Tuesday, December 9, 2008

Study: a quarter of female OBGYNs prefer and suggest cesarean delivery

New research from Iran, 'Caesarean or normal vaginal delivery: overview of physicians' self-preference and suggestion to patients' has found a correlation between a physician's self-preferred mode of delivery and the mode of delivery they suggest to their patients.

Hantoushzadeh et al sent questionnaires to 1,000 female obstetricians and gynaecologists practicing in Tehran in the winter of 2007. They were asked their preferred mode of delivery and the mode they suggest when being consulted by parturient. 785 cases (78.5%) responded to the survey, with 60.8% in favor of suggesting normal vaginal delivery, 25.8%, cesarean section, and 13.6%, painless vaginal delivery.

The study conclusions
The authors clearly have concerns about the 25.8% figure above: "Physicians normally suggest to their patients as the safe mode of delivery what they prefer for themselves. This preference and subsequent suggestion is influenced by different factors including their age, marital status, and previous modes of delivery. As conclusion, it is inferred that informing a physician to choose the right mode of delivery for herself leads to better suggestions to the patients."

What the conclusion says, in effect, is that we not only need to educate women that planned vaginal delivery is a "better suggestion" than planned cesarean delivery, but we also need to tell obstetricians and gynecologists (who are surely sufficiently educated and 'informed' in the subject of birth risks and benefits) what's "better" for them personally too.

Please - It is one thing to argue that ordinary pregnant women are incapable of TRULY understanding the risks involved in a planned cesarean delivery or of coming to terms with the complexities of birth method comparisons (which incidentally, I disagree with), but to imply that OBGYNs are not capable of making their own informed decisions is ludicrous.

Ethical considerations
What I find most interesting about this study is the link between a health worker's personal preferred delivery method and what they suggest to others. I am sure that this element of the survey will illicit stern criticism from groups who are already concerned that physician pressure is one of the factors behind unwanted cesareans.

However, while I would agree that physicians should not coerce healthy women into choosing a birth that is not what they really want, I would also point out that this preference/suggestion behavior is not exclusive to doctors or for that matter, cesareans. I receive emails from many women who are under unwanted pressure to plan a vaginal delivery from their midwife or doctor (when their own preferred mode of delivery is a cesarean) , and this is not ethical either.

Different women want different births. Doctors and midwives should be trying to accommodate ALL women's different birth preferences rather than pressuring them into mirroring their own personal preferences.

1 comment:

Morgan said...

I guess I just don't understand why- why have surgery during birth if you don't have to? Even after 4 (and possibly a 5th. in the future), I can honestly say I just don't understand.

I would love to be able to give birth and be up walking an hour later. To avoid the risk of a spinal headache, which hurts so bad you feel as though you are going to die. To be able to hold my baby as soon as he/she's pulled out of my womb, or maybe even be able to catch the baby myself!

Instead, it's the beeping of the monitors, being cut open while awake, having my baby taken to the other side of the room for the first 15 mins., risking respiratory distress, the risks of a uterine rupture should I go into labor before a scheduled date, the risks of having my baby's placenta grow through my previous scar, and the possibility that my organs could fuse to my uterus and bladder due to the surgery and scarring. Not fun. So why do women choose this route?