Caesarean on maternal request after sexual assault — counselling station

Communication and counselling station on a request driven by trauma: candidate elicits the reason, screens safely, offers structured support, counsels the benefit-and-harm balance in absolute terms, and ends with one of the two RANZCOG C-Obs 39 endings — all while holding a trauma-informed conversation. Includes assessor key and marking domains.

Prompt

A 27-year-old primigravida at 20 weeks requests a planned caesarean in clinic. She is articulate and calm but avoids eye contact when labour is mentioned. In the course of the consultation she discloses a sexual assault three years ago that she has not told anyone about. You are the registrar; your consultant is available.

Station brief

Format. Communication and counselling station, approximately 12 minutes. You are the obstetric registrar in an antenatal clinic with a 30-minute appointment slot. A continuity midwife and a perinatal mental health service are available on referral. The assessor plays the woman; a faculty observer marks the domains. ^[1]

Candidate instruction. Conduct the consultation. Elicit the reason for the request, screen safely for what is driving it, offer what may make the request unnecessary, and move towards a lawful and documented plan. Do not make the conversation conditional on her withdrawing the request. ^[1]^[8]

References6Show

[1]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request. Obstet Gynecol, 2019.PMID 30575678
[3]Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol, 2006.PMID 16738145
[5]Keag OE, Norman JE, Stock SJ Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med, 2018.PMID 29360829
[7]Tähtinen RM, Cartwright R, Tsui JF, et al. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol, 2016.PMID 26874810
[8]Hofberg K, Brockington I Tokophobia: an unreasoning dread of childbirth. A series of 26 cases. Br J Psychiatry, 2000.PMID 10789333
[9]Saisto T, Salmela-Aro K, Nurmi JE, et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol, 2001.PMID 11704175

Caesarean on maternal request after sexual assault — counselling station

Station brief

References6Show

[1]American College of Obstetricians and Gynecologists ACOG Committee Opinion No. 761: Cesarean Delivery on Maternal Request. Obstet Gynecol, 2019.PMID 30575678
[3]Silver RM, Landon MB, Rouse DJ, et al. Maternal morbidity associated with multiple repeat cesarean deliveries. Obstet Gynecol, 2006.PMID 16738145
[5]Keag OE, Norman JE, Stock SJ Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis. PLoS Med, 2018.PMID 29360829
[7]Tähtinen RM, Cartwright R, Tsui JF, et al. Long-term Impact of Mode of Delivery on Stress Urinary Incontinence and Urgency Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol, 2016.PMID 26874810
[8]Hofberg K, Brockington I Tokophobia: an unreasoning dread of childbirth. A series of 26 cases. Br J Psychiatry, 2000.PMID 10789333
[9]Saisto T, Salmela-Aro K, Nurmi JE, et al. A randomized controlled trial of intervention in fear of childbirth. Obstet Gynecol, 2001.PMID 11704175