Improving Decisional Quality on Labor and Delivery: What Do Women Know About Cesarean Delivery? [23K]

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We aim to describe decisional quality (defined by decision-specific knowledge, decisional conflict and patient satisfaction) for women whose gestational age indicated that they should have been counseled regarding birthing options. We also aim to understand how confident patients are regarding their birthing choice and predictors of decisional conflict.


A convenience sample of antepartum patients receiving care at University based clinics was selected. Patients were P0, 35 weeks or greater gestation, and without medical indication for cesarean delivery. Knowledge was measured using a new instrument developed by a multi-stakeholder panel. The SURE scale was used to measure decisional conflict. Satisfaction with care, shared decision-making, and sources of information regarding treatment decision-making was also measured.


91% of respondents (N=81) planned on a vaginal delivery, 7% reported they were undecided and a single respondent reported they planned to have a cesarean delivery. Overall knowledge score was 52%. Knowledge scores individually and overall did not correlate with decisional conflict, however those with lower knowledge scores were less sure that they would stay with their decision (OR 5.6). Most patients report “friends and family” as their most influential source (63%), however this was also associated with higher decisional conflict (P=.035). Patients whose providers had asked them about delivery preferences had lower decisional conflict (P=.01).


This initiative provided a comprehensive assessment of knowledge areas that were deemed important for a woman in making the choice between cesarean and vaginal delivery as well as factors predictive of choice certainty. Future work to improve decisional quality is warranted.

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