Doctor-patient power imbalance may result in unneeded Caesarian deliveries

U of A research explored the reasons why some women opt for riskier birthing procedure.


New UAlberta research reveals why some women choose to deliver their babies by Caesarian section that are not medically necessary and could be riskier for them and their baby—a lack of knowledge about delivery options.

“Our findings are very important for women and children given how C-sections are shown to result in adverse outcomes,” said Tharsini Sivananthajothy, a graduate student at U of A’s School of Public Health.

There is evidence that increased C-sections are associated with higher rates of fetal death and severe maternal morbidity and mortality, as well as an increased risk of obesity and allergies for kids in childhood.

Sivananthajothy conducted the research at a teaching hospital, following 54 women, both newcomers and Canadians, and their families for 10 months from prenatal appointments to the delivery room.

The study arose from previous research conducted by Zubia Mumtaz, an associate professor with the School, that showed newcomer women were 12 per cent more likely to have a C-section compared to Canadian-born women, even though physician recommendations rates were similar for both groups.

Sivananthajothy wanted to find out if there were differences between newcomer and Canadian-born women’s abilities to negotiate their doctor’s recommendations for C-section.

“Our most surprising finding was how empowered both newcomer and Canadian-born women are in the delivery room when they have healthcare experience and knowledge about healthy delivery approaches,” she added.

Knowledge and social supports are needed

On the other hand, all women who lacked health information to make an informed decision experienced a doctor-patient power imbalance in the delivery room, she said. “It was a significant barrier to participating in the decision.”

The study also showed that one of the main reasons why immigrant women may be choosing planned C-sections is lack of social supports, such as not having family to help arrange with childcare for vaginal delivery.

“The clinical decision to have a C-section should involve what is best for the mother and baby,” said Sivananthajothy. “The fact that social factors are affecting the decision needs to be taken into account. When obstetricians are having the conversations with expectant moms, they need to explore what her considerations are and possibly assist if social supports are needed.”

In general, women need to be better informed of their rights, know what interventions are available, and feel confident to ask about and decline procedures to help reduce unneeded C-sections, said Sivananthajothy.

“One place to provide this information is in prenatal classes,” she added.

Obstetricians also need to be aware of how some of their everyday practices, such as not having enough time to educate patients about options in in-depth conversations, and subtle behaviours such as telling instead of asking, may be barriers to active patient decision making, said Sivananthajothy.

The study was funded by supporters of the Lois Hole Hospital for Women through the Women & Children’s Health Research Institute.