title: Effect of mode of delivery on perceived risks of maternal health outcomes among expectant parents: a cohort study in Beijing, China.
abstract: BACKGROUND
  Misperceptions regarding maternal health outcomes after vaginal delivery (VD) and cesarean delivery (CD) may contribute to the increasing trend towards CD. The effects of mode of delivery on parents' perceived risks of health outcomes are unclear. This study aimed to compare the perceived risks of maternal health outcomes among pregnant women and their partners before and after delivery, and to evaluate factors related to inaccurate perceptions among women after delivery.
  
  
  METHODS
  Consecutive eligible nulliparous women at 36-40 weeks gestation were approached during antenatal registration for electronic fetal monitoring, regardless of whether CD or VD was planned. Eligible women were aged 18-45 years, received antenatal care and planned delivery at the First Hospital of Tsinghua University, Beijing, and had partners who could be approached. Concerns about 12 maternal health outcomes were identified by literature search and validated using the content validity index. Women and their partners were questioned anonymously about the perceived risks of outcomes after CD and VD before delivery, and the perceived risks of the delivery experienced at 2-3 days after delivery. Perceived risks were compared with reported risks, and factors associated with inaccurate perceptions were evaluated.
  
  
  RESULTS
  Among 272 couples approached, 264 women (97%) and 257 partners (94%) completed the questionnaire both before and after delivery. After CD, the perceived risk of seven health outcomes decreased in women and the perceived risk of two health outcomes increased in partners. After VD, the perceived risk of two outcomes decreased and of one outcome increased in women, and the perceived risk of three outcomes increased in partners. Women perceived higher risks of long-term perineal pain, pelvic organ prolapse, urinary/fecal incontinence, sexual dissatisfaction, and negative impact on the couple's relationship after VD than after CD (all p < 0.05). CD was the most common factor associated with inaccurate perceptions among women after delivery.
  
  
  CONCLUSIONS
  The perceived risks of maternal health outcomes decreased after delivery in women and increased after delivery in their partners. Women continued to have inaccurate perceptions of the risks of health outcomes after delivery, indicating that further education is important.
authors.affiliation: Department of Obstetrics and Gynecology, First Hospital of Tsinghua University, Tsinghua University, No, 6 Jiuxianqiao 1st Street, Beijing 100016, Chaoyang District, China. muziwen9999@hotmail.com.
authors.forename: Wen-Ying
authors.initials: WY
authors.lastname: Li
authors.forename: Tippawan
authors.initials: T
authors.lastname: Liabsuetrakul
authors.forename: Babill
authors.initials: B
authors.lastname: Stray-Pedersen
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000009:adverse effects / Q000523:psychology; D002681:China; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000523:psychology*; D005242:Fecal Incontinence / Q000209:etiology; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D010146:Pain / Q000209:etiology; D010290:Parents / Q000523:psychology*; D036801:Parturition / Q000523:psychology*; D017060:Patient Satisfaction; D056887:Pelvic Organ Prolapse / Q000209:etiology; D010465:Perception; D011181:Postnatal Care; D049590:Postpartum Period; D011247:Pregnancy; D011295:Prenatal Care; D018570:Risk Assessment; D019529:Sexuality; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000209:etiology; D055815:Young Adult