Women Value Safety Over Choice

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New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology suggests that 'choice' may not be the best way to understand women's decision-making about birth method. The results of the study question the current focus on choice in UK maternity care policy, and challenge prevailing notions about caesarean delivery for maternal request.

... Current guidelines highlight the role of women's preferences in choosing between birth methods such as vaginal birth and caesarean section.

Caesarean delivery on maternal request (CDMR) is a subset of elective caesarean section, performed not by medical necessity, but on request of the pregnant woman. CDMR is perceived as a leading reason for increasing caesarean section rates.

In this study, researchers tracked 454 women at the Liverpool Women's Foundation NHS Trust. The study aimed to explore the views and experiences of women ... to identify how they report decision-making surrounding birth method. This is the first longitudinal study of women's views of CDMR in the UK to follow the same cohort of women from their antenatal booking appointment to 12 months after birth.

The key findings indicate that while most women felt that vaginal birth might be preferable, they accepted that their actual birth method would be determined by the circumstances of their pregnancy, the position of the baby, the course of their labour, and the practices of midwives and obstetricians they encountered.

... By late pregnancy the proportion of women expressing a preference for CDMR had declined to 2%, while those reporting a preference for vaginal birth increased to 80% ...

Moreover, women felt that health concerns should take precedence in decision-making and entrusted health professionals to act appropriately. Any personal preference, such as convenience, was viewed as secondary to maintaining the safety of the baby.

The study found that the percentage of women who expressed a preference for planned caesarean section was very low ...

I have met very few women who request a CS. The vast majority of women want to have a natural vaginal birth with as little intervention as possible. The issue lies with our current maternity system that is, for the most part, obstetrically-driven and is based around CYA policies.

Most women will not know if their CS is truly necessary or not, just as I would not know if I really need a new ball joint or brake pads on my car. Maybe that's why my car services always cost $1,000!! Jokes aside, should women pre-arm themselves with oodles of information before they have a hospital birth, just so they can avoid being one of the 35% women who have a CS? According to the study, our CS rate is not as high as it is because of women wanting a CS: only about 2% CSs are done because women want them. The other 33% have them because their care providers have recommended them, yet for at least 50% of these women, the CS was not necessary. So should women have to have a private midwife, read wide and far about birth and be prepared to fight for a positive birth experience in hospital? It would be nice if a woman could go to hospital with a birth plan and have the staff work with her to achieve her birth plan. Sadly this is not the case. For the time being, the best advice I can give a woman who is planning a natural birth in hospital, is to have a private midwife with her. Private midwives are obliged to ensure that the care provided by hospital staff is evidence-based and regarded as good practice. In the event that hospital staff do not provide care that is considered to be safe and necessary, your private midwife will challenge this on your behalf.

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