April 2007 - Volume 1, Issue 2

ROLE OF MOTHER'S PREFERENCE ON TYPE OF DELIVERY

	Fakhrolmolouk Yassaee MD
	Fakhrolmolouk Yassaee MD Assistant Professor - Behnaz Mohseni Resident of OB & GyN, Shaheed Beheshti University University of Medical Sciences Taleghani Hospital, Evin, Tehran, Iran Tel: 22406935 Fax: 22403694 Email: dr_ fyass@yahoo.com Mobile: 09121262358

ABSTRACT Background: The rate of caesarean section in our society is increasing every day. Most caesareans are performed in private hospitals mainly on the mother's preference and without obstetric indications. In fact, in contrast to the past, these days, it is the mothers, who decide to select the type of delivery. This study was conducted to determine the role of mother's wishes on the course of labor and the type of delivery. Material & Methods: 106 women, who came for prenatal care were included in this descriptive study. Criteria for inclusion were : First pregnancy , no systemic disease , no obstetric indication for caesarean before labor pain , no history of infertility, non smoker. All women , regardless of their wish, were informed about the benefits of normal vaginal delivery, were given trial of labor and were supported through different stages of labor. Results: From a total of 106 pregnant women; 65 preferred to have a normal vaginal delivery, and 41 of them preferred caesarean section. The rate of caesarean section in the first group was 12.3% (8 from 65) and in the second group it was 34.2% (14 from 41)(P<0.01) , (Table 1). Conclusion: The results of this study shows that mother's preference has a meaningful impact to the route of her delivery.

Key words: Caesarean section, Vaginal delivery, Mother's wish INTRODUCTION

For most countries, rates of caesarean section have risen as operative vaginal rates has fallen.

As disturbances in psychological condition like stress and fear of delivery, may cause disturbances in normal physiologic mechanisms, fear of normal vaginal delivery or a preference of caesarean section can cause disturbances in the pattern of normal vaginal delivery (1).

14.5% of women in the U.K. opted for an elective caesarean section on maternal request. The main reasons being to avoid prolonged labor and for fetal well being (2).

In contrast Asian women seem to largely prefer vaginal deliveries with only 3.7% preferring an elective caesarean section on maternal request. The reason for the request was pretty similar to that of U.K. mothers (3).

We did a study on 106 women who were referred to Mahdieh and Taleghani hospitals for delivery from January to December 2000.
MATERIALS AND METHODS

In this descriptive study 106 mothers came to these hospitals for delivery. They were primigravida ,with no systemic disease , no obstetric cause for caesarean section, no history of infertility , and non smokers. They were divided into two groups according to their preference for type of delivery. Group 1: vaginal delivery. Group 2: caesarean section. Course of labor was observed when they were admitted with labor pain. If date for delivery was delayed, oxytocin was started for induction of labor. Mother's choice as to the type of delivery, that was recorded previously on medical sheet, age, level of education, and her occupation was recorded on form A. Type of delivery, course of labor, gestational age , how labor pain started - spontaneously or by induction of syntoscinun, use of vacuum or forceps was recorded on form B. Comparison between the two groups was done and data processesing done with chi - square. RESULTS

The subject's mean age was 21.5 ± 1.1 years. Mother's preference for caesarean section in highly educated women (i..e with at least a Bachelor's degree ) was 54.5 %, and in women with lesser education was 22.2%.

Preference for caesarean delivery was 52 % in working ladies and 38 % in house wives .
The rate of caesarean section in the group 1 was 12.3 % and its rate in the group 2 was 34.2 % ( Table 1 ), p < 0.01. The mean duration of second stage of delivery in group 1 was 35.5 ± 10.38 minutes and its duration in group 2 was 44.74 ± 13.9 minutes.
t = 3.56 , P < 0.003

Use of oxytocin for induction of labor and delivery in group 1 was 18.4 %, and in group 2 was 36.5 %, ( P < 0.05). Post term pregnancy in group 1 was 21.5% and in group 2 was 39 %, (P < 0.06).

Use of forceps or vacuum in group 1 was 3% and in group 2 was 4.8 % (NS).
respectively.
DISCUSSION

This study shows that there is a significant relationship between mother's preference as to the type of delivery, ( P < 0.01 ). In a research that was done in 1998 in obstetrics and gynecological department of Central Hospital in Helsingborg in Sweden, it is mentioned that fear of delivery caused an increase in the rate of emergency caesarean delivery (4). This compares well with our study which shows increased rate of caesarean delivery in mothers who preferred it, and it may have been due to fear or stress about normal delivery. In another research that was done in Karolinska Institute in Sweden, it is mentioned that women affected by stress and those who are afraid of normal delivery, need more specific psychological support. Finally women with fear of childbirth remembered the pregnancy as distressing, in spite of support. Also those who infially had asked for a caesarean section but eventually underwent a vaginal delivery (5). A research that was done in health school of Latrobe University in Victoria on immigrant Australian Thai women, showed that in the group of women who considered caesarean delivery as a safe method of birth, emergency caesarean delivery was higher when compared with controls (6). This corresponds with our study. In Norway a recent survey showed that 8.4% of their caesarean sections were for maternal request (7).

Mother's preference is helpful in second stage of delivery for bearing down and relaxation of perineal muscles for shorter duration of second stage. We also showed in our study that when the mother preferred a normal delivery, mean duration of second stage of delivery was 35.5± 10.38 minutes compared with mothers who preferred caesarean delivery, in whom its duration was 44.74 ± 13.9 minutes (P< 0.003). On questioning obstetricians in the UK in 1999, 69% of consultants said they would agree to a maternal request for caesarean section with no clinical indication. Of these 60% feel that their practice has changed recently (8).

Mind and body are two different essences. One of them is liberated and metaphysical, while the world of matter and material limits the other. These two make the identity of a person, and have mutual and opposing effects on each other (9). The human mind has always been interested in acquiring voluntary control over involuntary processes like pulse, blood pressure, respiration (10). It has been suggested that hypothalamus and limbic systems and reticular systems in the brain play important roles in controlling emotion. Stimulation of the paraventricular nucleuses causes secretion of oxytocin from neuronal cells and may play a role in the progress of labor and delivery of newborns (1). Since it is well known that oxytocin acts through the paracrine system, we could not find a rational explanation for the effect of fear and stress on the process of labor. Although the mechanism of labor is not known, it has been seen that oxytocin injection is needed for induction of labor in post term pregnancy. As this problem was seen more in women who had preferred caesarean section from the beginning, the possibility remains that failure to start labor in these women could have been due to the effect of limbic systems and hippocampus on the hypothalamous and hypophysis.

Irvine in North Thames region of England concluded that maternal request for caesarean section is patient and not obstetrician led (11). REFERENCES

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