The choice of elective cesarean delivery in obstetrics: a voluntary survey of Canadian health care professionals

Abstract

To survey Canadian health care professionals about their willingness to offer elective cesarean delivery and to evaluate how their knowledge of obstetric-related pelvic-floor injury influences their practice. A voluntary questionnaire was distributed to health care professionals attending the 58th Annual Meeting of the Society of Obstetricians and Gynaecologists of Canada in 2002. Appropriate statistical analysis was used. One hundred and sixty-two questionnaires were completed. One hundred respondents were female (62%). Twenty-three percent (37/162) of respondents approved elective cesarean delivery after informed request in nulliparous women without an obstetrical indication. Males were more likely than females to perform cesarean delivery in these circumstances (34% versus 16%; OR 2.7, CI 1.2, 6.0). When questioned about the impact of mode of delivery on bladder and bowel continence, the number of respondents who answered "usually" or "always has a detrimental effect" were: vaginal birth, 16%; forceps, 20%; and cesarean delivery "reduces bladder and bowel problems", 44%. Males were more likely to emphasize a protective effect of cesarean delivery (55% versus 38%; OR 1.9, CI 1.0, 4.0). Health care professionals would opt for cesarean delivery for themselves when forceps delivery was the alternative more often than they would offer cesarean delivery to their patients (OR 1.98, CI 1.1, 3.5). While a significant number of women's health care professionals are prepared to offer cesarean delivery to nulliparous women, informed choice seems to motivate the offer rather than a conviction that cesarean delivery will protect the pelvic floor.

Obstetricians’ and Midwives’ Attitudes toward Cesarean Section

“…Indeed, when obstetricians were analyzed separately, the same attitude was detected in males and females (data not shown). This finding is in contrast with those of other studies, where male obstetricians were more likely to perform, to agree to, and to believe that a woman has a right to have an elective cesarean section (19,25,26), whereas female obstetricians were more negative toward cesarean delivery (15,16,26), especially when they had already experienced a vaginal delivery (28). It should be acknowledged, however, that our sample of obstetricians could be underpowered to detect a gender difference.…”

“…The strengths of this survey are that all practitioners who attend childbirths in the district of Modena were involved and that the response rate was 94.6 percent, which is much higher than that of previous surveys (25,26). Therefore, we can be confident in the value of the information provided.…”

“…This survey, in recognizing the influence of health practitioners’ attitudes on both the cesarean section rate and women’s requests, aimed to explore the attitudes toward cesarean section of obstetricians and midwives who worked in the same geographical area. Although numerous studies have analyzed obstetricians’ views (15,16,24–30), only a few studies have also explored the views of midwives (31–33).…”

Is it the decision of women to choose a cesarean section as the mode of birth? A review of literature on the views of stakeholders

“…In Australia, 77.3% of the 1032 obstetricians and 81% of the 258 obstetric trainees would agree to a CSMR in uncomplicated pregnancies [7]). The lowest level of support for a CSMR was among obstetricians from Spain and Canada, where only 15 and 23% of obstetricians respectively would agree to perform a CSMR [5, 8]. In the US, 10.2% of obstetricians reported that they routinely perform CSMRs [9].…”

“…Gender differences were noted between male and female obstetricians in their support for CSMRs [8, 12]. In Canada, male obstetricians (34%) were more likely than female obstetricians (16%) to agree to perform a CSMR [8].…”