The association of patient preferences and attitudes with trial of labor after cesarean

Anjali J. Kaimal*, William A. Grobman, Allison Bryant, Cinthia Blat, Peter Bacchetti, Juan Gonzalez, Mari Paule Thiet, Yamilee Bermingham, Miriam Kuppermann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objective: To evaluate the association of patient preferences and attitudes with TOLAC. Study design: Prospective observational study of TOLAC-eligible women at 26–34 weeks gestation. Preferences (utilities) were elicited using the time trade-off and standard gamble metrics. Logistic regression was used to identify preference- and attitude-based factors associated with TOLAC. Results: Of the 231 participants, most (n = 197, 85%) preferred vaginal delivery, but only 40% (n = 93) underwent TOLAC. Utilities for uterine rupture outcomes did not differ based on delivery approach. In multivariable analysis, strength of preference for vaginal delivery, value for the experience of labor, and the opinion of the person whom the participant thought of as most important to this decision were associated with TOLAC. Conclusions: Future decision support interventions incorporating individualized information regarding the likelihood of vaginal birth and empowering patients to express their preferences and engage their families in the decision-making process may improve decision quality and increase TOLAC rates.

Original languageEnglish (US)
Pages (from-to)1340-1348
Number of pages9
JournalJournal of Perinatology
Issue number10
StatePublished - Oct 1 2019

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health


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