Counselling women about the risks of caesarean delivery in future pregnancies

Key content In order to provide appropriate counselling about the risk to future pregnancies imposed by caesarean delivery, providers must be knowledgeable about and able to synthesise a multitude of variables such as institutional policies, the clinical implications of each current delivery option for future pregnancies, patient understanding of maternal and neonatal risks and benefits, the woman's reasons for requesting this type of delivery and the woman's desired family size. The rate of successful vaginal birth after caesarean section ranges 50–85%, with lower rates associated with both modifiable factors (gestational age >40 weeks, maternal obesity, short interpregnancy interval and increased birthweight) and non‐modifiable factors (maternal age, non‐white ethnicity, pre‐eclampsia and recurrence of the indication for the initial caesarean delivery). In future pregnancies, the risk of adverse outcomes such as haemorrhage, endometritis, operative injury, hysterectomy and maternal death goes up with each additional caesarean section. Learning objectives To be knowledgeable about and able to provide accurate counselling for three important clinical situations: caesarean delivery on maternal request; women with a history of one or two caesarean deliveries; and women with a history of three or more caesarean deliveries. Ethical issues When counselling women about the risks of caesarean delivery on future pregnancies, providers should always consider the principles of beneficence and non‐maleficence while synthesising a myriad of scenarios and outcomes. If properly counselled on the risks, benefits and alternatives of a delivery decision, her autonomy should be respected.