Strength of preference for vaginal birth as a predictor of delivery mode among women who attempt a vaginal delivery.
OBJECTIVE
We sought to assess the relationship between strength of preference for vaginal birth and likelihood of vaginal delivery among women attempting this delivery mode.


METHODS
We conducted a longitudinal study of mode of delivery preferences among women who were <36 weeks' pregnant. Participants completed a sociodemographic and clinical questionnaire and were asked if they preferred vaginal or cesarean delivery. Participants who preferred vaginal delivery completed a standard gamble exercise to assess the strength of this preference on a 0-to-1 scale (higher scores indicate stronger preference for vaginal delivery); those preferring cesarean delivery were assigned a value of 0. Data on clinical characteristics and delivery mode were obtained via telephone interview or chart review. Logistic regression was used to identify predictors of delivery mode among women who attempted a vaginal delivery.


RESULTS
Of 210 participants, 156 attempted a vaginal delivery. Their mean and median vaginal delivery preference scores were 0.70 (SD 0.31) and 0.75 (interquartile range, 0.50-0.99), respectively. In multivariate analyses, women with a prior cesarean delivery (adjusted odds ratio [aOR], 0.08; 95% confidence interval [CI], 0.02-0.39) or who delivered an infant ≥4000 g (aOR, 0.04; 95% CI, 0.01-0.28) had significantly lower odds of having a vaginal delivery. After controlling for potential confounders, participants with a stronger preference for vaginal delivery were at significantly higher odds of having a vaginal delivery (aOR, 1.54; 95% CI, 1.01-2.34 for every 0.2 increase on the 0-to-1 scale).


CONCLUSIONS
Among women who attempt a vaginal delivery, the strength of preference for vaginal birth is predictive of the delivery mode ultimately undergone.
Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Orange, CA.
Erica
E
Wu
Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
Anjali J
AJ
Kaimal
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
Kathryn
K
Houston
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
Lynn M
LM
Yee
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
Sanae
S
Nakagawa
Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, School of Medicine, San Francisco, CA.
Miriam
M
Kuppermann
D000328:Adult; D001290:Attitude; D002585:Cesarean Section / Q000523:psychology; D002755:Choice Behavior; D036861:Delivery, Obstetric / Q000523:psychology*; D005260:Female; D006801:Humans; D016015:Logistic Models; D057240:Patient Preference; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*
delivery mode; patient preferences