Women more willing than docs to accept labor risks

NEW YORK (Reuters Health) - Pregnant women are more willing to accept potential risks of delivering their baby vaginally than are the medical professionals caring for them, Australian researchers report.

And among the health care workers surveyed, midwives were ready to take the greatest risks, while colorectal surgeons and urogynecologists — the medical professionals involved in treating severe complications such as incontinence and tears — were the most risk-averse.

More and more women are having C-sections, which could at least in part be due to concerns about the dangers of vaginal delivery, Dr. C. E. Turner of the Royal Prince Alfred Hospital in Sydney, New South Wales, and colleagues note in their report.

The researchers sought to put a number on how much risk pregnant women and their caregivers would be willing to accept before opting for an elective C-section. They looked at 17 potential complications, including various degrees of vaginal tearing, fecal incontinence, or urinary incontinence; emergency C-section; pain in delivery, labor and after birth; sexual problems; and vaginal prolapse. For each one of the complications, study participants gave a percentage for the risk they would be willing to accept before deciding on a C-section.

The survey included 122 women pregnant for the first time, 2 percent of whom said they were thinking about having an elective C-section; 84 midwives; 166 obstetricians; 12 urogynecologists; and 79 colorectal surgeons.

Midwives’ views were the closest to those of the pregnant women. Nevertheless, 10 percent said they would choose to have a C-section for themselves or for their partners, compared to 21 percent of obstetricians, 44 percent of colorectal surgeons and 50 percent of urogynecologists.

Pregnant women were least willing to accept the risk of severe anal incontinence; on average, they said that if the risk of having this complication was any greater than 32 percent they would opt for a C-section. Emergency C-section, moderate anal incontinence, severe urinary incontinence, and severe tears were less acceptable to pregnant women than were pain, less severe tears, and prolonged labor.

Severe or moderate anal incontinence and severe urinary incontinence were among the top five least acceptable risks for all of the medical professionals surveyed, as well as the pregnant women.

The risks the women said they would accept were much higher than the actual risks they would face; for example, women said they would accept a 72 percent risk of third- and fourth-degree tears, while such tears occur in 0.3 percent to 6 percent of deliveries.

“When the women were informed of these rates at the end of the interview, they felt generally relieved,” the researchers report.

The researchers are currently involved in a study looking at whether women’s views change following delivery.

SOURCE: BJOG, November 2008.

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