Personal Preference of Mode of Delivery. What do Urogynaecologists choose? Preliminary Results of the DECISION Study

Abstract

Introduction Currently, almost every third child in Germany is delivered by caesarean section. Apart from straightforward and clear indications for caesarean section which account for approx. 10%, the large proportion of relative indications in particular needs to be critically reviewed if the current C-section rate is to be effectively lowered. It is more than doubtful, however, whether this can be a realistic goal in Germany, especially in the context of international developments. All studies on this topic demonstrate that the personal attitude of the obstetric team has a considerable influence on the pregnant womanʼs personally preferred mode of delivery. Therefore, in the first part of the DECISION study, the personal preferences of urogynaecologists were evaluated regarding the best suitable mode of delivery. Material and Methods All 432 delegates at the 9th German Urogynaecology Congress in Stuttgart in April 2017 were invited to participate in an online questionnaire study. The questionnaire was developed especially for this study. Results Of the 432 registered delegates, 189 (43.8%) participated in the survey. 84.7% (n = 160) of the study participants would prefer a vaginal delivery, in an otherwise uncomplicated pregnancy. Only 12.2% (n = 23) opted for an elective caesarean section. The main reasons stated for this decision were concerns about incontinence (87.5%) and pelvic floor trauma (79.2%). Amongst the study participants, 83.6% would like to be part of a risk stratification system presented in the questionnaire which, with the aid of specific parameters, is intended to allow early identification of a population with a high risk of developing pelvic floor disorders. There was also great interest in postpartum pelvic floor recovery (97.8%) and an associated optional pessary therapy (64.4%). The type of delivery already experienced (vaginal delivery vs. primary caesarean section) and parity also reveals to have a significant influence on the personal preferred mode of delivery as well. Conclusions Urogynaecologists prefer vaginal delivery for themselves. There is a great interest to participate in a risk stratification process in order to approach childbirth in an individualized and risk-adapted manner.

Vaginale Geburt und Inkontinenz – ist eine Aufklärung über dieses Risiko vor Geburt zielführend?

“…Richtungsweisend sind dabei die Ergebnisse der Decision-Studie, die zeigen konnte, dass 84,7 % der befragten Fachspezialisten für sich selbst oder für ihre Frauen eine vaginale Geburt bevorzugen würden. 12,2 % zogen im Hinblick auf ihre berufliche Erfahrung und persönliche Einstellung einen Kaiserschnitt generell einer vaginalen Geburt vor [8]. [11] und die OR für Stuhlinkontinenz 1,65 [12].…”

Breast feeding after caesarean delivery on maternal request: protocol of a systematic review and meta-analysis

“…5 The reasons behind women's preference for CDMR have been investigated in systematic reviews of quantitative or qualitative studies. [6][7][8][9][10][11] Decisions for CDMR were typically driven by women's emotional experiences of fear and unknown, personal experiences of previous births or clinician guidance and social norms that recognise CS as a modern and autonomous way that offers guaranteed safety for both the mother and the foetus. 6 7 Similarly, patient surveys and narratives often suggest that CS is a less risky 8 and painless 9 medical procedure that avoids multiple harms from vaginal delivery.…”