Caesarian Section at Demand- A Patient perspective Al Saffar N 1 ,Gupta M 1 ,Vaidya A 1 , Bhattacharya A 2 (Farwaniya Hospital Kuwait-1; Faculty of Medicine Kuwait-2). Introduction
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Caesarian Section at Demand- A Patient perspectiveAl Saffar N1,Gupta M1,Vaidya A1, Bhattacharya A2(Farwaniya Hospital Kuwait-1; Faculty of Medicine Kuwait-2)
Trends in child-birth have become more women centric1, with “informed choice” becoming the buzz-word for patient care. One of the major choices which any women would like to make would be the choice of route of delivery. 2,3
There has been almost a threefold increase in caesarian section at demand. 4
In Farwaniya hospital Kuwait, Caesarian sections on maternal demand accounted for nearly 20 % of the indications in 2010.
However, caregivers have to balance the risks of Caesarian sections 5,6 with the need for respecting patient choice.
The increasing trend of requests for CS is a phenomenon which needs to be researched in depth.
Recognisingthe motivation behind this request is one of the keys to understanding this.
82 patients (67.2%) of the patients had a previous Caesarian section, 26 patients(21.3%) had previous normal deliveries. 14(11.47%) had Instrumental deliveries
Out of the 26 patients who cited high social premium on baby as a reason, 8 (31%) had history of infertility which was significantly higher than those who gave other reasons (p<0.001)
Nearly half the patients in our study cited fear of labour as a cause for choosing CS as the mode of delivery and all of them had a previous negative labour experience.7,8(Sample size was small to include use of epidural analgesia in the analyses)
Patients with a history of infertility placed a high social premium on their baby and cited that as a reason for choosing CS, leading to the inference that CS is safer for the baby.9
These above findings although small in number as of now(the study is still on) to prove statistically significant are consistent with findings in other studies.
However as clinicians we know that in spite of the relative safety of the procedure, un-indicated CS offers no additional benefits to the baby, 10 and may increase the risk of neonatal respiratory problems. 11 The risks to the mother’s health are also substantial, especially in terms of implications on future pregnancies. 3,4
There are many obstetricians who believe in the safety of CS for the baby over Vaginal delivery, 12 Given this scenario, in-depth counseling the patients about the risks versus benefits of CS may entail a change in beliefs of the caregivers,
One of the primary motivating factors which propel women to opt for a caesarian section seems to be a fear of child-birth.
Better obstetric analgesia including effective epidural service is a likely means to reduce this trend
Patients with a history of infertility tend to opt for CS as a mode of delivery owing to a belief that it is safer for the baby compared to vaginal birth.
Continous, on-going pre-natal counseling about the risks and benefits of CS will empower women to make an informed choice
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