title: Historic cohort study on mode of delivery of a macrosomic baby: the women's point of view.
abstract: BACKGROUND
  A historic cohort study was conducted to evaluate satisfaction with childbirth of a macrosomic baby according to mode of delivery.
  
  
  METHODS
  All 559 nulliparous women who delivered a neonate weighing >4000 g between 2008 and 2012 were included. The degree of women's satisfaction with childbirth after elective cesarean, vaginal delivery or cesarean during labor was assessed using a five-level scale. Immediate neonatal and maternal outcomes were retrieved from clinical records. Long-term maternal outcomes were evaluated using four questionnaires on urinary incontinence, anal incontinence, and sexual functioning.
  
  
  RESULTS
  Ninety-nine women underwent elective cesarean, whereas 460 attempted a vaginal delivery. In the latter group, 276 women delivered vaginally, whereas 184 underwent a cesarean during labor. Long-term outcomes were assessed in 273 women (49%; elective cesarean, n = 55; vaginal delivery, n = 135; cesarean in labor, n = 83) after a mean 3-year follow up. The proportion of long-term stress or mixed urinary incontinence was, respectively, 8%, 34%, and 12%, whereas that of anal incontinence was 7%, 19%, and 6%. Sexual functioning was similar in the three groups. No major neonatal complications were observed. When pooling the vaginal delivery and the cesarean in labor groups, the likelihood of being satisfied with childbirth was 63% in the "attempted vaginal delivery" group and 85% in the elective cesarean group (adjusted risk ratio, 0.72; 95% CI 0.61-0.84).
  
  
  CONCLUSIONS
  About one-third of women attempting a vaginal delivery of a macrosomic baby, would choose an elective cesarean if they could turn back time.
authors.affiliation: Department of Women's and Children's Health, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Vercellini
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Monica
authors.initials: M
authors.lastname: Fumagalli
authors.affiliation: Epidemiology Unit, Department of Preventive Medicine, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Dario
authors.initials: D
authors.lastname: Consonni
authors.affiliation: Department of Women's and Children's Health, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Lucrezia
authors.initials: L
authors.lastname: de Braud
authors.affiliation: Department of Women's and Children's Health, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Giussy
authors.initials: G
authors.lastname: Barbara
authors.affiliation: Department of Women's and Children's Health, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Enrico
authors.initials: E
authors.lastname: Iurlaro
authors.affiliation: Neonatal Intensive Care Unit, Department of Clinical Science and Community Health, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Mosca
authors.affiliation: Department of Women's and Children's Health, University of Milan and Foundation Institute for Treatment and Research (IRCCS Ca' Granda) - Hospital Maggiore Polyclinic, Milan, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Fedele
mesh_terms: D000328:Adult; D002585:Cesarean Section / Q000523:psychology* / Q000706:statistics & numerical data; D015331:Cohort Studies; D036861:Delivery, Obstetric / Q000523:psychology* / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000523:psychology* / Q000706:statistics & numerical data; D005242:Fecal Incontinence / Q000453:epidemiology; D005260:Female; D005320:Fetal Macrosomia / Q000453:epidemiology*; D005500:Follow-Up Studies; D006801:Humans; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D017060:Patient Satisfaction; D011247:Pregnancy; D012725:Sexual Behavior; D013315:Stress, Psychological / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014219:Trial of Labor; D014549:Urinary Incontinence / Q000453:epidemiology
keywords: Fetal macrosomia; birth injuries; elective cesarean section; patient satisfaction; urinary incontinence