{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T00:29:13Z","timestamp":1788481753585,"version":"build-2803163510"},"reference-count":45,"publisher":"Public Library of Science (PLoS)","issue":"11","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Objective<\/jats:title>\n<jats:p>To investigate pregnant women\u2019s preferences for risks of vaginal and caesarean birth, including possible impacts on future fertility.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>In this discrete choice experiment, low-risk nulliparous pregnant women recruited after 28 weeks of gestation evaluated eight choice sets, each between two different hypothetical births scenarios which intermixed the risks of planned caesarean or vaginal birth. Scenarios consisted of six attributes: pain, maternal health, neonatal health, risk of unplanned intervention, impact on fertility and risk of complications in the next pregnancy. All scenarios contained risks to neonatal health as neither vaginal nor caesarean birth guarantee an ideal outcome. Choice data were analysed using a conditional logistic regression model.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Between June and September 2023, 211 participants, including 34 from pilot interviews, completed the questionnaire. Influential attributes were maternal health (conditional odds ratio [COR] 1.29, 95% CI 1.17 to 1.42, p&lt;0.001) and risk of unplanned intervention (COR 1.37, 95% CI 1.24 to 1.51, p&lt;0.001), favouring caesarean birth. Conversely, impact on fertility (COR 0.75, 95% CI 0.68 to 0.83, p&lt;0.001) and complications in the next pregnancy favoured vaginal birth (COR 0.90, 95% CI 0.82 to 1.00, p = 0.045).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Participants weighed the included morbidity risks of planned caesarean and vaginal birth in a low-risk pregnancy approximately equally. To facilitate an informed birth decision, clinicians should, apart from neonatal outcomes, particularly consider discussing impacts on fertility, maternal health and the risks of unplanned intervention or future pregnancy complications.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0310560","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T18:34:28Z","timestamp":1731004468000},"page":"e0310560","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Women\u2019s preferences for caesarean or vaginal birth with a perspective of future fertility: A discrete choice experiment"],"prefix":"10.1371","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7665-7135","authenticated-orcid":true,"given":"James D.","family":"Crispin","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ben W.","family":"Mol","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Madelon","family":"van Wely","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2263-3592","authenticated-orcid":true,"given":"Daniel L.","family":"Rolnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,11,7]]},"reference":[{"key":"pone.0310560.ref001","article-title":"Planned Caesarean Birth: Consent Advice No. 14","author":"Royal College of Obstetricians and Gynaecologists","year":"2022","journal-title":"Royal College of Obstetricians and Gynaecologists."},{"key":"pone.0310560.ref002","volume-title":"Caesarean Birth on Maternal Request (CBMR) Clinical Guidance Statement (C-Obs 39).","author":"Royal Australian and New Zealand College of Obstetricians and Gynaecologists","year":"2023"},{"issue":"1","key":"pone.0310560.ref003","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1097\/AOG.0000000000003007","article-title":"ACOG Committee Opinion No. 761 Summary: Caesarean Delivery on Maternal Request","volume":"133","author":"American College of Obstetricians and Gynaecologists","year":"2019","journal-title":"Obstetrics & Gynecology."},{"key":"pone.0310560.ref004","doi-asserted-by":"crossref","first-page":"103578","DOI":"10.1016\/j.midw.2022.103578","article-title":"Epidemiology of Caesarean section on maternal request in Australia: A population-based study.","volume":"117","author":"T Begum","year":"2023","journal-title":"Midwifery."},{"issue":"5","key":"pone.0310560.ref005","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1111\/1471-0528.16491","article-title":"Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression.","volume":"128","author":"T Begum","year":"2021","journal-title":"BJOG."},{"issue":"5","key":"pone.0310560.ref006","doi-asserted-by":"crossref","first-page":"100839","DOI":"10.1016\/j.ajogmf.2022.100839","article-title":"Obstetrical provider preferences for cesarean delivery on maternal request in uncomplicated pregnancies: a systematic review of the literature.","volume":"5","author":"T Rana","year":"2023","journal-title":"Am J Obstet Gynecol MFM"},{"key":"pone.0310560.ref007","doi-asserted-by":"crossref","first-page":"d7108","DOI":"10.1136\/bmj.d7108","article-title":"Caesarean section: summary of updated NICE guidance","volume":"343","author":"M Gholitabar","year":"2011","journal-title":"Bmj"},{"issue":"4","key":"pone.0310560.ref008","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1503\/cmaj.060870","article-title":"Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term.","volume":"176","author":"S Liu","year":"2007","journal-title":"CMAJ."},{"issue":"11","key":"pone.0310560.ref009","doi-asserted-by":"crossref","first-page":"2318","DOI":"10.1007\/s10995-016-2055-4","article-title":"Effect of Planned Mode of Delivery in Women with Advanced Maternal Age.","volume":"20","author":"M Lavecchia","year":"2016","journal-title":"Matern Child Health J."},{"issue":"2","key":"pone.0310560.ref010","doi-asserted-by":"crossref","first-page":"361","DOI":"10.1016\/j.clp.2008.03.009","article-title":"Neonatal morbidity and mortality after elective cesarean delivery.","volume":"35","author":"C Signore","year":"2008","journal-title":"Clin Perinatol."