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The association of patient preferences and attitudes with trial of labor after cesarean

Journal of Perinatology volume 39, pages 1340–1348 (2019)Cite this article

Subjects

A Correction to this article was published on 10 October 2019

This article has been updated

Abstract

Objective

To evaluate the association of patient preferences and attitudes with TOLAC.

Study design

Prospective observational study of TOLAC-eligible women at 26–34 weeks gestation. Preferences (utilities) were elicited using the time trade-off and standard gamble metrics. Logistic regression was used to identify preference- and attitude-based factors associated with TOLAC.

Results

Of the 231 participants, most (n = 197, 85%) preferred vaginal delivery, but only 40% (n = 93) underwent TOLAC. Utilities for uterine rupture outcomes did not differ based on delivery approach. In multivariable analysis, strength of preference for vaginal delivery, value for the experience of labor, and the opinion of the person whom the participant thought of as most important to this decision were associated with TOLAC.

Conclusions

Future decision support interventions incorporating individualized information regarding the likelihood of vaginal birth and empowering patients to express their preferences and engage their families in the decision-making process may improve decision quality and increase TOLAC rates.

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Change history

  • 10 October 2019

    An amendment to this paper has been published and can be accessed via a link at the top of the paper.

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Funding

This work was supported by NIH/NICHD R01 HD078748 (PI Kuppermann).

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA

    Anjali J. Kaimal & Allison Bryant

  2. Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    William A. Grobman

  3. Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA

    Cinthia Blat, Juan Gonzalez & Mari-Paule Thiet

  4. Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Peter Bacchetti

  5. Marin Community Clinic, San Rafael, CA, USA

    Yamilee Bermingham

  6. Departments of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Miriam Kuppermann

Authors
  1. Anjali J. Kaimal
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  2. William A. Grobman
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  3. Allison Bryant
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  4. Cinthia Blat
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  5. Peter Bacchetti
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  6. Juan Gonzalez
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  7. Mari-Paule Thiet
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  8. Yamilee Bermingham
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  9. Miriam Kuppermann
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Contributions

All authors certify that they made substantial contributions to the conception or design of the work (AK, WG, AB, PB, and MK); or the acquisition, analysis, or interpretation of data for the work (AK, WG, AB, PB, MK, CB, JG, MPT, and YB); and Drafted the work or revising it critically for important intellectual content (AK, WG, AB, PB, MK, CB, JG, MPT, and YB); and Gave final approval of the version to be published (AK, WG, AM, PB, MK, CB, JG, MPT, and YB); and Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. (AK, WG, AM, PB, MK, CB, JG, MPT, and YB).

Corresponding author

Correspondence to Anjali J. Kaimal.

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Kaimal, A.J., Grobman, W.A., Bryant, A. et al. The association of patient preferences and attitudes with trial of labor after cesarean. J Perinatol 39, 1340–1348 (2019). https://doi.org/10.1038/s41372-019-0399-5

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