Maternal request for caesarean section after a negative birth experience: A systematic review
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Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
Fourth Department of Nursing/Midwifery, Maternity Hospital Elena Venizelou, Athens, Greece
Department of Obstetrics and Gynecology, Maternity Hospital Mitera, Athens, Greece
Department of Obstetrics and Gynecology, Rea Maternity Hospital, Athens, Greece
Publication date: 2023-10-24
Corresponding author
Eleni Marina Tsotra   

Department of Midwifery, Faculty of Health and Caring Sciences, University of West Attica, Athens, Greece
Eur J Midwifery 2023;7(Supplement 1):A148
As far as the childbirth is concerned it is well known that it constitutes a major life process for every woman. We should also take into consideration that a positive experience during pregnancy and labor has a beneficial impact on mother’s psychological well-being and on mother-newborn relationship. However, many women have a negative birth experience, creating a secondary fear of vaginal birth1,2,3,4 and affecting their future birth preference5. To be more specific, a previous traumatic birth experience includes insufficient pain relief, dystocia, baby injury6, extreme fear because of deficient information and support during or after delivery, increased interventions7, lack of trust in healthcare professionals, absence of security and experience of abuse and contempt7. Traumatic vaginal birth makes women stressful, unconfident and fearful leading to planned caesarean sections to avoid a repetition of the trauma7,9. Consequently, midwives should provide support and information to women, especially to women who have experienced a traumatic birth, to live a positive labor experience and to prefer a natural mode of delivery instead of a planed caesarean section without medical reasons10.

Material and Methods:
A systematic review was carried out to investigate the maternal request for caesarean section after a negative birth experience using a PubMed Database and Google Scholar search between January 2018 and January 2022. We searched through advanced strategy using the following terms: traumatic birth experience, caesarean section, maternal request for caesarean section, preference for caesarean section. In addition, we included full-text observational studies and clinical trials, which had full text papers. After the screening process, we included papers with full text papers and which investigated multigravida with a negative birth experience. Papers which did not fulfil the objective of our study, studies conducted over the past five years and systematic reviews were excluded. As a result of the scanning, 144 studies were obtained, of which 81 studies did not meet the inclusion criteria, 25 studies were systematic reviews and 6 studies conducted over the past five years. After excluding all the unrelated articles, 11 studies left discussing the traumatic childbirth experience and 3 associated with the midwife’s impact on woman’s labor experience.

Three themes were identified: reasons for traumatic birth experience, post-traumatic feelings, the impact of trauma on future delivery mode and midwife’s role. Theme 1: Reasons for traumatic birth experience The reasons for traumatic birth experience include insufficient information, pain relief, support, distrust of the care professionals, an operative delivery, an experience of abuse, a prolonged labor, no respect to patient rights and dramatic events (Table 1)7,6,8,9,12. Theme 2: Post-traumatic feelings The post-traumatic feelings are reported to Table 212. Theme 3: The impact of trauma on future delivery mode and midwife’s role According to the surveys, a negative birth experience can create a secondary fear of vaginal birth affecting the future delivery mode. More specifically, women with a previous traumatic labor request for a caesarean section, believing that is a safe and painless procedure. Furthermore, women with a negative birth experience request for a caesarean section because they do not want to recall their painful memories and they anticipate to create a calm birth experience. To reduce the unnecessary caesarean sections, midwives provide support, information13, pre-birth training classes and special counselling promoting the vaginal delivery. More specifically, women who receive information and psychological support change their preference from caesarean section to natural delivery. In addition, during the pre-birth training classes multiparous women share their experiences and they deal with their shame and fears feeling that they are not alone. Moreover, through the counselling midwives encourage women, strengthen their self-confidence and discuss their previous experience to correct misunderstandings. The provision of care is also very important, because women prefer to have a vaginal delivery and they have a positive labor experience6,14.

A negative birth experience can be caused by complications, insufficient information, lack of support, loss of control, prolonged labor and operative delivery. As a result, women feel anxious, sad, shocked and fearful during or after the labor and they prefer a caesarean section for their next pregnancy to experience a safe and calm birth. Midwives can contribute to the reduction of unnecessary caesarean sections, providing support, information, pre-birth training classes and counselling promoting the vaginal birth and helping women to face their fears.

The authors have no conflicts of interest to disclose.
There was no source of funding for this research.
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