Making the choice: Cesarean delivery by maternal request versus planned vaginal birth

Though verifiable statistics are difficult to produce, of the 1.3 million cesarean deliveries in the U.S. each year, somewhere between 4% and 18% of these surgeries are thought to be performed without medical indication and by maternal choice. Motivations for these decisions are not well understood, and may be biased by how and when women are asked the question. Neither the National Institutes of Health nor the American College of Obstetricians/Gynecologists have declared the risks and benefits of planned cesarean or planned vaginal birth to be greater than the other. Current policy allows women to autonomously make the decision using information provided to them by their provider, in addition to the experiences of their friends, their family and the media. To test the hypothesis that providing accurate risk, benefit and cost information for both types of delivery in an accessible and private format of an internet based decision tool will impact a women's choice of delivery, three versions of the Birth Choices Decision Tool and Survey, created by the author, were administered to a random sample of 1209 pregnant and non-pregnant women. Conclusions: Information on risks and benefits of each type of delivery influenced a woman's choice towards vaginal delivery when combined with information on costs to the health care system, although women planning a pregnancy within the next six months were influenced by risk and benefit information alone. Safety for the baby was the strongest independent factor in a woman's decision, and comfort with her decision, as measured by the Decisional Conflict Scale, increased significantly after seeing any version of the Decision Tool. It may be valuable for providers to encourage non pregnant, as well as pregnant women, to access a Decision Tool such as this in order to have accurate information available before discussing a future choice between cesarean and vaginal delivery.