Expectant parents' preferences for mode of delivery and trade-offs of outcomes for breech presentation

ObjectiveTo assess patients' preferences and trade-offs for mode of delivery in case of breech presentation at term.MethodsEighty women (40 with a foetus in breech presentation and 40 with a foetus in cephalic presentation) with a gestational age from 36 weeks onwards were offered scenarios of vaginal and caesarean breech delivery in which 1-month and 2-year neonatal and maternal complication rates were varied; expectant fathers (when present) were interviewed separately. Thresholds for complication rates where patients switch preferences were visualised graphically in trade-off curves. Differences in preference thresholds were tested using the Wilcoxon signed ranks test.ResultsCaesarean delivery was the preferred mode of delivery for breech presentation in 65% of the patients interviewed. The trade-off questions showed that the 2-year neonatal outcome after breech delivery was the most important outcome for the mothers, whereas the fathers were more influenced by the maternal outcome.ConclusionWhen realistic assumptions for complications are made, most women prefer a caesarean delivery over vaginal delivery for at term breech presentation. In the balance of pros and cons, 2-year neonatal outcome is the most important factor in the decision between caesarean and vaginal delivery.Practice implicationsThe results of this study can be used by the clinician to help patients weigh risk, benefit, and potential harm with regard to breech delivery.Marjolein Kok, Lonneke Gravendeel, Brent C. Opmeer, Joris A.M. van der Post, Ben W.J. Mo