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Wagaw AC, Sendekie AK, Nigatu SG, Mihretie GS. Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study. BMC Pregnancy Childbirth 2023; 23:585. [PMID: 37582715 PMCID: PMC10428546 DOI: 10.1186/s12884-023-05891-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 08/01/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Vaginal births after cesarean or elective repeat cesarean sections (CS) are the options for delivery after one cesarean scar. However, there is a lack of data regarding the preferred next mode of delivery in Ethiopia after a previous cesarean section. Thus, this study assessed the preferred mode of delivery and determinants after one previous CS in the antenatal clinic at the University of Gondar Comprehensive Specialized Hospital (UoGCSH). METHODS An institutional-based cross-sectional study was conducted among pregnant mothers with one previous CS at UoGCSH from March to August 2022. Structured questionnaires were used to collect the data. The collected data were entered, cleaned, and edited using Epi-data 4.6 and exported to SPSS version 26 for analysis. A binary logistic regression was performed to assess the determinants of the preferred mode of delivery. A p-value of < 0.05 at the 95% confidence level (CI) was considered statistically significant. RESULTS The majority, 71.5% (95% CI: 64.7, 77.1), of participants preferred the trial of labor after cesarean (TOLAC) as their mode of delivery. Mothers who were married (AOR = 4.47, 95% CI: 1.19-16.85), had a diploma educational level (AOR = 3.77, 95% CI: 1.84-12.36), had previous post-cesarean complications (AOR = 3.25, 95% CI: 1.08-9.74), and knew about the success of the trial of labor after cesarean (AOR = 13.56, 95% CI: 4.52-37.19) were found to prefer the trial of labor compared with their counterparts. CONCLUSION This study concluded that most pregnant mothers preferred labor trials after one CS, which is a bit lower but comparable with recommended practice guidelines. Providing adequate information and counseling mothers to make informed decisions about their preferred mode of delivery could be substantial.
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Affiliation(s)
- Abebe Chanie Wagaw
- Department of Obstetrics and gynecology, School of Medicine, College of Medicne and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Ashenafi Kibret Sendekie
- Department of Clinical Pharmacy, School of Pharamcy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Solomon Gedlu Nigatu
- Department of Epidemilogy & Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getasew Sisay Mihretie
- Department of Obstetrics and gynecology, School of Medicine, College of Medicne and Health Sciences, University of Gondar, Gondar, Ethiopia
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Thornton PD, Liese K, Adlam K, Erbe K, McFarlin BL. Barriers to labor after cesarean: A survey of United States midwives. Birth 2022; 49:675-686. [PMID: 35460106 DOI: 10.1111/birt.12633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 10/31/2021] [Accepted: 03/08/2022] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Despite calls for increased vaginal birth after cesarean (VBAC), <14% of candidates have VBAC. Requirements for documentation of scar type, and prohibitions on induction or augmentation of labor are not supported by evidence but may be widespread. The purpose of this study was to document midwives' perceptions of barriers to labor after cesarean (LAC) and their effects on midwives' ability to accommodate patient desires for LAC. METHODS Midwives certified by the American Midwifery Certification Board (AMCB) were surveyed in 2019. Multiple option and open-ended text responses were analyzed using quantitative statistics and thematic content analysis. Select barriers to LAC, ability to accommodate LAC, and supportiveness of collaborators among midwives offering LAC were explored. RESULTS Responses from 1398 midwives were analyzed. Eighty-four percent felt able to accommodate LAC "most of the time," and 39% reported one or more barriers to LAC. Barriers decreased ability to accommodate LAC by as much as 80%. Analysis of text responses revealed specific themes. CONCLUSIONS Thirty-nine percent of midwives reported their practice was limited by one or more barriers that were inconsistent with professional guidelines. Imposition of barriers was driven primarily by collaborating physicians, and superceded supportive practices of midwives, nurses, and system administrators. Affected midwives were significantly less able to accommodate patient requests for LAC than those not affected. Midwives also reported pride in providing VBAC care, restrictions specific to midwifery scope of practice, and variation in physician support for LAC within practices affecting their ability to provide care.
