title: Mode of delivery preferences in a diverse population of pregnant women.
abstract: OBJECTIVE
  The objective of the study was to assess women's preferences for vaginal vs cesarean delivery in 4 contexts: prior cesarean delivery, twins, breech presentation, and absent indication for cesarean.
  
  
  METHODS
  This was a cross-sectional study of pregnant women at 24-40 weeks' gestation. After assessing stated preferences for vaginal or cesarean delivery, we used the standard gamble metric to measure the strength of these preferences and the time tradeoff metric to determine how women value the potential processes and outcomes associated with these 2 delivery approaches.
  
  
  RESULTS
  Among the 240 participants, 90.8% had a stated preference for vaginal delivery. Across the 4 contexts, these women indicated that, on average, they would accept a 59-75% chance of an attempted vaginal birth ending in a cesarean delivery before choosing a planned cesarean delivery, indicating strong preferences for spontaneous, uncomplicated vaginal delivery. Variations in preferences for labor processes emerged. Although uncomplicated labor ending in vaginal birth was assigned mean utilities of 0.993 or higher (on a 0-1 scale, with higher scores indicating more preferred outcomes), the need for oxytocin, antibiotics, or operative vaginal delivery resulted in lower mean scores, comparable with those assigned to uncomplicated cesarean delivery. Substantially lower scores (ranging from 0.432 to 0.598) were obtained for scenarios ending in severe maternal or neonatal morbidity.
  
  
  CONCLUSIONS
  Although most women expressed strong preferences for vaginal delivery, their preferences regarding interventions frequently used to achieve that goal varied. These data underscore the importance of educating patients about the process of labor and delivery to facilitate incorporation of informed patient preferences in shared decision making regarding delivery approach.
authors.affiliation: Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL.
authors.forename: Lynn M
authors.initials: LM
authors.lastname: Yee
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Biology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Anjali J
authors.initials: AJ
authors.lastname: Kaimal
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Kathryn A
authors.initials: KA
authors.lastname: Houston
authors.affiliation: Department of Obstetrics and Gynecology, University of California, Irvine, School of Medicine, Orange, CA.
authors.forename: Erica
authors.initials: E
authors.lastname: Wu
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Mari-Paule
authors.initials: MP
authors.lastname: Thiet
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Sanae
authors.initials: S
authors.lastname: Nakagawa
authors.affiliation: Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR.
authors.forename: Aaron B
authors.initials: AB
authors.lastname: Caughey
authors.affiliation: Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, School of Medicine, San Francisco, CA.
authors.forename: Atoosa
authors.initials: A
authors.lastname: Firouzian
authors.affiliation: 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. Electronic address: kuppermannm@obgyn.ucsf.edu.
authors.forename: Miriam
authors.initials: M
authors.lastname: Kuppermann
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000523:psychology*; D003430:Cross-Sectional Studies; D018864:Cultural Diversity; D003657:Decision Making; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology; D005006:Ethnicity; D005260:Female; D007722:Health Knowledge, Attitudes, Practice / Q000208:ethnology; D006801:Humans; D007407:Interviews as Topic; D010358:Patient Participation; D057240:Patient Preference / Q000208:ethnology / Q000523:psychology / Q000706:statistics & numerical data*; D011247:Pregnancy; D012495:San Francisco
keywords: mode of delivery; patient preferences; shared decision making; standard gamble; time tradeoff