Objectives

1. Caesarian Section at Demand- A Patient perspectiveAl Saffar N1,Gupta M1,Vaidya A1, Bhattacharya A2(Farwaniya Hospital Kuwait-1; Faculty of Medicine Kuwait-2) Introduction Trends in child-birth have become more women centric1, with “informed choice” becoming the buzz-word for patient care. One of the major choices which any women would like to make would be the choice of route of delivery. 2,3 There has been almost a threefold increase in caesarian section at demand. 4 In Farwaniya hospital Kuwait, Caesarian sections on maternal demand accounted for nearly 20 % of the indications in 2010. However, caregivers have to balance the risks of Caesarian sections 5,6 with the need for respecting patient choice. The increasing trend of requests for CS is a phenomenon which needs to be researched in depth. Recognisingthe motivation behind this request is one of the keys to understanding this. Results 82 patients (67.2%) of the patients had a previous Caesarian section, 26 patients(21.3%) had previous normal deliveries. 14(11.47%) had Instrumental deliveries Out of the 26 patients who cited high social premium on baby as a reason, 8 (31%) had history of infertility which was significantly higher than those who gave other reasons (p<0.001) Discussion Nearly half the patients in our study cited fear of labour as a cause for choosing CS as the mode of delivery and all of them had a previous negative labour experience.7,8(Sample size was small to include use of epidural analgesia in the analyses) Patients with a history of infertility placed a high social premium on their baby and cited that as a reason for choosing CS, leading to the inference that CS is safer for the baby.9 These above findings although small in number as of now(the study is still on) to prove statistically significant are consistent with findings in other studies. However as clinicians we know that in spite of the relative safety of the procedure, un-indicated CS offers no additional benefits to the baby, 10 and may increase the risk of neonatal respiratory problems. 11 The risks to the mother’s health are also substantial, especially in terms of implications on future pregnancies. 3,4 There are many obstetricians who believe in the safety of CS for the baby over Vaginal delivery, 12 Given this scenario, in-depth counseling the patients about the risks versus benefits of CS may entail a change in beliefs of the caregivers, Conclusions One of the primary motivating factors which propel women to opt for a caesarian section seems to be a fear of child-birth. Better obstetric analgesia including effective epidural service is a likely means to reduce this trend Patients with a history of infertility tend to opt for CS as a mode of delivery owing to a belief that it is safer for the baby compared to vaginal birth. Continous, on-going pre-natal counseling about the risks and benefits of CS will empower women to make an informed choice • The most common reasons for opting for CS were: • Fear of child-birth -58(47.5%) • high social premium on baby- 26(21.3%), • difficult labour-16(13.1%), • convenience- 10(8.2%), • previous CS (as the only reason)- 12(9.8%). • Objectives • A structured oral questionnaire survey was designed study the patient perspective on the issue. • We were seeking answers to: • What were the common motivating factors for requesting CS? • Did previous child-birth experience have an impact on current decision? • Methods • 122 patients who opted for caesarian section as the mode of delivery were interviewed over 6 months(1/10/2011 to 31/03/2012) and their responses recorded on a questionnaire. Data Analysed included: • Age, • Ethnicity, • Occupation, • Level of education, • Previous child-birth experience, • Medical and gynecological history • Reasons for opting CS, • Desired family size • Knowledge of risks(Scoring system: 0=no knowledge; 1= partial knowledge; 2= complete knowledge.) • The data was analysed using SPSS software. Test of significance used was chi-square test. • 58 patients cited fear as the motivation out of which the negative labour experience was as follows • 14(24%) had delivered vaginally • all of them said they had a bad experience in labour • Among the 64 Patients who cited other reasons, 22 (34.37%) delivered vaginally and 6(27.2%) had a negative experience overall. • Among patients who cited fear as the primary reason the incidence of bad labour experience was significantly higher when compared to those who gave other reasons References ChangingChildbirth Report Should doctors perform an elective caesarean section on request? Yes, as long as the woman is fully informed. Br Med J 1998; 317: 462–63. Paterson-Brown S. Feinmann J. How to limit caesareans on demand – too NICE to push? Lancet 2002; 9308: 774. Cs without medical reason, 1997 to 2006: a Swedish register study. Birth. 37(1):11-20, 2010 Mar Karlstrom A. E-t al J Matern Fetal Med. 2001 Dec;10(6):414-9.Placenta previa: obstetric risk factors and pregnancy outcome.Sheiner E, Shoham-Vardi I, Hallak M, Hershkowitz R, Katz M, Mazor M. National Institutes of Health Consensus Development Conference Statement ---vaginal Birth after Cesarean: New Insights March 8-10, 2010 Women’s attitudes regarding mode of delivery and cesarean delivery on maternal request The Journal of Maternal-Fetal and Neonatal Medicine, July 2011; 24(7): 894–899 LEO PEVZNER1, CHRISTINE PRESLICKA2, MELISSA C. BUSH3, & KENNETH CHAN2 Cesarean section on request at 39 weeks: Impact on shoulder dystocia, fetal trauma, neonatal encephalopathy, nd intrauterine fetal demise. SeminPerinatol 2006;30:276–87. doi:10.1053/j.semperi.2006.07.009 Hankins GD, ClarkSM, Munn MB Who consensus statement 1985 Obstetricians’ personal choice and mode of delivery. Lancet 1996; 347: 544. Al-Mufti R, McCarthy A, Fisk NM. Temporal and geographical variation in UK obstetricians’personal preference regarding mode of delivery. Eur J ObstetGynecolReprodBiol 2002; 100: 185–88. Groom KM, Paterson-Brown S, Fisk NM.