Speakers - 2026

Title: Rapid labour progression in a patient requesting cesarean after stillbirth: trauma-informed ethical decision-making

Abstract

Background:

Maternal request for cesarean delivery may arise from prior obstetric trauma, including stillbirth. These scenarios present ethical challenges in balancing maternal autonomy with beneficence and non-maleficence, particularly in acute intrapartum settings.

Case:

A 33-year-old gravida 2 para 1 woman with a prior term stillbirth presented at 38+5 weeks in spontaneous labour, requesting immediate cesarean delivery due to fear of recurrent loss. Her pregnancy was medically uncomplicated but marked by significant anxiety consistent with secondary tokophobia. On admission, she was 5 cm dilated with reassuring fetal status. A trauma-informed, patient-centred approach was implemented. Her concerns were acknowledged, and a “double setup” strategy was initiated, preparing for cesarean delivery while continuing labour support. Risks and benefits of cesarean versus vaginal birth were discussed in real time, supporting shared decision-making. Epidural analgesia was established to optimise comfort and allow rapid surgical conversion if required.

Labour progressed rapidly to full dilation within 45 minutes. In theatre, with the fetal head at low station and reassuring fetal status, cesarean delivery was deemed higher risk than imminent vaginal birth. With informed consent, the patient proceeded with vaginal delivery. A healthy infant was delivered with Apgar scores of 9 and 9. A second-degree perineal tear was repaired under regional anaesthesia. Postpartum recovery was physically uncomplicated, though psychological support was required.

Conclusion:

This case highlights the ethical complexity of cesarean delivery on maternal request following perinatal loss. Trauma-informed care and shared decision-making enabled alignment of maternal autonomy with clinical safety. Flexible strategies, such as a double setup, can support both psychological safety and optimal maternal–fetal outcomes in urgent obstetric contexts.