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OB: elective primary sectionFrom: art fougner, md (evsono@pipeline.com)Fri Mar 2 07:36:22 2001
In tomorrow's Lancet - Home The Journal Current Issue Correspondence Volume 357, Number 9257 03 March 2001 Correspondence Obstetricians' choice of delivery Sir--R Al-Mufti and colleagues (Feb 24, 1996, p 544)1 surveyed 282 obstetric consultants in London to find out the method of delivery they would prefer if they or their partners were pregnant for the first time in an otherwise uncomplicated pregnancy. They found that, overall, 17% would choose an elective caesarean delivery, including 31% of female and 8% of male obstetricians. This choice was based on concern about perineal damage from vaginal delivery, risk of injury to the baby, and the desire for an electively timed delivery. 68% preferred a caesarean delivery for a cephalic presentation with an estimated weight of more than 4·5 kg, and 39% for an estimated weight of 4·0-4·5 kg. Al-Mufti and colleagues conclude that feelings of obstetricians might influence the way they counsel their patients, which raises the question of whether caesarean delivery should be offered routinely to all pregnant women. Marsden Wagner (Nov 11, p 1677)2 reviewed this issue. Stimulated by Al-Mufti's findings, we surveyed North American obstetricians attending the American College of Obstetricians and Gynecologists (ACOG) District VIII and IX Meeting held in August, 2000. These two districts encompass the states of Alaska, Arizona, Colorado, Hawaii, Washington, Oregon, Idaho, Montana, Nevada, New Mexico, Utah, Wyoming, and California. They also include American Samoa and Guam, and, in Canada, the Northwest Territory, British Columbia, Alberta, and the Yukon Territory. Participants at the meeting could respond to questions from speakers or from panelists by a handheld audience response system. We also collected demographic information. We could tabulate responses immediately, and provided this feedback to the participants. During a panel discussion on the risks and benefits of vaginal birth after caesarean delivery, members of the audience were asked if they would personally prefer to be delivered by caesarean section. Of 117 participants, 46·2% said they would choose caesarean delivery. Of note, 56·5% of the male and 32·6% of female obstetricians said they would prefer a caesarean section. When asked what route of delivery they would personally select for an infant weighing 4·0-4·5 kg, 70% said they would prefer a caesarean section, and for an estimated weight of 4·6 kg or more, 88% would desire a caesarean section. Most of the participants were members of single-specialty practices (25%), multispecialty group practices (14%), and academic-based practices (13%). Nearly 70% were older than 40 years, with most being aged 51-59 years. Our survey results support the findings of Al-Mufti and colleagues. Nearly half of the obstetricians surveyed would prefer a caesarean delivery and, surprisingly, more of the male obstetricians desired caesarean delivery. With birthweights of 4 kg or more, at least 70% would request a caesarean section. W Benson Harer Jr, President of the ACOG wrote ". . . a woman's right to participate in the decision and to choose to deliver her child by caesarean delivery will be respected".3 The patient's choice seems to be being supported by obstetricians themselves. *Steven G Gabbe, Gerald B Holzman art
-- art fougner, md
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