A recent study from the US suggests that women do not know enough about their birth options prior to making decisions about the way in which they will attempt birth following a previous caesarean. No surprises there.
But what is particularly worrying is not simply that women don’t know even basic information but that a significant number are having to go ahead and make life changing decisions regardless.
As Berstein points out “they [VBAC and repeat CS] are both safe options” but each mode has risks these are different and need to be weighed up by Mum. They can only do this if they have all relevant information.
For example the likelihood of achieving a VBAC (Vaginal Birth After Caesarean) is around 75% but nearly three quarters of the women interviewed in this study couldn’t hazard a guess at the VBAC success rate. Despite this over half had already opted for a VBAC regardless. (Incidentally a 75% success rate is interpreted by many as great odds, but it is worth remembering that for others, particularly those who have experienced a traumatic birth previously, it might leave enough uncertainty to lead them to request a repeat caesarean).
Unfortunately Bernsteins advice to women for tackling such gaps in their knowledge is to “have a really good discussion of your options with your OB…Don’t just read about it online or listen to your friends.” I have a several problems with this. Such an approach assumes:
- That the practitioner has sufficient time to spend giving the mother all the information she needs to make a truly informed decision
- That the mother can take in all the information during the appointment. That she can ask useful/probing questions pertinent to her specific concerns as the information is revealed
- That the practitioner is willing and able to give the mother an unbiased account of her options. It is unfortunately the case that both personal opinion and hospital/surgery policies sometimes get in the way of this
In addition, while this study is important for highlighting the poor level of information support some women are getting during the antenatal period, this is yet another study that takes as it’s starting point the idea that poor education is causing women to plan a repeat caesarean. Despite Berstein’s comment that “they are both safe options” there appears to be the preconception that caesarean birth would be avoided if only women were better educated. There does not appear to be any space for the idea that with balanced information about comparative risks some women might actually choose a caesarean.