Patient Counseling and Preferences for Elective Repeat Cesarean Delivery

Area of Science:

• Obstetrics and Gynecology
• Reproductive Health
• Maternal-Fetal Medicine

Background:

• Vaginal birth after cesarean (VBAC) offers benefits, but elective repeat cesarean delivery (ERCD) remains a common choice for women with a prior cesarean.
• Informed decision-making is crucial for selecting delivery methods, yet counseling quality regarding VBAC success rates can vary.

Observation:

• A prospective study evaluated 68 women undergoing ERCD who had one prior cesarean and no contraindications to labor.
• Counseling adequacy was assessed based on recall of counseling, VBAC success probability, and accuracy of quoted rates.

Findings:

• Only 11.8% of participants received adequate counseling regarding their delivery options.
• A significant majority of women with a high probability of successful VBAC (over 70%) were inadequately counseled.
• Primary drivers for choosing ERCD over VBAC included personal preferences, concerns about fetal injury, and physician recommendations.

Implications:

• There is a critical need to improve the quality and consistency of counseling for women considering VBAC versus ERCD.
• Enhanced patient education can empower women to make more informed decisions aligned with their health and preferences.
• Addressing patient and physician factors in counseling may help optimize delivery mode selection and improve maternal-child outcomes.