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Information women receive in pregnancy affects their childbirth preferences after prior cesarean delivery

Cesarean delivery rates account for 29 percent of births in the United States. However, vaginal birth after cesarean (VBAC) rates declined from 28 percent in 1996 to 9 percent in 2004. According to a new study, many women who undergo VBAC or cesarean delivery receive little or no information about the risks of both procedures, including forceps or vacuum delivery, future urinary or fecal incontinence problems, and risk of fetal death or injury.

Researchers asked 92 women who had a previous cesarean to complete questionnaires 1-4 days after either a VBAC or repeat cesarean at a large teaching hospital. Overall, 44 percent had scheduled cesareans, 28.8 percent had VBAC, and 27.1 percent had a cesarean following an attempted VBAC. Women who had a repeat cesarean were more likely than women who chose a trial of labor to report that risk of uterine rupture, forceps or vacuum delivery, recovery time, and bleeding and blood transfusion after a trial of labor were not addressed. Women who chose a trial of labor were more likely to report that possible urinary or fecal incontinence was not addressed.

There was no difference in information received by the two groups of women for the following additional topics: infection following cesarean or vaginal delivery, spontaneous or induction of labor, need for urgent cesarean, bleeding or blood transfusion for cesarean, plans for future children, pain relief during and after delivery, and fetal death or injury. Although the majority of women reported receiving insufficient information, 92 percent were satisfied with the information they did get.

All women who chose a trial of labor, but only 80 percent of women who chose a cesarean, felt involved in the decision. Women who felt involved in the delivery decision were more likely to have received information on uterine rupture (89.7 vs. 16.7 percent), bleeding after cesarean (89.7 vs. 50 percent) or vaginal delivery (79.3 vs. 33.3 percent), and recovery after vaginal delivery (78.9 vs. 33.3 percent). Women who felt more informed felt more satisfied with care.

The study was supported by the Agency for Healthcare Research and Quality (HS11338).

See "Informational factors influencing patients' childbirth preferences after prior cesarean," by R.M. Renner, M.D., M.P.H., K.B. Eden, Ph.D., P. Osterweil, B.S., and others, in the May 2007 American Journal of Obstetrics & Gynecology 196(5), pp. e14-e16.

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