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

Abstract

<h4>Objective</h4>To assess patients' preferences and trade-offs for mode of delivery in case of breech presentation at term.<h4>Methods</h4>Eighty 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.<h4>Results</h4>Caesarean 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.<h4>Conclusion</h4>When 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.<h4>Practice implications</h4>The results of this study can be used by the clinician to help patients weigh risk, benefit, and potential harm with regard to breech delivery.