Caesarean Section Case Study

Case Scenario 6 – Caesarean section – patient choice

Delivery by a Caesarean section has become more common over the last several years for a number of various reasons. The old saying “once a c-section, always a c-section”, however, no longer is true. Many women who have had a baby by Caesarean section could deliver their next child vaginally if they so choose. In this case scenario, clinicians are confident that the labour would progress without a complication and that there would not be a need for a Caesarian section. However, the clinician’s opinion conflicts with the mother’s wish to have a C-section. It may not always be the case that what the clinician believes is in the best interest of the patient is what the patient wishes or will

Another view, known as the “patient-centered” view, considers what is necessary to enable the patient to make an informed choice. This is what is referred to in ethics as “informed consent”. The physician must ensure that the mother understands the nature of the procedure, risks involved, consequences, and alternative procedures. This is why informed consent is a matter of judgment. The main feature is that it should be enabling for the mother. Ask not what the physician needs to tell the mother, but what the mother needs to understand so that she can pick the plausible decision in the light of her needs and

It is the incision on the uterus that is the most important in determining whether you are an acceptable candidate for VBAC attempt.

2) Also, if a woman has had two previous cesarean sections with low transverse uterine incisions and a previous vaginal delivery, you may also have the option of choosing a VBAC attempt.

3) If a woman has had a previous surgical procedure on your uterus which involve making a uterine incision such as a myomectomy (removal of the uterine fibroid), a woman cannot be an acceptable candidate for a VBAC attempt.

4) Likewise, if a woman has experienced a uterine rupture with a prior pregnancy, VBAC is not recommended.

In addition to these conditions, ACOG also recommends that certain conditions need to be met by hospitals that offer VBAC attempts. These conditions include:

1) A physician capable of performing an immediate cesarean section available throughout active labor.

2) Immediate availability of both anesthesia and operating room personnel in case emergent cesarean section is necessary.

Only few hospitals today satisfy both of these requirements and potentially offer the option of a VBAC