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EDITORIALS: Jeremy A Lauer and Ana P Betrán Decision aids for women with a previous caesarean section BMJ 2007; 334: 1281-1282 [Full text]

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Consent for cord blood gases

David JR Hutchon   (22 June 2007)

The Trend towards Cesarean Surgery and its Consequences in Iran

Afsaneh Tehranian, Marzieh Vahid Dastgerdi, and Mahdi Malekpour   (27 June 2007)

Consent for cord blood gases 22 June 2007
David JR Hutchon, Consultant Obstetrician & Gynaecologist Darlingotn Memorial Hospital. DL3 6HX Send response to journal: Re: Consent for cord blood gases	Decisions involving your own saftey and that of your unborn baby will never be easy. Any decision aid which results in a better outcome for both is to be welcomed. The amount of information given to women regarding caesarean section prior to delivery can be limited by circumstances and the knowledge of the informant. For example if there is fetal distress, how many women are told that a sample of the baby's blood will be tested for signs of hypoxia (1), that this requires the umbilical cord to be clamped immediately after delivery (2), that this can lead to hypvolaemia and hypotension and that these conditions can interfere with resuscitation? (3) References 1. Royal College of Obstetricians and Gynaecologists, Royal College of Midwives. Towards safer childbirth. Minimum standards for the organisation of labour wards. Report of a joint working party. London: RCOG Press, 1999:22. 2. ACOG committee opinion no 348 November 2006 3. Niermeyer S. Volume resuscitation: Crystalloid versus Colloid. In Clinics in Perinatology 33 (2006) 122-140 Competing interests: None declared
The Trend towards Cesarean Surgery and its Consequences in Iran 27 June 2007
Afsaneh Tehranian, Associate Professor, Obstetrician Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Marzieh Vahid Dastgerdi, and Mahdi Malekpour Send response to journal: Re: The Trend towards Cesarean Surgery and its Consequences in Iran	Afsaneh Tehranian, Marzieh Vahid Dastgerdi and Mahdi Malekpour Department of Obstetrics and Gynecology, Arash Hospital, Tehran University of Medical Sciences, Tehran/Iran afsanehtehranian@yahoo.com Lauer and Betran have discussed different rates of caesarean section in the world and the rates are compared according to the nation's development and income.1 Additionally supported by the work of Montgomery and colleagues, focusing on women's preferences improves decision making.2 In Iran with the GDP per capita of $8700, the story is different.3 There is a tendency towards cesarean surgery among Iranian women and obstetricians. Subsequent longer hospitalization and superimposed costs ensue. Cesarean delivery is announced to constitute 50% of deliveries in the capital and 39% of all the deliveries nationwide, which is far beyond the acceptable international normal range, according to the official site of the Ministry of Health and Medical Education of the Islamic Republic of Iran.4 The increase in the rate of cesarean surgery is also found in other parts of the world but not this striking.5 In our unpublished data we found that more than 70% of urban pregnant women believe that cesarean surgery is more prestigious and actively seek situations to talk about their cesarean surgery. On the other hand, monetary benefit is the major reason for which patients are advised to accept it especially in the private centers. Besides, patients are kept more in hospital and the oral intake starts later for the fear of postoperative complications and suing the obstetrician. As depicted, this problem has cultural, monetary and legal aspects. Measures to deal with the cultural and monetary aspects require long time and considerable budget. Some shortcuts to deal with peri-operative management could temporarily reduce the economical burdens of the patients. For examples, one of the main goals of postoperative care is adequate nutritional support for the patients. The traditional practice has been to delay oral intake until bowel sounds have returned and flatus has been passed.6 It is still a widespread practice in many gynecology wards in Iran, that women are not given oral intake before spontaneous return of bowel function. So any patient should be kept for at least 12 hours before the beginning of oral water intake after which the risk of impairment in alimentary function might increase. This practice potentially brings about the must for a longer hospital stay while women undergoing cesarean delivery in Iran are usually young and healthy. Serious steps should be taken to change the culture and prevent unprofessional practice of non-indicated cesarean surgeries. In Iran, much time is needed to apply measures such as decision aid for mode of delivery for women.2 Reference 1. Lauer JA, Betran AP. Decision aids for women with a previous caesarean section. BMJ 2007;334:1281-2. 2. Montgomery AA, Emmett CL, Fahey T, Jones C, Ricketts I, Patel RR, Peters TJ, Murphy DJ et al. Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial BMJ 2007;334:1305-8. 3. CIA-The world factbook. 2007. https://www.cia.gov/library/publications/the-world-factbook/geos/ir.html (accessed June 25, 2007). 4. Ministry of Health and Medical Education of the Islamic Republic of Iran. 2006. http://www.mohme.gov.ir/HNDC/Indicators/Simaye_Salamt/Simaye_Salamat.htm (accessed September 2, 2006). 5. Usha Kiran TS, Jayawickrama NS. Who is responsible for the rising caesarean section rate? J Obstet Gynaecol 2002;22:363-5. 6. Horowitz IR, Basil JB. Postanesthesia and postoperative care. In Telinde’s operative gynecology. 9th edition. Edited by Rock JA, Jones III HW. Philadelphia: JB Lippincott; 2003;123-162. Competing interests: None declared