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Study Finds Pregnant Women with Prior Cesarean Choose the Delivery Method Preferred by Their Doctor
In a study to be presented today at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in Dallas, Texas, researchers will report findings that women who have undergone one prior delivery via cesarean section appear to know little about the risks and benefits associated with undergoing either a second cesarean or trial of labor to attempt a vaginal delivery, and that the preference of their medical provider strongly affects their selection between the two options.
Although trial of labor after a prior cesarean is considered a reasonable option with an overall success rate of 60 to 80 percent, the majority of women who would be eligible for it undergo an elective repeat cesarean. The study, Trial of Labor After a Previous Cesarean Section Versus Repeat Cesarean Section: Are Patients Making an Informed Decision?, sought to determine if this is due, in large part, to poor education of patients on the risks and benefits of both options.
“Even though most women can achieve a vaginal delivery with trial of labor, less than 10 percent of them attempt to do so,” said Sarah Bernstein, MD, with St. Luke’s-Roosevelt Hospital Center, Obstetrics and Gynecology, in New York, and one of the study’s authors. “In fact, when patients perceived that their doctor preferred a repeat cesarean, very few chose to undergo trial of labor, whereas the majority chose trial of labor if that was their doctor’s preference.”
Bernstein and her colleagues, Shira Matalon-Grazi and Barak Rosenn, also with St. Luke’s-Roosevelt Hospital Center, Obstetrics and Gynecology, observed 155 women who presented at the hospital for delivery between November 2010 and July 2011, and had a history of one prior cesarean and no contraindications for trial of labor. Consenting women were asked to fill out a questionnaire upon presentation for labor and delivery, either prior to their scheduled repeat cesarean or upon admission for trial of labor.
The study found that 87 of the 155 chose to undergo trial of labor, with the remaining 68 opting for a repeat cesarean. There were no differences in age, level of education, ethnicity and provider type between the groups. Women in both groups demonstrated lack of knowledge on the risks and benefits of the options, particularly women in the elective repeat cesarean group. Specifically, patients were not familiar with the chances of a successful vaginal delivery with trial of labor (13 percent of trial of labor patients knew, as did four percent of cesarean patients), the effect of indication for previous cesarean on success, the risk of uterine rupture, and the increase in risk with each successive cesarean. Fifty-two percent of patients did not know which delivery method has a faster recovery time. When patients perceived their providers as having a preference for cesarean, only four percent chose trial of labor. Conversely, 43 percent chose trial of labor when they thought that was their provider’s preference.
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A copy of the abstract is available at http://www.smfmnewsroom.org/annual-meeting/2011-meeting-abstracts/. For interviews please contact Vicki Bendure at Vicki@bendurepr.com, 540-687-3360 (office) or 202-374-9259 (cell), or Jacqueline Boggess at email@example.com, 540-687-5399 (office) or 202-738-3054 (cell).
The Society for Maternal-Fetal Medicine (est. 1977) is a non-profit membership group for obstetricians/gynecologists who have additional formal education and training in maternal-fetal medicine. The society is devoted to reducing high-risk pregnancy complications by providing continuing education to its 2,000 members on the latest pregnancy assessment and treatment methods. It also serves as an advocate for improving public policy, and expanding research funding and opportunities for maternal-fetal medicine. The group hosts an annual scientific meeting in which new ideas and research in the area of maternal-fetal medicine are unveiled and discussed. For more information, visit www.smfm.org or www.facebook.com/SocietyforMaternalFetalMedicine.
Trial of labor after previous cesarean section versus repeat cesarean section: are patients making an informed decision?
Sarah Bernstein 1, Shira Matalon-Grazi 1, Barak Rosenn 1
1 St. Luke’s-Roosevelt Hospital Center, Obstetrics and Gynecology, New York, NY
OBJECTIVE: Although trial of labor after cesarean (TOLAC) is considered a reasonable option for most women, with an overall rate of success of 60-80%, the majority of women who would be eligible for a TOLAC undergo an elective repeat c-section (ERCS).We hypothesized that this is due, in large part, to poor education of patients on the risks and beneﬁts of both options.
STUDY DESIGN: We conducted an IRB approved, prospective observational study of women who presented to our hospital for delivery between November 2010 and July 2011 with a history of one prior c-section and no contraindications for TOLAC. Consenting women were asked to ﬁll out a questionnaire upon presentation to labor and delivery, either prior to their scheduled ERCS or upon admission for their TOLAC. Chi-Square and t-test were used,as appropriate,with Bonferroni correction for multiple comparisons.
RESULTS: The study included a total of 155 women, 87 that presented for TOLAC and 68 that presented for ERCS. There were no differences in age, level of education, ethnicity and provider type between the groups. Women in both groups demonstrated lack of knowledge on the risks and beneﬁts of TOLAC and ERCS, particularly women in the ERCS group. Speciﬁcally, patients were not familiar with the chances of a successful TOLAC, the effect of indication for previous CS on success, the risk of uterine rupture, and the increase in risk with each successive CS. Only 13% of TOLAC patients and 4% of ERCS patients knew the chances for a successful TOLAC, while the majority in both groups stated that they “did not know”. The majority (64%)of ERCS patients did not know the risk of uterine rupture during TOLAC and 52% did not know which delivery mode had a faster recovery time. When patients perceived their providers as having a preference for ERCS, only 4% chose TOLAC. Conversely, 43% chose TOLAC when they thought that was their provider’s preference.
CONCLUSION: Candidates for TOLAC appear to have little knowledge of the risks and beneﬁts associated with their choice for mode of delivery and provider preference affects this choice, either directly or indirectly.