Ethical dilemma of cesarean section on maternal request (Csmr)

Abstract

Objective: To study the demographic characteristics of pregnant ladies and factors contributing towards rise in cesarean section on maternal request to aid the obstetricians in decision making. Study Design: Cross sectional analytical survey. Place and Duration: Gynecology Department of Pak Emirates Military Hospital, Rawalpindi, from Nov 2019 to Mar 2020. Methodology: One hundred and fifteen women of child bearing age requesting cesarean section were included in the study. Demographic details were noted. A study proforma was filled for determinants of primary and secondary tocophobia and factors that may be improved for vaginal delivery. Results: A total of 115 patients with mean age of 27.99 years were included. Amongst them, 88 (76.5%) were Punjabi with 92 (80%) living in rural area. Primigravida were 11 (9.6%), 83 (72.2%) had previous lower segment cesarean section and 3 (2.6%) had vaginal delivery. For primary tocophobia, 22 ( 24.4%) experienced anxiety. Fear of labor pains was seen in 20 (19.2%) and lack of control in 27 (26%). For secondary tocophobia, 15 (37.5%) were fearful of prolonged labor and 5 (22.5%) of sub optimal birth outcome. In women with previous one cesarean section, 13 (14.8%) correlated negatively with birth experience and 20 (22.7%) found timed cesarean section convenient. For vaginal delivery, pain relief was preferred by 19 (20.2%) and 31 (33%) wanted pain relief and attendant. Conclusion: Better understanding of fears behind maternal request for cesarean section can lead to improved attitudes towards vaginal delivery. The negative perceptions of pregnant ladies should be addressed in antenatal visits.