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Published on: January 27, 2010
UK O&G trainees' attitudes to caesarean delivery for maternal request
Mehrnoosh Aref-Adib1, Evangelia Vlachodimitropoulou1, Rajvinder Khasriya2
1a Newham General Hospital, Barts Health NHS Trust , London , UK.
Summary
UK Obstetrics and Gynaecology trainees show varied attitudes towards caesarean delivery for maternal request (CDMR). While many would grant CDMR, a significant portion disagree with the procedure, highlighting the need for clearer guidance.
Area of Science:
- Obstetrics and Gynaecology
- Maternal Health
- Surgical Procedures
Background:
- The caesarean section rate in the UK has tripled over 30 years, reaching 25% of all deliveries.
- Rising caesarean rates incur financial burdens and excess clinical risks.
- Understanding the attitudes of obstetricians in training is crucial for managing caesarean delivery for maternal request (CDMR).
Purpose of the Study:
- To assess UK Obstetrics and Gynaecology (O&G) trainees' attitudes towards caesarean delivery for maternal request (CDMR).
- To identify differences in trainees' attitudes towards patients requesting CDMR and their own delivery preferences.
- To explore reasons behind trainees' attitudes and preferences regarding CDMR.
Main Methods:
- An internet survey was distributed electronically to UK O&G trainees from February to June 2013.
- The survey covered personal preferences, experiences, and attitudes towards CDMR, as well as treatment of patients requesting CDMR.
- Two hundred and forty O&G trainees participated in the survey.
Main Results:
- 6% of trainees (or their partners) had opted for CDMR; 21% would choose CDMR for their first pregnancy, citing concerns over pelvic floor, baby safety, and convenience.
- 58.6% of respondents would grant a patient's request for CDMR, citing maternal choice, psychological concerns, and fear of perineal injury.
- While 29.6% agreed with CDMR, 46.4% disagreed. Trainees' attitudes were not associated with having children but were linked to personal experience or future plans regarding CDMR.
Conclusions:
- Trainees' attitudes towards CDMR are varied, with a notable proportion willing to grant requests but also significant disagreement with the procedure.
- Concerns about pelvic floor integrity are a primary driver for CDMR requests among trainees.
- Clearer guidance and training on managing patient requests for CDMR are recommended to individualize patient care and potentially influence caesarean rates.
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