Many Not Counseled
About Childbirth Choices
Excerpt By Charnicia Huggins, Reuters Health

NEW YORK (Reuters Health) - Although women who have had previous cesarean deliveries may subsequently have successful vaginal deliveries, a lack of counseling may prevent some women from making that choice, new study results suggest.

``Whether a woman chooses a trial of labor or a scheduled repeat cesarean, it is important to document informed patient choice, and this was done less frequently in hospitals that did more cesareans,'' lead study author Dr. Joy Melnikow of the University of California, Davis, told Reuters Health.

Vaginal delivery after a previous cesarean section is controversial, with recent reports suggesting that spontaneous labor can triple the risk of rupturing the uterus, and that induced labor can increase this risk by 15 times. However, since the 1980s, many obstetricians and patients with prior cesarean sections have wanted to try vaginal delivery before opting for surgery.

In a review of medical records from 51 different California hospitals, Melnikow and her colleagues investigated the delivery experiences of 369 women who had had a prior cesarean.

More than 75% of the 312 women who were eligible for a vaginal delivery underwent a cesarean, the authors report in the September issue of Obstetrics & Gynecology. Women considered ineligible included those who experienced breech birth or other complications and those who had experienced three or more prior cesareans.

Women who delivered in hospitals with high cesarean rates were less likely to have counseling about the option of vaginal delivery documented in their records than were those who delivered in hospitals with low cesarean rates, the report indicates.

Further, among the women whose records indicated that they did undergo counseling, those who delivered in hospitals with high cesarean rates were more likely to afterward refuse an attempt at vaginal delivery.

Overall, vaginal deliveries accounted for less than one third of the births in hospitals with high cesarean rates, the researchers note. In contrast, nearly three quarters of births in hospitals with low-cesarean rates were via vaginal delivery.

The proportion of women who failed their attempt to deliver vaginally, however, was similar in hospitals with high, intermediate and low cesarean rates, according to Melnikow and her team.

``This finding suggests that once a patient had been counseled and consented to a trial of labor, she had an equal likelihood of delivering vaginally regardless of the hospital cesarean rate,'' the authors write.

Yet both cesarean and vaginal deliveries have risks and benefits, Melnikow stressed.

Women who have successful vaginal births after previous cesareans are more likely to have a faster recovery and fewer complications than those with a repeat cesarean, she said, but they may also put themselves at a very small risk for uterine rupture.

``Not all women are eligible for a trial of labor after a cesarean, and not all hospitals are staffed and equipped to offer them,'' Melnikow said.

SOURCE: Obstetrics & Gynecology 2001;98:421-426.

Reference Source 89

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