Cohort study of maternal views on future mode of delivery after operative delivery in the second stage of labor

Objective: The purpose of this study was to assess maternal views on the future mode of delivery after either previous instrument vaginal delivery or cesarean delivery at full dilatation. Study design: We conducted a prospective cohort study of 393 women with term singleton cephalic pregnancies. Results: More than one half of the cohort intended to have a further pregnancy, with no significant differences between the instrument vaginal delivery and caesarean delivery groups (51% vs 54% before discharge; adjusted odds ratio, 1.04; 95% CI, 0.2, 6.0), and there was little change in maternal views over time. Women were more likely to aim for a future vaginal delivery after an instrument vaginal delivery (79% vs 39% before discharge; adjusted odds ratio, 4.5; 95% CI, 2.2, 9.2), but the proportion decreased over time (68% vs 42% at 1 year; adjusted odds ratio, 3.6; 95% CI, 1.6, 8.1). There were no significant differences in preferred future mode of delivery for women who had a caesarean delivery after a failed instrument delivery and those who were delivered by immediate caesarean delivery. Conclusion: A high proportion of women who have had a previous difficult instrument vaginal delivery would still prefer vaginal delivery in a future pregnancy. (Am J Obstet Gynecol 2003;188:542-8.)