Why do women opt for a repeat caesarean when they could have a VBAC

New research, suggests that the opinion of the practitioner strongly influences the decision a woman will make about the mode of birth she will request.

BERNSTEIN, MATALON-GRAZI and ROSENN wanted to investigate why it was that so many women were choosing to undergo a repeat caesarean rather than a ‘trial of labour’ also known as a VBAC (Vaginal Birth After Caesarean).

They found that “When patients perceived their providers as having a preference for ERCS [repeat caesarean], very few chose TOLAC [VBAC] whereas the majority chose TOLAC if this was their provider’s preference.”

Even though the sample size was relatively small (155 women and 3/4 were educated to degree level and over the age of 30) the trend was very clear. Practitioner opinion still heavily influenced the decision the woman then went on to make. Interestingly when the woman was not aware of the practitioner expressing any particular preference the split of who chose what was exactly 50:50.

More alarming perhaps is that researchers found that regardless of which birth mode the woman chose she had a woefully inadequate level of knowledge about both the benefits and the risks of her preferred choice.

The multi-choice questionnaire assessed the woman’s level of understanding of the mode of birth they were to undergo and despite the fact that they had all received prenatal care and counselling they were unable to accurately answer such questions as:

  • If I were to try for a trial of vaginal labor, my overall chances of success are…
  • If I try for a vaginal delivery (VBAC), the risk that my uterus will rupture (opening of the uterine scar) is…
  • The reason for my previous cesarean section is an important factor in determining my chances of a successful vaginal delivery…

ACOG (American College of Obstetricians and Gynecologists) clearly define informed consent and this study reveals that women are not being given the level of unbiased, informative material they require in order to be able to genuinely make an informed decision.

As researcher point out “Informed consent, is defined as a process of communication whereby a patient is enabled to make an informed and voluntary decision about accepting or declining medical care and has become a mainstay of contemporary medical practice. It is viewed by many as a collaborative process between physician and patient intended to facilitate the patient’s autonomy in the process of ongoing choices. Our respondents showed insufficiencies in the area of comprehension, a major tenet of informed consent. They lacked awareness and understanding of their situation and possibilities. From our data, it appears that provider bias may affect the opinion of some patients, with undue influence on patient’s voluntary decision making.”

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