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Childbirth Preferences after Cesarean Birth: A Review of the Evidence


  • Karen Eden is an assistant professor, Jeanne-Marie Guise is an assistant professor, Patricia Osterweil is a research assistant, Peggy Nygren is a research associate in the Department of Medical Informatics and Clinical Epidemiology and Evidence-based Practice Center, Jeanne-Marie Guise is an assistant professor, and Jason Hashima is a resident in the department of Obstetrics and Gynecology, at Oregon Health & Science University in Portland, Oregon.

  • This study was conducted by the Oregon Health & Science University Evidence-based Practice Center under contract to the Agency for Healthcare Research and Quality (contract no. 290-97-0018), Rockville, Maryland. Support for Dr. Guise was also provided by the Agency for Healthcare Research and Quality grant no. 1 K08 HS11338-01.

  • The authors of this article are responsible for its contents, including any clinical or treatment recommendations. No statement in this article should be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services, Rockville, Maryland.

*Karen B. Eden, PhD, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Mail code: BICC, Portland, OR 97239-3098, United States.


Abstract: Background: Conflicting evidence on maternal and fetal safety of vaginal and cesarean childbirth after a previous cesarean makes patients and practitioners uncertain about pursuing a trial of labor or an elective repeat cesarean delivery. This review systematically evaluated and summarized the evidence related to women's preference for delivery. Methods: The Cochrane Database of Systematic Reviews and Registry of Controlled Trials and the MEDLINE, HealthSTAR, PsycINFO, and CINAHL databases were searched from 1980 to August 2002. We reviewed controlled trials, case-control studies, and observational studies that contained original patient data on preference for women with a previous cesarean delivery and that were of “good” or “fair” quality. Results: Women with a previous vaginal delivery were more likely to select trial of labor than women who did not have one. The most commonly cited reason for selecting trial of labor was ease of recovery and desire to return quickly to caring for other children (reported in 6 of 7 studies). Safety for the mother and/or infant was cited as an important reason for delivery choice in 4 of 11 studies. Important ethnic differences were reported. Nonwhite women were more likely to identify their provider as an important influence (39% vs 19%), and perceived labor as something to be avoided if another option resulted in a healthy baby compared with white women, who perceived labor as a challenge and an experience not to be missed. Conclusions: A woman's choice for delivery was often based on family obligations, such as the need for a shorter recovery so that she could care for her infant and children at home, rather than the safety of herself or her infant. It remains unclear if education on vaginal birth after cesarean increases the proportion of women who choose trial of labor. Future studies should evaluate the impact of education and timing of education on patient preference. (BIRTH 31:1 March 2004)