Factors influencing the decision making on the mode of delivery in pregnant women after one previous cesarean delivery: Basis for development of counselling checklist

Title : Factors influencing the decision making on the mode of delivery in pregnant women after one previous cesarean delivery: Basis for development of counselling checklist

Abstract:

Background: There has been a rise in total cesarean delivery rates from 7% in 1990 to 21% in 2021 and the increasing number of repeat cesarean deliveries (CD) is one of the contributing factor. Based on practice guidelines, pregnant patients with previous cesarean birth may either undergo trial of labor after cesarean birth (TOLAC) or elective repeat cesarean delivery (ERCD). Majority of studies has been on the comparison of the risks associated with either mode of delivery. There is noted limited knowledge on decision making process and the factors considered in choosing which mode of delivery.

Objective: Identify the factors influencing the decision making on mode of delivery in pregnant women after a previous CD

Materials and Methods: This is a descriptive, correlational study done at a tertiary institution. This study included pregnant patients with previous CD and structured questionnaire was used by the interviewer 24-48 hours post partum

Results: Out of 83 participants, 47(56.63%) opted ERCD while 36(43.37%) decided on TOLAC. Majority of those who decided for ERCD was made by the physician (40.43%). The history of CPD (57.89%) was the most common reason of physician for choosing ERCD while fear of pain (76.47%) for patients. Out of 36 who planned for TOLAC, 17(47.22%) underwent CD secondary to failure of labor to commence at 39 weeks gestation (41.18%).

Conclusion: Physician’s decision is a vital factor that contributes to CD rates. The history of cephalopelvic disproportion (CPD), fear of pain, failure of labor to commence and lack of knowledge on complications are the factors that contribute to the choice of CD. These misdirected factors can be addressed by a thorough prenatal counselling to decrease total CD rate.

Keywords: Repeat Cesarean Delivery, Trial of Labor after Cesarean Delivery, Vaginal Birth after Cesarean Delivery

Biography:

Dr. Sheba Rae Reotro studied Nursing at Cebu Doctors’ University then proceeded with Medicine at Cebu Institute of Medicine. She is currently a senior Obstertics and Gynecology resident at Chong Hospital Mandaue, Cebu Philippines. This is the first research study that she will be submitting for a convention outside the Philippines. She chose to have this study because of the rampant elective repeat cesarean section despite the patient being a good candidate for trial of labor. This study helped her produce a Prenatal Counselling Checklist to be used by the Obstetricians to decrease CS rate and its morbidity.