C-section vs vaginal birth

[obiwan]

seeing how its been almost 10 years since my ob-gyn rotation, i was just wondering if there has been any updates with respect to recommendations between elective c-section vs vaginal birth. how do you approach a patient who asks about the 2 ?

thanks

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[elevation1]

seeing how its been almost 10 years since my ob-gyn rotation, i was just wondering if there has been any updates with respect to recommendations between elective c-section vs vaginal birth. how do you approach a patient who asks about the 2 ?

thanks

I'd recommend you look at the guidelines rather than asking on here for a more complete answer.

Short answer is that vaginal deliveries are preferred unless there is an indication requiring a C-section.
If there is no indication for a C-section as per the guidelines, then a vaginal delivery should be done.
"Patient preference" is not technically an indication for a C-section.
Vaginal deliveries have lower risks and potential complications vs. C-sections in the context of a C-section not being indicated.
Vaginal birth after previous C-section (VBAC) is risky, particularly risk of uterine rupture.

As for how to approach a patient, I'd just follow the same lines of communication that you usually use...
>Why do you prefer a C-section?
>What fears do you have regarding vaginal delivery?
>Are you aware of the epidurals available to relieve pain during labor?
>Inform about the risks of C-section and vaginal delivery
>Etc.

Disclaimer:
1) I'm a med student and these are just some of the points I remember from my rotation.
2) This information is not intended to be used for diagnosis or treatment of medical conditions. Always consult your doctor.

 

[THP]

I'd recommend you look at the guidelines rather than asking on here for a more complete answer.

Short answer is that vaginal deliveries are preferred unless there is an indication requiring a C-section.
If there is no indication for a C-section as per the guidelines, then a vaginal delivery should be done.
"Patient preference" is not technically an indication for a C-section.
Vaginal deliveries have lower risks and potential complications vs. C-sections in the context of a C-section not being indicated.
Vaginal birth after previous C-section (VBAC) is risky, particularly risk of uterine rupture.

As for how to approach a patient, I'd just follow the same lines of communication that you usually use...
>Why do you prefer a C-section?
>What fears do you have regarding vaginal delivery?
>Are you aware of the epidurals available to relieve pain during labor?
>Inform about the risks of C-section and vaginal delivery
>Etc.

Disclaimer:
1) I'm a med student and these are just some of the points I remember from my rotation.
2) This information is not intended to be used for diagnosis or treatment of medical conditions. Always consult your doctor.

I agree that this is what is taught in medical school, however, ACOG does have a practice bulletin regarding elective primary c-section. May be something you want to read.

As an OB/GYN in private practice with an affluent patient population, I have a lot of highly educated patients (including physicians) who can definitely understand the risks and benefits of one versus the other.

In general we encourage vaginal deliveries if possible, however, if a patient simply desires a primary c-section and they can understand the risks then it is perfectly acceptable to have one. Really, it is safer for the baby, and studies bear this out, although truly is a minimal benefit on a large scale. That starts to change however when you get to the 4th c-section. At that point the risks do start outweighing the benefits of a c-section for the baby. I counsel a patient if they think there is any possibility they would want 4 or more children they should really try for a vaginal delivery or VBAC if first baby was a c-section.

 

[npappasan]

The data actually seem to show increases in the composite risks after a woman's second cesarean delivery. Elective cesarean on maternal request is a tricky subject. I rarely encounter it but discuss the risks and benefits of both modes of delivery and do my best to sway towards vaginal delivery. If a patient wants a cesarean though, that is what I do and document my counseling accordingly. You'll usually never dig yourself into a hole by doing a cesarean. The inverse is not true should anything untoward occur with a vaginal delivery attempt that a patient resisted