Women's recommendations: vacuum extraction or caesarean section for prolonged second stage of labour, a prospective cohort study in Uganda

Barbara Nolens, Thomas van den Akker, John Lule, Sulphine Twinomuhangi, Jos van Roosmalen, Josaphat Byamugisha

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Objectives: To investigate what women who have experienced vacuum extraction or second stage caesarean section (CS) would recommend as mode of birth in case of prolonged second stage of labour. Methods: A prospective cohort study was conducted in a tertiary referral hospital in Uganda. Between November 2014 and July 2015, women with a term singleton in vertex presentation who had undergone vacuum extraction or second stage CS were included. The first day and 6 months after birth women were asked what they would recommend to a friend: vacuum extraction or CS and why. Outcome measures were: proportions of women choosing vacuum extraction vs. CS and reasons for choosing this mode of birth. Results: The first day after birth, 293/318 (92.1%) women who had undergone vacuum extraction and 176/409 (43.0%) women who had undergone CS recommended vacuum extraction. Of women who had given birth by CS in a previous pregnancy and had vacuum extraction this time, 31/32 (96.9%) recommended vacuum extraction. Six months after birth findings were comparable. Less pain, shorter recovery period, avoiding surgery and the presumed relative safety of vacuum extraction to the mother were the main reasons for preferring vacuum extraction. Main reasons to opt for CS were having experienced CS without problems, CS presumed as being safer for the neonate, CS being the only option the woman was aware of, as well as the concern that vacuum extraction would fail. Conclusions: Most women would recommend vacuum extraction over CS in case of prolonged second stage of labour.

Original languageEnglish
Pages (from-to)553-562
Number of pages10
JournalTropical Medicine and International Health
Issue number5
Early online date25 Feb 2019
Publication statusPublished - 1 May 2019


  • caesarean section
  • delivery
  • low- and middle-income countries
  • vacuum extraction
  • women's preferences

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