Women’s Preference for Mode of Delivery after a First Delivery by Caesarean Section at a Tertiary Hospital in Port Harcourt, Nigeria

Background: The continuous increase in the rate of repeat caesarean sections after a first prior caesarean delivery is alarming. There is a decrease in the rate of vaginal birth after caesarean delivery (VBAC) and trial of labour after caesarean section (TOLAC) in women with a prior caesarean delivery. However, like other surgical operations, caesarean section puts the woman at risk of various complications and health challenges which can range from immediate to long-term health risks. This can affect her fertility and the outcome of her future pregnancies.

Aim: To determine women’s preference for mode of delivery after a prior caesarean delivery and the reasons for their preferred choices.

Methodology: This was a cross-sectional study of 229 consenting pregnant women with one previous caesarean delivery attending antenatal clinic at the University of Port Harcourt Teaching Hospital (UPTH) from 1st March to 31st May, 2023. Structured interviewer administered questionnaires were used to collect information on participant’s prior caesarean related birth experience, complications and current delivery desires. The data was analysed with SPSS version 25.

Results: The modal maternal and gestational age groups were 30-39years (66.5%) and 24-34weeks (48.5%). Approximately 58.9% were in their second pregnancy and 61.6% experienced labour pain in their previous caesarean delivery. Maternal and neonatal complications documented were wound infection and birth asphyxia respectively. Majority of the respondents (89.1%) had satisfactory overall birth experience. Of the 229 respondents, 82.1% preferred vaginal delivery in the index pregnancy due to the cost of caesarean section and innate desire to experience natural birth while 41(17.9%) of them preferred repeat caesarean delivery due to phobia for labour pain.

Conclusion: Majority of the women with prior caesarean delivery attending the antenatal clinic preferred TOLAC in subsequent pregnancies as against a repeat caesarean delivery. Women with a prior caesarean delivery should be adequately counselled during the antenatal period for possible TOLAC in the cases that meet the eligibility criteria in order to reduce the caesarean delivery rate.