Anjali J Kaimal1, William A Grobman2, Allison Bryant3, Cinthia Blat4, Peter Bacchetti5, Juan Gonzalez4, Mari-Paule Thiet4, Yamilee Bermingham6, Miriam Kuppermann7. 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 (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. 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.
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 (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. 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.
Authors: Miriam Kuppermann; Anjali J Kaimal; Cinthia Blat; Juan Gonzalez; Mari-Paule Thiet; Yamilee Bermingham; Anna L Altshuler; Allison S Bryant; Peter Bacchetti; William A Grobman Journal: JAMA Date: 2020-06-02 Impact factor: 56.272
Authors: William A Grobman; Grecio Sandoval; Madeline Murguia Rice; Jennifer L Bailit; Suneet P Chauhan; Maged M Costantine; Cynthia Gyamfi-Bannerman; Torri D Metz; Samuel Parry; Dwight J Rouse; George R Saade; Hyagriv N Simhan; John M Thorp; Alan T N Tita; Monica Longo; Mark B Landon Journal: Am J Obstet Gynecol Date: 2021-05-24 Impact factor: 8.661
Authors: Kartik K Venkatesh; Suzanne Brodney; Michael J Barry; Jamie Jackson; Kiira M Lyons; Asha N Talati; Thomas S Ivester; Maria C Munoz; John M Thorp; Wanda K Nicholson Journal: BMC Pregnancy Childbirth Date: 2021-09-23 Impact factor: 3.007