Decision to undergo repeat cesarean operation among selected women in Cavite: factors and outcomes

The rate of caesarian section (CS) in this country is still high despite relative safety of vaginal birth after previous CS (VDAC) and expensive cost of CS operation. Repeat CS (RCS) cases constitute the bulk of total CS cases. This is a retrospective and descriptive study that examines the health provider factors, individual patient factors and the outcomes and consequences of the decision to undergo RCS among 57 selected women who delivered both in a private and a public hospitals in Cavite. Five doctors were also interviewed. Data collection was done through self-administered questionnaires, in-depth interviews and observation of the activities inside the outpatient obgyne clinics of private and public hospitals. Content analysis and statistical treatments were used to analyze the data. The study found that doctor respondents preferred RCS to vaginal delivery. They also admitted that their CS and RCS rates are high. The reasons for the high RCS rate according to the health providers are fear to feel labor pains, CPD as an indicator of the previous CS, and doctors\u27 preference of RCS to VDAC. The reasons behind preference to RCS to VDAC are relative safety of surgical procedure, perception that trial of labor (TOL) is taxing and time-consuming, lack of facilities for TOL and the financial incentives in CS. Moreover, manipulation of breech babies to headfirst position is not practiced anymore by four of the doctors. Health providers perceived that they should play and active role in the decision making for the health care of their patients. The women respondents came from either the middle class or low-income group who availed of private or charity accommodations in the said hospitals respectively. All respondents claimed they regularly seek prenatal care although 18 percent were emergency caesarean cases. Most women did not take action to address possible signs and symptoms of reproductive health problem. It was inferred and confirmed the women\u27s low level of knowledge of caesarean. Private women perceived a doctor could not operate CS on a woman if she does not want to and contrary, women respondents in the public group perceived a doctor could always decide to operate CS on a woman even if she does not want to be operated on. For almost all women, a family is never complete without a child. To them the repeat CS was the only available option to deliver a healthy child so that to undergo a repeat CS is not mainly for their sake but for the baby\u27s safety. Caesarian is perceived by most to be inconvenient, physically and financially. Women articulated three types of outcomes and consequences of a repeat CS: physical, financial and emotional. Both the health provider factors and the individual patient factors interact and created a conducive atmosphere for the woman to submit to RCS, regardless of whether she likes it or not. For best results and satisfaction of both the health provider and patient have to maintain open communication lines. There is no room for paternalism or patient autonomy in real clinical medicine, specially in making a decision on RCS