title: Previous cesarean delivery: understanding and satisfaction with mode of delivery in a subsequent pregnancy in patients participating in a formal vaginal birth after cesarean counseling program.
abstract: The objective of this study was to determine patient satisfaction with delivery experience in a pregnancy subsequent to primary cesarean and to evaluate knowledge about a trial of labor after cesarean in patients enrolled in a formal vaginal birth after cesarean educational program. During a 12-month period, women with a history of cesarean delivery who were participating in a formal counseling program regarding the risks and benefits of vaginal birth after cesarean were surveyed in the antepartum and postpartum periods. Patient demographics, past birth experience, understanding of the risks and benefits of vaginal birth after cesarean, pregnancy outcomes, and ratings of satisfaction and recovery following the current delivery were collected. Patients were divided into four groups depending on their mode of delivery in the current pregnancy: group 1 succeeded at vaginal birth, group 2 underwent repeat cesarean in labor, group 3 delivered by cesarean before labor, and group 4 chose repeat cesarean. Ninety-five patients enrolled in the study. There were 26 patients in group 1, 18 patients in group 2, 16 patients in group 3, and 35 patients in group 4. The four groups had significant differences in patient satisfaction following the current delivery compared with the previous cesarean delivery ( p = 0.001). The patients who had a successful trial of labor exhibited the largest median change in score. The patients who delivered by cesarean during labor had the smallest median change in score. Nonetheless, 92% of these patients were pleased that they had attempted a vaginal birth. When questioned about the risks associated with a trial of labor after cesarean delivery, 92% of postpartum patients answered all questions correctly. Patients participating in a formal counseling program exhibit a high level of understanding about the risks and benefits of a trial of labor. Although the most satisfied patients were those who succeeded at vaginal birth, most women valued the opportunity to attempt a vaginal birth regardless of outcome.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, New York Presbyterian Medical Center, College of Physicians and Surgeons, Columbia University, 620 West 168th Street, New York, NY 10032, USA.
authors.forename: Jane
authors.initials: J
authors.lastname: Cleary-Goldman
authors.forename: Kelly
authors.initials: K
authors.lastname: Cornelisse
authors.forename: Lynn L
authors.initials: LL
authors.lastname: Simpson
authors.forename: Julian N
authors.initials: JN
authors.lastname: Robinson
mesh_terms: D001034:Apgar Score; D003376:Counseling; D005260:Female; D005865:Gestational Age; D006801:Humans; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean