Journal of Isfahan Medical School

Journal of Isfahan Medical School

Perspectives of Pregnant Women about Commitment of Obstetricians and Gynecologists to Informed Consent Principle Regarding Delivery Method, Isfahan, Iran

Document Type : Original Article (s)

Authors
Ahmad Reza Zamani 1
Ziba Farajzadegan 1
Reza Sirous 2
1 Associate Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
2 General Practitioner, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
Background: Natural vaginal delivery is usually considered as the best method of delivery. However, the rate of cesarean section has been increasing several times during recent decades. Nowadays, approximately 50-65% of deliveries in Iran are performed as cesarean section. This trend can be dealt with by providing correct information about the advantages and disadvantages of cesarean and vaginal delivery. The present study aimed to investigate the extent of information gynecologists provide to pregnant mothers about the advantages and disadvantages of various childbirth methods (informed consent factors).Methods: This cross-sectional, descriptive study was conducted on 482 pregnant women at the third trimester of pregnancy who had been admitted in obstetrics and gynecology ward of a certain number of private hospitals, university hospitals, non-academic public hospitals, and hospitals affiliated to Social Security Organization for delivery or any other reason. Pregnant mothers were selected though convenient non-randomized method. The informed consent questionnaire consisted of 30 questions about disadvantages, advantages, costs, alternative methods, and the method and quality of presenting information to mothers. The data was analyzed by chi-square, Kruskal-Wallis and Mann-Whitney tests in SPSS16.Findings: Mean total information presented to the pregnant women was 1.06 ± 0.93 out of 4. The presented information included complications of cesarean (0.82 ± 1.07), complications of natural vaginal delivery (0.85 ± 1.1), advantages of cesarean (1.29 ± 1.00), advantages of vaginal delivery (1.34 ± 1.00), costs (2.29 ± 1.30), and alternative deliveries (0.95 ± 1.10). Quality of information presentation was scored as 1.21 ± 1.14. Conclusion: The commitment of obstetricians and gynecologists to obtain informed consents from mothers was very low. In addition, it was associated with a particular bias in some cases. Thus, implementing developed and proper planning seems necessary to educate and promote awareness and knowledge of patients toward patient rights. On the other hand, the attention of physicians needs to be attracted toward concentrating more on patient rights.
Keywords
Cesarean section
Natural vaginal delivery
Informed Consent
  1. Villar J, Valladares E, Wojdyla D, Zavaleta N, Carroli G, Velazco A, et al. Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America. Lancet 2006; 367(9525): 1819-29.
  2. Jamshidi Manesh M, Haghdoost Oskouei SF, Jouybary L, Sanagoo A. The process of women’s decision making for selection of cesarean delivery. Iran J Nurs 2008; 21(56): 55-67.
  3. Mostafazadeh F, Mashoufi M, Rostamnegad M. Attitude of Pregnant Women and Health Personnel towardNormal Delivery Vs Cesarean Section. J Ardabil Univ Med Sci 2007; 6(4): 403-8.
  4. Minkoff H. The ethics of cesarean section by choice. Semin Perinatol 2006; 30(5): 309-12.
  5. Rahimikian F, Mirmohamadali M, Mehran A, Aboozari K, Salmaani Barough N. Effect of education designed based on health belief model on choosing delivery mode. Hayat 2008; 14(3-4): 25-32.
  6. Sharifi-Rad Gh, Fathi Z, Tirani M, Mahaky B. Evaluation of vaginal delivery and cesarean in pregnant women base on behavioral intention model. J Ilam Univ Med Sci 2007; 15(1): 21-3.
  7. Gregory KD, Jackson S, Korst L, Fridman M. Cesarean versus vaginal delivery: whose risks? Whose benefits? Am J Perinatol 2012; 29(1): 7-18.
  8. Lee YM, D'Alton ME. Cesarean delivery on maternal request: the impact on mother and newborn. Clin Perinatol 2008; 35(3): 505-18, x.
  9. Piquette-Miller M, Jamali F. Selective effect of adjuvant arthritis on the disposition of propranolol enantiomers in rats detected using a stereospecific HPLC assay. Pharm Res 1993; 10(2): 294-9.
