Prenatal care counseling and delivery method among women with multiple Cesareans: A cross-sectional study from Democratic Republic of Congo

Abstract

Prenatal care (PNC) and counseling about delivery method is an important strategy to prevent delivery complications among women with multiple prior Cesarean sections (CS). In low income countries, an elective CS is recommended for this population. This cross-sectional study examined factors associated with counseling about delivery method and its influence on the likelihood of an elective CS delivery. A total of 422 women with ≥2 prior CS who delivered across five hospitals in Democratic Republic of Congo (DRC) were interviewed about PNC and counseling. Descriptive statistics and multivariate regression were completed to ascertain factors associated with counseling. Only 33.6% delivered via planned CS; 60.7% required an emergency CS. One-quarter completed four PNC visits; 64.5% received counseling. Number of PNC visits and number of prior CS were significant predictors of receipt of counseling. Women who received ≥2 PNC visits were 2.2 times more likely to have received counseling (p = 0.000). Among women who received counseling, 38.6% had a planned CS compared with 24.7% in the non-counseled group. Counseling was associated with mode of delivery; emergency CS and vaginal delivery were more frequent among women who did not receive counseling (p = 0.008). These findings highlight the importance of counseling during PNC visits. This study also highlights the poor coverage and quality of counseling in this high-risk population and the need for improvements in PNC. Less than 40% of counseled women followed provider recommendations for a planned delivery via CS. The majority labored at home and later delivered emergently. The significant number of women who trial labor without medical supervision despite their high-risk status sheds light on the influence of patient perceptions about CS and acceptance of medical intervention during birth.

Factors influencing the success of trial of labor after one previous caesarean section in a secure inter-delivery interval at Panzi Hospital.

“…Regarding the delivery phase, the majority of Newborns, 52.8%, arrived in the active phase (OR = 13.21; 95% CI: 3.65-47. 28) and the association is signi cant (p <0.05). It also appears that 30 women giving birth, or 12.9%, used contraceptive methods, which does not have a signi cant association with mode of delivery.…”

“…It is therefore important to encourage a secure IDI by contraception, in the context of a high birth rate such as in sub-Saharan Africa [28]. Good post caesarean delivery counseling is of paramount important to improve this antepartum factor and avoid IDI less than 18 months since the last CS [29].…”

Receiving antenatal care components and associated factors in Northwestern Tanzania

“…and current WHO guideline recommends 8 number of ANC contacts/visits [ 4 ]. More frequent ANC visits increase opportunities to interact with health care workers and potentially enhance health talks and ANC in general [ 61 , 62 ]. Promoting the number of ANC visits should go together with investing in human and material resources to ensure better quality ANC [ 14 ].…”

Evolution in caesarean section practices in North Kivu: Impact of caregiver training

“…Dystocia is mainly caused by insufficient uterine contractions, sometimes due to cephalopelvic disproportion, lack of progress in foetal descent due to a tumour; however, it is sometimes difficult to make this diagnosis prior to labour [ 19 ]. Certain authors wondered whether dystocia was being over-diagnosed nowadays, in order to justify more frequent use of CS [ 11 ]. Our study shows fewer indications of dystocia after training than before (p = 0.005).…”

“…A study conducted in Goma (North Kivu) between 2013 and 2016 in four referral hospitals reported a caesarean rate of 16%, that the majority of CS were performed as an emergency and under loco regional anaesthesia, and that the perinatal risk was higher when the CS was performed as an emergency and under loco regional anaesthesia [ 10 ]. Several risk factors which increase maternal and perinatal morbidity and mortality in the intra- and post-CS period have been identified, in particular the shortage of qualified health staff, lack of health staff training, inadequate medical infrastructure, difficulties in performing the CS in due time when women need one, as well as the high cost of the procedure in relation to the population’s income [ 11 ]. Periodic analyses of maternal deaths in the United Kingdom have shown that more than half of maternal and neonatal deaths were due to suboptimal care and that they were therefore potentially preventable [ 12 ].…”