The Importance of Pre-Labour Counselling for Caesarean Section

The Importance of Pre-Labour Counselling for Caesarean Section

It is undeniable that giving birth is an extremely daunting act for many women. As such, it is important that women feel as comfortable and as prepared as possible for this. Therefore, it is imperative that a pre-labour discussion outlining options for mode of delivery, along with the risks and benefits of such, should be had. This is even more imperative when the woman has a multiple pregnancy (e.g., twins, triplets, etc.) with the national recommendation being that this discussion takes place by 32 weeks gestation.

Caesarean sections are generally based on a risk-benefit analysis that takes into account all clinical information and this analysis must determine whether delivery through the maternal abdomen rather than vaginal delivery is in the best interests of the mother and foetus – hence the importance of the aforementioned discussions. Pre-labour risks which indicate the need for a caesarean section include foetal breech presentation, placenta praevia and certain infections in pregnancy. In some cases, women request elective caesarean section delivery, despite there being no concerns. Again, in this instance, a pre-delivery discussion regarding the risks and benefits is imperative so the woman can make an informed decision.

The discussion for caesarean section should include the long-term benefits such as a lower chance of developing urinary incontinence and a slightly reduced chance of pelvic organ prolapse. This discussion should also include short-term benefits such as a lower chance of perineal trauma, avoidance of labour associated pain, and reduced risk of shoulder dystocia.

Thus, in summary, it is extremely important to outline the risks and benefits regarding a caesarean section so as to ensure the patient feels as calm as they can before labour and to ensure informed consent is given to whatever mode of delivery they opt for.

References

  • Keag OE, Norman JE, Stock SJ. Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med. 2018;15(1):e1002494. Published 2018 Jan 23. doi:10.1371/journal.pmed.1002494
  • Co-authored by The TMLEP Clinical Risk and Patient Safety Publishing Group and Ms Georgia Millington, TMLEP Analyst.. (2021). The Importance of Pre-Labour Counselling for Caesarean Section. TMLEP Clinical Risk Case Studies. 4 (7), 1.

Important Note

This article is intended to raise awareness to clinical risk issues in an effort to reduce incidence recurrence and improve patient safety. This is not intended to be relied upon as advice. Facts have been altered to ensure this case is non-identifiable, albeit clinical learning points remain applicable. To request an independent clinical review, please contact admin@tmlep.com or call +44 (0) 203 355 9796.