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Affiliation(s)
- Patrick D Thornton
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Kylea Liese
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | - Kirby Adlam
- Department of Human Development Nursing Science, College of Nursing, University of Illinois Chicago, Chicago, Illinois, USA
| | | | - Barbara L McFarlin
- Department of Human Development Nursing Science, University of Illinois Chicago, Chicago, Illinois, USA
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Dereje L, Tilahun T, Markos J. Determinants of successful trial of labor after a previous cesarean delivery in East Wollega, Western Ethiopia: A case–control study. SAGE Open Med 2022; 10:20503121221097597. [PMID: 35600713 PMCID: PMC9118888 DOI: 10.1177/20503121221097597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: Vaginal birth after cesarean could be considered a reasonable and safe option for most women with a previous cesarean section. However, it is not easy to select pregnant mothers who are a candidate for a trial of labor after cesarean. Therefore, this study is aimed to identify determinants of successful vaginal birth after previous cesarean delivery in public hospitals in East Wollega, Western Ethiopia, 2020. Methods: A facility-based unmatched case–control study was conducted on 115 cases and 115 controls. Cases were those women who successfully delivered vaginally and controls were those women delivered by cesarean section after trial of labor. Data were collected using a pre-tested structured questionnaire and organized using Epidata version 3.1. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. Results: The study revealed that rural residence (adjusted odds ratio = 3, 95% confidence interval = 1.25–7.21), having no history of stillbirth (adjusted odds ratio = 4.2, 95% confidence interval = 1.20–14.62), prior vaginal birth after cesarean (adjusted odds ratio = 2.4, 95% confidence interval = 1.2–6.4), counseling about a trial of labor after cesarean during antenatal follow-up (adjusted odds ratio = 4.7, 95% confidence interval = 1.88–11.74), and birth interval of >2 years (adjusted odds ratio = 8.9, 95% confidence interval = 3.25–24.67) were found to be determinants of successful vaginal birth after cesarean. Conclusion: Place of residence, history of stillbirth, history of vaginal birth after cesarean, counseling about mode of delivery during antenatal care, and birth interval were determinants of successful trial of labor after cesarean. Given these factors, it is recommended that care providers should advocate delaying pregnancy for at least 2 years and counseling women about trial of labor after cesarean during antenatal care follow-up.
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Affiliation(s)
- Lemane Dereje
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Temesgen Tilahun
- Department of Obstetrics and Gynecology, School of Medicine, Wollega University. Nekemte, Ethiopia
| | - Jote Markos
- Department of Nursing, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
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Williams AC, Martinez LI, Garrison A, Frost CJ, Gren LH. Factors leading to satisfaction with counseling for Labor after Cesarean among Latina women in the United States. Birth 2022; 49:71-79. [PMID: 34263970 DOI: 10.1111/birt.12575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 06/28/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cesarean birth, especially repeat cesarean, is associated with significantly higher morbidity than vaginal birth. Appropriately counseling women who are candidates for labor after cesarean (LAC) has the potential to confer significant health benefits for women. Little guidance exists about optimal counseling techniques, especially for Latina women. The aim of this study was to evaluate satisfaction among Latinas about how LAC counseling is performed, specifically as it relates to shared decision making. METHODS We conducted a qualitative study of pregnant women at several clinics in a Federally Qualified Health Center system in Utah. We interviewed eleven Latina women about satisfaction with recent LAC counseling with a specific aim of obtaining rich, personal narratives rather than reaching data saturation. A codebook representing the most common themes was developed. RESULTS Three major themes emerged related to LAC counseling including influences on satisfaction, influences on the birth decision process, and preferences surrounding method and timing of counseling. Women experienced greater satisfaction from providers who used jargon-free communication, were perceived as trustworthy, cared about her experiences, and empowered her to make an informed decision. Women's decisions were influenced by prior birth experiences, desire for a safe delivery and easy recovery, and future family planning. CONCLUSIONS Understanding the aspects of LAC counseling that are most meaningful for Latina women can promote effective communication between patient and provider and improve patient satisfaction. Globally, our findings highlight the importance of evaluating the experiences and preferences of minority groups; majority populations cannot be assumed to speak for minority populations.
