham
- Department of Obstetrics and Gynaecology, Queen's University, Kingston ON
| | - Susan Chamberlain
- Department of Obstetrics and Gynaecology, Queen's University, Kingston ON
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