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J Perinatol. 2019 Jul 3. doi: 10.1038/s41372-019-0399-5. [Epub ahead of print]

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

Author information

1
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA. akaimal@partners.org.
2
Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
3
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA.
4
Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, San Francisco, CA, USA.
5
Department of Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
6
Marin Community Clinic, San Rafael, CA, USA.
7
Departments of Obstetrics, Gynecology & Reproductive Sciences and Epidemiology & Biostatistics, University of California, San Francisco, San Francisco, CA, USA.

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 (nā€‰=ā€‰197, 85%) preferred vaginal delivery, but only 40% (nā€‰=ā€‰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.

PMID:
31270433
DOI:
10.1038/s41372-019-0399-5

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