  10. Duckworth S. Should maternal choice be an indication for caesarean section? Int J Surg 2008; 6(4): 277-80.
  11. Miesnik SR, Reale BJ. A review of issues surrounding medically elective cesarean delivery. J Obstet Gynecol Neonatal Nurs 2007; 36(6): 605-15.
  12. Penna L, Arulkumaran S. Cesarean section for non-medical reasons. Int J Gynaecol Obstet 2003; 82(3): 399-409
  13. David H, Norman J. Gynecology illustrated. 5th ed. London: Churchill Livingstone Co; 2000.
  14. Malcolm S, Ian M. Essential obstetrics and Gynecology. 3th ed. Edinburg: Churchill Livingstone Co; 1998
  15. Laluei A, Kashanizadeh N, Teymouri M. The influence of academic educations on choosing preferable delivery method in obstetrics medical team: investigating their viewpoints. Iran J Med Educ 2009; 9(1): 78-69.
  16. . Mohammadbeigi A. Mohammad Salehi N. Modeling of Associated Factors that A ffect the M ethod of Pregnancy Termination. Iran J Obstet Gynecol Infertil 2009; 12(1): 17-24.
  17. Arjomandi B, Farzin Moghadam S. Assessment of the Level of the Pregnant Womens Knowledge Towards the Advantages and Disadvantages of Normal Vaginal Delivery and Cesarean Section, Tehran (2005). Razi J Med Sci 2007; 14(55): 13-22
  18. Kalish RB, McCullough LB, Chervenak FA. Is non-directive counseling for patient choice cesarean delivery ethically justified? J Perinat Med 2007; 35(6): 478-80.
  19. Christilaw JE. Cesarean section by choice: constructing a reproductive rights framework for the debate. Int J Gynaecol Obstet 2006; 94(3): 262-8.
  20. Azizi M, Salari P. Ethical approach on cesarean delivery with maternal request. Iran J Med Ethics Hist Med 2009; 2(2): 55-66.
  21. Tabandeh A, Kashani E. The incidence of cesarean section in women's medical education in Gorgan (2005) (short Brief). J Gorgan Univ Med Sci 2007; 9(2): 67-70.
  22. Moayyed Mohseni S, Mohammadi Kh. Anticipated increase in the cesarean. according to some current available data. Daneshvar Med 2006; 14(66): 59-62.
  23. Betran AP, Merialdi M, Lauer JA, Bing-Shun W, Thomas J, Van LP, et al. Rates of caesarean section: analysis of global, regional and national estimates. Paediatr Perinat Epidemiol 2007; 21(2): 98-113.
  24. Robson SJ, Tan WS, Adeyemi A, Dear KB. Estimating the rate of cesarean section by maternal request: anonymous survey of obstetricians in Australia. Birth 2009; 36(3): 208-12.
  25. Leonie P. Caesarean section on request for non-medical Indications. Int J Gynaecol Obstet 2012; 14(3): 220-3.
  26. Errol R Norwitz, Charles J Lockwood VAB. Cesarean delivery on maternal request. [Online]. 2009. Available from: URL: http://www.uptodate.com/contents/cesarean-delivery-on-maternal-request.
  27. Kingdon C, Neilson J, Singleton V, Gyte G, Hart A, Gabbay M, et al. Choice and birth method: mixed-method study of caesarean delivery for maternal request. BJOG 2009; 116(7): 886-95.
  28. Eriksson C, Westman G, Hamberg K. Content of childbirth-related fear in Swedish women and men--analysis of an open-ended question. J Midwifery Womens Health 2006; 51(2): 112-8.
  29. Kolas T, Hofoss D, Daltveit AK, Nilsen ST, Henriksen T, Hager R, et al. Indications for cesarean deliveries in Norway. Am J Obstet Gynecol 2003; 188(4): 864-70.
  30. Zar M, Wijma K, Wijma B. Pre and post partum fear of childbirth in nulliparous and parous women. Scandinavian Journal of Behaviour Therapy 2001; 30(2): 75-84.
  31. Melender HL. Experiences of fears associated with pregnancy and childbirth: a study of 329 pregnant women. Birth 2002; 29(2): 101-11.
  32. Mehdizadeh A, Roosta F, Chaichian S, Alaghehbandan R. Evaluation of the impact of birth preparation courses on the health of the mother and the newborn. Am J Perinatol 2005; 22(1): 7-9.
  33. Scotf JR, Danforth DN. Danforth's obstetrics and gynecology. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 1999.
  34. Hajian S, Vakilian K, Shariati M, Ajami ME. Perspective of Pregnant Women, midwives, obstetrics and gynecology specialists and anesthetists to delivery: a qualitative study. Payesh Health Monit 2010; 10(1): 39-48.
Journal of Isfahan Medical School
Volume 29, Issue 153 - Serial Number 153
July and August 2011
Pages 1297-1310

  • Receive Date 03 November 2011
  • Accept Date 06 April 2022