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.
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Funding: Atlee Foundation, Department of Obstetrics and Gynaecology, Dalhousie University
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Appendices
Appendix 1
Questions in section one of a survey of health care professionals
On the role of elective cesarean in obstetric practice
Please answer the following questions basing your answers on your current knowledge and practice, using the Likert scale* below each statement.
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A.
After an informed discussion it is acceptable medical practice to perform, at her request, an elective caesarean delivery for a nulliparous woman in the absence of an obstetric indication.
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B.
The following issues may be included in your informed discussion with a woman requesting elective caesarean delivery. Please rate the following statements based upon your assessment of the current evidence.
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(i)
Vaginal delivery has a detrimental effect on bladder and bowel continence.
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(ii)
Forceps delivery has a detrimental effect on bladder and bowel continence.
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(iii)
Caesarean delivery when compared to any mode of vaginal delivery will reduce problems with bladder and bowel continence.
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(iv)
Elective caesarean delivery reduces the risk of maternal mortality and morbidity compared to intrapartum caesarean delivery.
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(v)
Elective caesarean delivery reduces the risk of fetal mortality and morbidity when compared to intrapartum caesarean delivery.
*Likert scale for each question included the choices never, rarely, sometimes, usually and always
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Farrell, S.A., Baskett, T.F. & Farrell, K.D. The choice of elective cesarean delivery in obstetrics: a voluntary survey of Canadian health care professionals. Int Urogynecol J 16, 378–383 (2005). https://doi.org/10.1007/s00192-005-1324-3
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DOI: https://doi.org/10.1007/s00192-005-1324-3