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Skip Navigation LinksHome > October 2008 - Volume 112 - Issue 4 > Mode of Delivery: Toward Responsible Inclusion of Patient Pr...
Obstetrics & Gynecology:
doi: 10.1097/AOG.0b013e3181888fd8
Current Commentary

Mode of Delivery: Toward Responsible Inclusion of Patient Preferences

Little, Margaret Olivia PhD1; Lyerly, Anne Drapkin MD, MA2; Mitchell, Lisa M. PhD3; Armstrong, Elizabeth M. PhD, MPA4; Harris, Lisa H. MD, PhD5; Kukla, Rebecca PhD6; Kuppermann, Miriam PhD, MPH7

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Abstract

Deciding when and how to incorporate patient preferences regarding mode of delivery is challenging for both obstetric providers and policymakers. An analysis of current guidelines in four clinical scenarios (prior cesarean, twin delivery, breech presentation, and maternal request for cesarean) indicates that some guidelines are highly prescriptive whereas others are more flexible, based on physicians' discretion or (less frequently) patient preferences, without consistency or explicit rationale for when such flexibility is permissible, advisable, or obligatory. Although patient-choice advocates have called for more patient-responsive guidelines, concerns also have been raised, especially in the context of discussions of cesarean delivery on maternal request, about the dangers of unfettered patient-preference–driven clinical decisions. In this article, we outline a framework for the responsible inclusion of patient preferences into decision making regarding approach to delivery. We conclude, using this framework, that more explicit incorporation of patient preferences is called for in the first three scenarios and indicate why expanding access to cesarean delivery on maternal request is more complicated and would require more data and further consideration.

© 2008 The American College of Obstetricians and Gynecologists

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