TY - JOUR
T1 - Mode of delivery
T2 - Toward responsible inclusion of patient preferences
AU - Little, Margaret Olivia
AU - Lyerly, Anne Drapkin
AU - Mitchell, Lisa M.
AU - Armstrong, Elizabeth M.
AU - Harris, Lisa H.
AU - Kukla, Rebecca
AU - Kuppermann, Miriam
PY - 2008/10
Y1 - 2008/10
N2 - Deciding when and how to incorporate patient preferences regarding mode of delivery is challenging for both obstetric providers and policymakers. An analysis of current guidelines in four clinical scenarios (prior cesarean, twin delivery, breech presentation, and maternal request for cesarean) indicates that some guidelines are highly prescriptive whereas others are more flexible, based on physicians' discretion or (less frequently) patient preferences, without consistency or explicit rationale for when such flexibility is permissible, advisable, or obligatory. Although patient-choice advocates have called for more patient-responsive guidelines, concerns also have been raised, especially in the context of discussions of cesarean delivery on maternal request, about the dangers of unfettered patient-preference-driven clinical decisions. In this article, we outline a framework for the responsible inclusion of patient preferences into decision making regarding approach to delivery. We conclude, using this framework, that more explicit incorporation of patient preferences is called for in the first three scenarios and indicate why expanding access to cesarean delivery on maternal request is more complicated and would require more data and further consideration.
AB - Deciding when and how to incorporate patient preferences regarding mode of delivery is challenging for both obstetric providers and policymakers. An analysis of current guidelines in four clinical scenarios (prior cesarean, twin delivery, breech presentation, and maternal request for cesarean) indicates that some guidelines are highly prescriptive whereas others are more flexible, based on physicians' discretion or (less frequently) patient preferences, without consistency or explicit rationale for when such flexibility is permissible, advisable, or obligatory. Although patient-choice advocates have called for more patient-responsive guidelines, concerns also have been raised, especially in the context of discussions of cesarean delivery on maternal request, about the dangers of unfettered patient-preference-driven clinical decisions. In this article, we outline a framework for the responsible inclusion of patient preferences into decision making regarding approach to delivery. We conclude, using this framework, that more explicit incorporation of patient preferences is called for in the first three scenarios and indicate why expanding access to cesarean delivery on maternal request is more complicated and would require more data and further consideration.
UR - http://www.scopus.com/inward/record.url?scp=55449125554&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=55449125554&partnerID=8YFLogxK
U2 - 10.1097/AOG.0b013e3181888fd8
DO - 10.1097/AOG.0b013e3181888fd8
M3 - Comment/debate
C2 - 18827136
AN - SCOPUS:55449125554
SN - 0029-7844
VL - 112
SP - 913
EP - 918
JO - Obstetrics and Gynecology
JF - Obstetrics and Gynecology
IS - 4
ER -