Women's Preferences Regarding the Processes and Outcomes of Trial of Labor after Cesarean and Elective Repeat Cesarean Delivery

Anjali J. Kaimal*, William A. Grobman, Allison S. Bryant, Laura Norrell, Yamilee Bermingham, Anna Altshuler, Mari Paule Thiet, Juan Gonzalez, Peter Bacchetti, Michelle Moghadassi, Miriam Kuppermann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Scopus citations

Abstract

Background: The decrease in trial of labor after cesarean (TOLAC) at institutions that offer this option suggests that patient preference could be a factor in the declining TOLAC rate. However, data regarding how women value the potential processes and outcomes of TOLAC and elective repeat cesarean delivery (ERCD) are limited. We sought to determine how women view the processes and outcomes of TOLAC and ERCD and identify sociodemographic and clinical factors associated with these preferences. Materials and Methods: This is a multicenter cross-sectional study of mode of delivery preferences among TOLAC-eligible women at 26-34 weeks gestation. The time tradeoff metric was used to obtain utilities for the processes and outcomes of TOLAC and ERCD. Multivariable regression analysis was utilized to identify independent predictors of utilities. Results: The 299 study participants constituted a geographically and racially/ethnically diverse group. Although uncomplicated TOLAC resulting in vaginal birth after cesarean and uncomplicated ERCD resulted in high utility values, any alteration in either the process or outcome resulted in substantial utility decrements. In multivariable regression analysis, race/ethnicity, insurance status, and order of scenario presentation emerged as statistically significant predictors. Conclusions: Information regarding both maternal and infant implications is important to women in discussions about approach to delivery. Both the way in which information regarding labor interventions and potential complications is presented and the characteristics of the women contemplating this information affect its impact. These findings underscore the need for evidence-based decision support to help create realistic expectations and incorporate informed patient preferences into decision-making to optimize both clinical outcomes and individual patient experience for women with a prior cesarean delivery.

Original languageEnglish (US)
Pages (from-to)1143-1152
Number of pages10
JournalJournal of Women's Health
Volume28
Issue number8
DOIs
StatePublished - Aug 2019

Keywords

  • mode of delivery
  • patient preferences
  • shared decision-making
  • time tradeoff
  • trial of labor after cesarean

ASJC Scopus subject areas

  • Medicine(all)

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