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Affiliation(s)
| | | | | | | | - Lisa H Gren
- University of Utah, Salt Lake City, Utah, USA
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Coates D, Thirukumar P, Spear V, Brown G, Henry A. What are women’s mode of birth preferences and why? A systematic scoping review. Women Birth 2020; 33:323-333. [DOI: 10.1016/j.wombi.2019.09.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 09/23/2019] [Accepted: 09/23/2019] [Indexed: 12/26/2022]
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Coates D, Thirukumar P, Henry A. Making shared decisions in relation to planned caesarean sections: What are we up to? PATIENT EDUCATION AND COUNSELING 2020; 103:1176-1190. [PMID: 31836248 DOI: 10.1016/j.pec.2019.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 12/02/2019] [Accepted: 12/03/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To map the literature in relation to shared decision making (SDM) for planned caesarean section (CS), particularly women's experiences in receiving the information they need to make informed decisions, their knowledge of the risks and benefits of CS, the experiences and attitudes of clinicians in relation to SDM, and interventions that support women to make informed decisions. METHODS Using a scoping review methodology, quantitative and qualitative evidence was systematically considered. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018. RESULTS 34 studies were included, with 9750 women and 3313 clinicians. Overall women reported limited SDM, and many did not have the information required to make informed decisions. Clinicians generally agreed with SDM, while recognising it often does not occur. Decision aids and educational interventions were viewed positively by women. CONCLUSION Many women were not actively involved in decision-making. Decision aids show promise as a SDM-enhancing tool. Studies that included clinicians suggest uncertainty regarding SDM, although willingness to engage. PRACTICE IMPLICATIONS Moving from clinician-led decision-making to SDM for CS has potential to improve patient experiences, however this will require considerable clinician training, and implementation of SDM interventions.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, Sydney, Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Maridulu Budyari Gumal, the Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Sydney, Australia.
| | | | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Department of Women's and Children's Health, St George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia
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Rosenstein MG, Norrell L, Altshuler A, Grobman W, Kaimal A, Kuppermann M. Hospital bans on trial of labor after cesarean and antepartum transfer of care. Birth 2019; 46:574-582. [PMID: 31691369 PMCID: PMC9536508 DOI: 10.1111/birt.12460] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 09/25/2019] [Accepted: 09/25/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hospital policies restricting access to trial of labor after cesarean (TOLAC) are prevalent. Many women with a previous cesarean birth are affected by these bans, but there are limited data on the effect of these bans and whether women would consider changing delivery hospitals in the setting of a real or hypothetical TOLAC ban. METHODS This was a survey of TOLAC-eligible women receiving prenatal care at four hospitals where TOLAC is available, and 1 non-TOLAC site. Participants were asked about their likelihood of switching hospitals to pursue TOLAC if it were unavailable. Women at the non-TOLAC site had their medical records reviewed to ascertain final location and approach to delivery. RESULTS A total of 297 women were interviewed, 48 from the non-TOLAC site. 162 (54%) participants indicated they would transfer care if TOLAC were unavailable. Among women at the non-TOLAC site, 57% who indicated an intention to switch hospitals did so. In a multivariable logistic regression model, variables associated with transferring care included race/ethnicity other than Latina (aOR 25.20 [95% CI 2.23-284.26]), being unaware of the TOLAC ban (19.81 [1.99-196.64]), and perceiving that a close friend/relative thought they should undergo TOLAC (17.31 [1.70-176.06]). CONCLUSIONS More than half of women with prior cesarean would consider transferring care if TOLAC became unavailable, and more than 1 of 3 of women at a non-TOLAC site transferred care. More research is needed on the impact of TOLAC bans and how to facilitate transfer for those who desire TOLAC.
