How can I effectively counsel patients on the risks and benefits of elective cesarean delivery?

Effective counselling for elective caesarean delivery involves providing balanced, evidence-based information about the benefits and risks of both caesarean and vaginal birth. Discuss these in the context of the woman's individual circumstances, concerns, priorities, and future pregnancy plans to support informed decision-making.

Explain that both modes of birth carry benefits and risks, some with small absolute risks and others with greater risks, and that the woman will need to consider which risks are more acceptable to her.

Highlight that there are additional risks not always included in summary tables, such as placental adherence problems from multiple caesarean births or fetal lacerations during caesarean birth, and that precise numerical risk estimates cannot be given for individuals.

Offer to explore the reasons for the request if the woman has no medical indication for caesarean birth, ensuring she receives balanced and accurate information and discussing alternative birth options that may address her concerns.

Provide opportunities for discussions with senior midwives, obstetricians, anaesthetists, or perinatal mental health professionals if anxiety or tokophobia influences the request.

Document the factors important to the woman in making her decision and record that the discussion about risks and benefits has taken place.

Respect the woman's dignity, privacy, views, and culture throughout the counselling process, and support her choice if she decides on elective caesarean birth after informed discussion.

Ensure that elective caesarean births requested without medical indication are offered within an obstetric unit.