Sunday, October 23, 2011
Grand Ballroom AB (Hyatt Regency Chicago)
Poster Board # 34
(DEC) Decision Psychology and Shared Decision Making

Kathryn Houston, MD, MA1, Anjali Kaimal, MD, MAS2, Ann Drapkin Lyerly, MD, MA3, Margaret Olivia Little, PhD4, Aaron B. Caughey, MD, MPP, MPH, PhD5, Sanae Nakagawa, MA1 and Miriam Kuppermann, PhD, MPH1, (1)University of California, San Francisco, San Francisco, CA, (2)Massachusetts General Hospital, Harvard Medical School, Boston, MA, (3)University of North Carolina, Chapel Hill, NC, (4)Georgetown University, Washington DC, DC, (5)Oregon Health & Sciences University, Portland, OR

Purpose: To examine attitudes and predictors of attitudes towards being offered a choice between planned vaginal and planned cesarean delivery among pregnant women.

Methods: We recruited pregnant women who were between their 24th and 36th gestational week for a study of mode of delivery preferences.  During a face-to-face interview, we administered a questionnaire which included items related to sociodemographic characteristics, delivery history, depression and self efficacy.  Participants also were asked to rate their agreement (on a 5-point scale) with two statements: “All pregnant women should be offered a choice between attempting a vaginal birth and having a cesarean delivery” and “Having a choice between having a cesarean delivery or attempting to have a vaginal birth would be a good thing for me.” Multivariate logistic regression analysis was used to identify predictors of agreement with each of these statements.

Results: The 160 women who participated in the study were racially/ethnically diverse (48% white, 26% African American, 18% Asian or Pacific Islander and 9% Latina) and varied substantially in their delivery histories (about a third each were nulliparous (34%), had only vaginal deliveries (35%), or had at least one cesarean section (31%)). Thirty percent of the participants agreed that women should be offered a choice of delivery approach and slightly more women (35%) felt that having this choice would be good for them. Having a prior cesarean section was the only significant predictor of believing that having a choice would be good for them (adjusted OR 2.78, 95% CI 1.15-6.71, p=.02), while having less than a college degree (adjusted OR 2.56, 95% CI 1.03-6.36, p=.04) and lower self-efficacy scores (adjusted OR=0.52, 95% CI 0.28-0.97, p=0.04 for every 1 point increase in this 5 point scale) emerged as predictors of feeling all women should have this choice.  

Conclusions: Women's attitudes toward being offered – or having others be offered - a choice between planned vaginal and planned cesarean delivery vary widely, and are related not only to their delivery history but also to their education and sense of self efficacy.  A better understanding is needed of women’s mode of delivery preferences, their attitudes towards different management options, and their preferences regarding how and when these options are discussed to help them experience the type of delivery they desire.