Counseling Scripts

"We are beginning to use a calculator that can help patients and providers better understand how likely it is that a specific patient will need a cesarean delivery at the start of an induction of labor. This will help us manage your labor and provide you with a more accurate prediction as to how your labor and delivery will progress. 

Some factors that go into the calculator are height, BMI, cervical exam, and whether or not you've had a baby before. When applied to you, the calculator suggests that the probability of a cesarean delivery for you is ***.”

Then:

<20%: “This suggests you are more likely to have a vaginal delivery than the average person undergoing an induction. This does not mean you won’t need a cesarean delivery; it is just less likely. This will be helpful for us to know as we manage your labor.”

20-40%: “This is around the average risk of having a cesarean delivery when undergoing an induction. This will be helpful for us to know as we manage your labor.”

40-60%: “This means your risk of cesarean delivery is likely higher than the average woman undergoing an induction of labor. This does not mean you will definitely need a cesarean delivery. In fact, about half of women with this estimated risk will still go on to have a vaginal delivery.”

60-80%: “This means you are at likely high risk of needing a cesarean delivery at some point during this induction. While your risk is high, it does not mean that you will definitely need a cesarean delivery and that you should not attempt induction with the goal of having a vaginal delivery."

“Do you have any questions?”

If patient says, I would consider or I want an outright cesarean delivery:

"We understand your concern regarding your potential risk for cesarean delivery based on our calculator. Keep in mind that the calculator provides a general risk assessment for people with similar characteristics. While the calculator suggests that your risk is high, we generally recommend an induction of labor as cesarean delivery is a surgery and is not without risk including an increased risk of bleeding, infection as well as potential for injury to nearby organs like bowel and bladder when compared to women who have a vaginal delivery. 

However, given your increased risk for needing a cesarean delivery during your induction, I can understand your question about proceeding with a cesarean delivery right from the outset as opposed to attempting an induction. I certainly understand that you may decide after considering the risks and benefits of proceeding with induction or cesarean delivery that you wish to proceed with a cesarean delivery."

Do you have any questions?