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Affiliation(s)
- Melissa G. Rosenstein
- Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
| | | | - Anna Altshuler
- Obstetrician/Gynecologist, California Pacific Medical Center
| | - William Grobman
- Professor of Obstetrics and Gynecology (Maternal-Fetal Medicine) and Preventative Medicine, Northwestern University
| | - Anjali Kaimal
- Associate Professor of Obstetrics, Gynecology and Reproductive Biology, Massachusetts General Hospital
| | - Miriam Kuppermann
- Assistant Professor, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco
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Rietveld AL, van Exel NJA, Cohen de Lara MC, de Groot CJM, Teunissen PW. Giving birth after caesarean: Identifying shared preferences among pregnant women using Q methodology. Women Birth 2019; 33:273-279. [PMID: 31171497 DOI: 10.1016/j.wombi.2019.05.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Caesarean rates are rising worldwide, the main contributor being the elective repeat caesarean. During the past decades, rates of vaginal birth after caesarean dropped considerably. This requires insight in women's preferences regarding giving birth following a previous caesarean. AIM To gain a better understanding of women's values and preferences regarding the upcoming birth following a previous caesarean. Using Q methodology, this study systematically explores and categorises their preferences. METHODS Q methodology is an innovative research approach to explore and compare a variety of viewpoints on a certain subject. Thirty-one statements on birth after caesarean were developed based on the health belief model. Thirty-six purposively sampled pregnant women with a history of caesarean ranked these statements from least to most important. By-person factor analysis was used to identify patterns which, supplemented with interview data, were interpreted as preferences. FINDINGS Three distinct preferences for giving birth after a caesarean were found; (a) "Minimise the risks for me and my child", giving priority to professional advice and risk of adverse events, (b) "Seek the benefits of normal birth", desiring to give birth as normal as possible for both emotional and practical reasons, (c) "Opt for repeat caesarean", expressing the belief that a planned caesarean brings comfort. CONCLUSIONS Preferences for birth after caesarean vary considerably among pregnant women. The findings help to understand the different types of information valued by women who need to decide on their mode of birth after a first caesarean.
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Affiliation(s)
- Anna L Rietveld
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.
| | - N Job A van Exel
- Erasmus University Rotterdam, Erasmus School of Health Policy & Management, Rotterdam, The Netherlands; Erasmus University Rotterdam, Erasmus School of Economics, Rotterdam, The Netherlands
| | | | - Christianne J M de Groot
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Pim W Teunissen
- Department of Obstetrics and Gynaecology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; School of Health Professions Education (SHE), Faculty of Health Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Jing C, Wang C. Combining Spinal-Epidural Anesthesia versus Single-Shot Spinal Anesthesia for Cesarean Delivery: A Meta-Analysis of 5 Randomized Controlled Trials. Med Sci Monit 2019; 25:2859-2867. [PMID: 30998665 PMCID: PMC6484872 DOI: 10.12659/msm.913744] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background This study compared combined spinal-epidural anesthesia (CSEA) and single-shot spinal anesthesia (SSSA) by performing a meta-analysis. Material/Methods An electronic search of relevant studies was done through 2017. Primary endpoints included duration of surgery, and time for (1) sensory recovery to thoracic vertebra (T10), (2) maximal sensory, (3) motor blockade, and (4) motor recovery. Secondary endpoints were the adverse effects. RevMan 5.3 analytical software was used with odds ratios (OR) and 95% confidence intervals (CIs) as the analytic parameters. Standard deviation and mean were used to evaluate data by weighted mean differences (WMDs) with 95% CI. Results A total of 370 patients were analyzed. A similar duration of surgery was observed with CSEA and SSSA (WMD: 0.24, 95%CI: −3.41–3.89; P=0.90). Time to maximal sensory blockade (WMD: 0.96, 95%CI: −2.91–4.83), time to maximal motor blockade (WMD: 0.25, 95%CI: −2.46–2.96), time for complete motor recovery (WMD: −6.28, 95%CI: −29.42–16.86), and time for sensory recovery to T10 vertebra (WMD: 0.42, 95%CI: −11.07–11.91) were not significantly different. Adverse effects such as hypotension (OR: 1.49, 95%CI: 0.27–8.31), pruritus (OR: 0.23, 95%CI: 0.03–2.18), nausea/vomiting (OR: 0.84, 95%CI: 0.12–5.99). and shivering (OR: 0.53, 95%CI: 0.11–2.56) were also similar with CSEA and SSSA. Conclusions CSEA was not associated with significantly different maximal duration of sensory/motor blockade, complete motor recovery, sensory regression to T10, or adverse drug events compared to SSSA. Hence, both should be considered effective in cesarean delivery.
