The Report: Once a Cesarean, Always a Choice

Most commonly known as Cesarean section or C-section, this procedure should be carried out because of medical reasons, that is, to take care for the health of the mother
and her baby in case of complications. Regarding the rise of the Cesarean section several possible reasons are associated. Among others woman´s unmotivated requests for this procedure, changes in pregnancy conditions (i.e. the increase of multiple births, the rise of pregnant women´s age, the growth of obesity incidence), fear of malpractice liability, side effects of common labor interventions, lack of information from the healthcare institutions and professionals and incentives to perform a procedure economically more convenient can be mentioned.

A very detailed research is being carried out in order to frame the controversy about the decision making process. In the course of the exploration it was possible to see how a second pregnancy for a woman that has already been subjected to a c-section, implies a complex dichotomy between two modes of delivery: the ERCS and the VBAC.

Indeed, the controversy dates back from 1916, when Dr. Edwin Cragin presented a talk entitled “Conservatism in Obstetrics” to the Eastern Medical Society of New York and said: “once a caesarean, always a caesarean”, meaning that the first surgery would necessarily lead to a second one, implying further risks. This thesis has been debated since the 1980s, when the American Congress of Obstetrician and Gynecologists presented the Vaginal Birth After Caesarean (VBAC) as a strong option for those pregnant women that have had a c-section previously. To sum up the general perception is still flowing in opposite directions.
Nevertheless, the actors involved in the controversy are not quite specific about their position, whether PRO-VBAC or PRO-ERCS. Many of them describe the procedure, talk about risks and benefits, but few of them dare to take part and assume a radical position about the issue. At the end they just expose the facts and let the decision in women´s hands. In view of this situation, our research is aimed to understand the environment that enclose the women who have to decide what will be the best mode of delivery for their babies after a previous c-section. The main questions are: what kind of information are the women receiving related to the subject, what does it say and what are the sources.

The Website: The Choice to Choose

This is the final outcome of the controversy analysis and it is based on the previous research made on You Tube, which showed how this is an open channel that allows publishing different kind of contents. After analyzing the typologies, the actors and the protagonist of the videos, we were able to conclude that there are three main kind of videos: those held by health professionals (presenting the subject through interviews), the surgeries (explicit images and explanations about the procedure) and those held by women, which in most cases are the protagonist of the videos.

It was possible to evidence that You Tube is a very consulted source of information, maybe because of their visual contents, that represent an advantage compare to the regular websites that just provide textual information. Also is a source very close to the moms because most of the videos are testimonials and provide a closer approach to the woman´s position in the discussion. It is important to mention that the impact produced by the images and videos are fundamental on the woman´s perception about the issue.

We intend to evidence the difficulties that moms have to face when searching information on YouTube about the mode of delivery after a previous c-section, that increase the distance between moms and doctors. We considered YouTube mainly because it is a multisense and emotional channel that allows a higher interaction with the authors of the videos. At that scope, we have analyzed the content of 94 videos regarding the controversy VBAC – ERCS, establishing the differences between mom´s and health professionals’ videos, considering topics like the category of video, the location and the type of communication.

The current gap is an opportunity for medical associations to involve mothers and healthcare professionals on the same channel, facilitating the research process for mothers

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Authors

Esther Ferruccio
Chiara Francione
Patricia Mancera
Federica Romano
Anastasia Santoro