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

A Correction to this article was published on 10 October 2019

This article has been updated



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.


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.


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

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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).

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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).

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