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Affiliation(s)
- Chenmeng Jing
- Department of Anesthesiology, New Century Women's and Children's Hospital, Beijing, China (mainland)
| | - Chen Wang
- Department of International Medical, China-Japan Friendship Hospital, Beijing, China (mainland)
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Izadi V, Zamanzadeh V, Seyedjavadi M, Mohammadi R, Mazaheri E. Investigation of factors affecting the tendency to choose the type of delivery in pregnant women referring to hospitals of Ardabil Province in 2016. J Family Med Prim Care 2018; 7:406-413. [PMID: 30090785 PMCID: PMC6060912 DOI: 10.4103/jfmpc.jfmpc_235_17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background and Purpose Childbirth is one of the most challenging events in a married woman's life and it has important emotional consequences for each woman. It is also a multidimensional process that has physical, physiological, psychological, emotional, cultural, and social dimensions. The aim of this study was to investigate the factors affecting the tendency to choose the type of delivery in pregnant mothers in hospitals of Ardabil Province in 2016. Methodology This study is a cross-sectional research that was conducted on 300 pregnant women who were referred to the hospitals for delivery during 3 months in 2016. Data collection tools was a five-part questionnaire including demographic, awareness, attitude, abstract norm questionnaires (other's role) in choosing delivery method, and Behavioral Intention Questionnaire was used in choosing the type of delivery. Results Statistically, there was not any significant relationship between level of awareness and type of delivery in pregnant mothers (P = 0.07). The mean scores of attitude in mothers with a tendency to natural delivery were 35.75 ± 14.43, and in mothers with a tendency to cesarean was 46.3 ± 10.96. ANOVA test showed statistically a significant relationship between attitude toward cesarean and type of delivery (P < 0.05). Chi-square test showed statistically a meaningful relationship between the recommendations of acquaintances, mothers, husbands, and doctors with choosing a type of delivery (P < 0.05). Conclusion Regarding the results of research, especially the positive attitude and high level of awareness in the choice of natural delivery, the promotion of natural delivery will be possible with education.
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Affiliation(s)
- Vahid Izadi
- Department of Student Research Committee of Ardabil University of Medical Science, Iran University of Medical Sciences, Ardabil, Iran
| | - Vahid Zamanzadeh
- Department of Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tabriz, Iran
| | - Mehri Seyedjavadi
- Department of Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Ardabil, Iran
| | - Rahele Mohammadi
- Department of Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Ardabil, Iran
| | - Effat Mazaheri
- Department of Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tabriz, Iran
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Thornton P. Limitations of Vaginal Birth After Cesarean Success Prediction. J Midwifery Womens Health 2018; 63:115-120. [PMID: 29356333 DOI: 10.1111/jmwh.12724] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 12/02/2017] [Accepted: 12/04/2017] [Indexed: 11/27/2022]
Abstract
The Society for Maternal-Fetal Medicine endorses an algorithm for estimating the probability of successful vaginal birth for women undergoing trial of labor after cesarean (TOLAC). The algorithm is available online in the form of an easy-to-use calculator. This calculator has significant limitations that are easily overlooked by women and providers alike. The calculator has much greater positive than negative predictive power, and it cannot predict unsuccessful TOLAC or uterine rupture. Furthermore, the calculator cannot predict rare catastrophes, such as unplanned hysterectomy, permanent injury, or death. Predictions are heavily influenced by race and ethnicity, which are social and not biological constructs. Relevant variables, such as provider attitudes and institutional differences, are not accounted for. Providers should be mindful and transparent about calculator limitations when counseling women, particularly Latina and African American women. It may be appropriate to use the calculator to inform but not restrict women's options.
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Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section – An online survey investigating women's preferences in Western Switzerland. Midwifery 2017; 50:219-227. [DOI: 10.1016/j.midw.2017.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/15/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
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