Pregnant women are much more willing than their doctors to accept the risks involved in having a normal vaginal delivery and most are prepared to risk even the most debilitating and painful outcomes rather than have an elective caesarean, Sydney researchers have found.

The study, of more than 100 women at Royal Prince Alfred Hospital, suggests it is primarily clinicians, rather than mothers, who are behind the nation's soaring caesarean rate, now standing at one in three births.

They ranked perineal discomfort, prolonged labour, superficial tears and mild urinary incontinence as risk factors they would readily accept. 

The study, published in the BJOG - An International Journal Of Obstetrics And Gynaecology also found that obstetricians and colorectal surgeons were significantly more concerned with a woman's sexual dissatisfaction after a natural delivery than mothers themselves, dispelling the myth that women choose elective caesareans to keep their vaginas "honeymoon fresh".

"Care providers think they know what women want, but it seems that women are not as bothered by their sexual satisfaction after birth as doctors think they are and they are more concerned overall with the health of their babies than any risks to their own bodies," said Hannah Dahlen, a spokeswoman for the Australian College of Midwives.

She said the study indicated doctors had a huge influence on whether a woman chose to have a caesarean or vaginal delivery.

"The intervention rate in the private sector is twice that of the public sector, yet the women seeing private obstetricians recorded the same tolerance of risks and were more concerned about the safety of the baby so it shows that doctors can greatly affect the outcome," Dr Dahlen said.

The women ranked severe anal incontinence as their most feared outcome and said they would take the least risk with it occurring before they would opt for a caesarean, but they ranked perineal discomfort, prolonged labour, superficial tears and mild urinary incontinence as risk factors they would readily accept.

"It shows that women are far more tolerant than doctors think," Dr Dahlen said.

Colorectal surgeons, who dealt with trauma from vaginal deliveries, were the most risk-averse and would recommend caesareans more often than obstetricians, urogynaecologists and midwives, while female doctors also were more likely to have negative opinions about caesareans than their male counterparts, the study found.

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