Trial of labour or elective repeat caesarean delivery:are women making an informed decision at Kenyatta national hospital?

Abstract

A successful trial of labour culminating in vaginal birth, a failed trial resulting in an emergency repeat caesarean delivery, or an elective repeat caesarean delivery are the three possible outcomes for the woman who has had a prior caesarean section. Planning the mode of delivery should be addressed early during prenatal care, and can begin even pre-conceptionally. With either approach, women who have undergone a prior caesarean delivery are at risk for serious maternal and perinatal complications and should be counselled about these risks [1].

In the USA, Federal Acts and regulations as well as professional guidelines clearly demonstrate that every pregnant woman has the right to base her maternity care decisions on accurate, up-to-date, comprehensible information [2]. Informed consent is "the willing acceptance of a medical intervention by a patient after adequate disclosure by the physician of the nature of the intervention and its alternatives with its risks and benefits " [3, 4]. It is thus more than just signing a consent form.

The decision for elective repeat caesarean delivery or trial of labour should be made by the woman in consultation with her provider. Both clinicians and patients desire individualized information about the chance of successful TOLAC and the balance between the risk of maternal or foetal morbidity if TOLAC is unsuccessful and the risk of maternal and foetal morbidity with ERCD [5]. Women in the USA report that their healthcare providers’ recommendations and preferences exert a strong influence on their decision whether or not to pursue TOLAC [6].

This information is also important on a population level, especially in the setting of rising caesarean delivery rates, as selection of candidates who are most likely to deliver vaginally after a previous operation can minimize the costs of ERCD and failed TOLAC [5]. In fact, improving patient education may not affect the increasing section rate; it would, however, empower women to make a well informed, educated decision [7].

The aim of this study was to determine whether patients with one previous caesarean delivery were making an informed decision about their preferred mode of delivery at “Kenyatta National Hospital”.