},{"key":"pone.0310560.ref011","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1186\/s13223-019-0367-9","article-title":"The association between caesarean section and childhood asthma: an updated systematic review and meta-analysis","volume":"15","author":"B Darabi","year":"2019","journal-title":"Allergy Asthma Clin Immunol"},{"key":"pone.0310560.ref012","doi-asserted-by":"crossref","first-page":"793400","DOI":"10.3389\/fped.2021.793400","article-title":"Effect of Elective Cesarean Section on Children\u2019s Obesity From Birth to Adolescence: A Systematic Review and Meta-Analysis.","volume":"9","author":"S Zhang","year":"2021","journal-title":"Front Pediatr."},{"issue":"1","key":"pone.0310560.ref013","doi-asserted-by":"crossref","first-page":"e1002494","DOI":"10.1371\/journal.pmed.1002494","article-title":"Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis.","volume":"15","author":"OE Keag","year":"2018","journal-title":"PLoS Med."},{"issue":"5","key":"pone.0310560.ref014","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.rbmo.2019.12.004","article-title":"Fertility outcomes of IVF\/ICSI after Caesarean section: a cohort study.","volume":"40","author":"L Wang","year":"2020","journal-title":"Reprod Biomed Online"},{"issue":"7","key":"pone.0310560.ref015","doi-asserted-by":"crossref","first-page":"1484","DOI":"10.1093\/humrep\/deaa094","article-title":"Post-Caesarean section niche-related impaired fertility: hypothetical mechanisms","volume":"35","author":"J Vissers","year":"2020","journal-title":"Hum Reprod"},{"issue":"7","key":"pone.0310560.ref016","doi-asserted-by":"crossref","first-page":"1943","DOI":"10.1093\/humrep\/det130","article-title":"Impact of Caesarean section on subsequent fertility: a systematic review and meta-analysis","volume":"28","author":"I Gurol-Urganci","year":"2013","journal-title":"Hum Reprod"},{"issue":"6","key":"pone.0310560.ref017","doi-asserted-by":"crossref","first-page":"1320","DOI":"10.1093\/humrep\/deu057","article-title":"A population-based cohort study of the effect of Caesarean section on subsequent fertility","volume":"29","author":"I Gurol-Urganci","year":"2014","journal-title":"Hum Reprod"},{"key":"pone.0310560.ref018","first-page":"2015","article-title":"Perineal care.","author":"J Frohlich","year":"2015","journal-title":"BMJ Clin Evid"},{"issue":"9","key":"pone.0310560.ref019","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1034\/j.1600-0412.2003.00194.x","article-title":"Elective cesarean section vs. spontaneous delivery: a comparative study of birth experience.","volume":"82","author":"M Schindl","year":"2003","journal-title":"Acta Obstetricia et Gynecologica Scandinavica"},{"issue":"4","key":"pone.0310560.ref020","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1016\/j.wombi.2019.09.005","article-title":"What are women\u2019s mode of birth preferences and why? A systematic scoping review.","volume":"33","author":"D Coates","year":"2020","journal-title":"Women Birth."},{"issue":"3","key":"pone.0310560.ref021","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1891\/1058-1243.21.3.158","article-title":"The Impact of Choice and Control on Women\u2019s Childbirth Experiences.","volume":"21","author":"K Cook","year":"2012","journal-title":"J Perinat Educ."},{"issue":"9","key":"pone.0310560.ref022","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/j.midw.2012.09.009","article-title":"Important factors working to mediate Swedish fathers\u2019 experiences of a caesarean section.","volume":"29","author":"M Johansson","year":"2013","journal-title":"Midwifery."},{"key":"pone.0310560.ref023","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1186\/1471-2393-14-191","article-title":"The influence of women\u2019s preferences and actual mode of delivery on post-traumatic stress symptoms following childbirth: a population-based, longitudinal study.","volume":"14","author":"S Garthus-Niegel","year":"2014","journal-title":"BMC Pregnancy Childbirth"},{"issue":"4","key":"pone.0310560.ref024","doi-asserted-by":"crossref","first-page":"403","DOI":"10.1016\/j.jval.2010.11.013","article-title":"Conjoint analysis applications in health\u2014a checklist: a report of the ISPOR Good Research Practices for Conjoint Analysis Task Force.","volume":"14","author":"JF Bridges","year":"2011","journal-title":"Value Health"},{"issue":"8","key":"pone.0310560.ref025","doi-asserted-by":"crossref","first-page":"661","DOI":"10.2165\/00019053-200826080-00004","article-title":"Conducting Discrete Choice Experiments to Inform Healthcare Decision Making.","volume":"26","author":"E Lancsar","year":"2008","journal-title":"PharmacoEconomics."},{"issue":"7","key":"pone.0310560.ref026","doi-asserted-by":"crossref","first-page":"e0219905","DOI":"10.1371\/journal.pone.0219905","article-title":"What attributes should be included in a discrete choice experiment related to health technologies? A systematic literature review.","volume":"14","author":"M Trapero-Bertran","year":"2019","journal-title":"PLoS One."},{"key":"pone.0310560.ref027","author":"O. Sedki","year":"2014","journal-title":"LiveGap Charts Maker"},{"issue":"3","key":"pone.0310560.ref028","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1016\/j.jogc.2018.05.002","article-title":"Brachial Plexus Birth Injury in Elective Versus Emergent Caesarean Section: A Cohort Study.","volume":"41","author":"HFM Augustine","year":"2019","journal-title":"J Obstet Gynaecol Can."},{"issue":"7172","key":"pone.0310560.ref029","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1136\/bmj.317.7172.1554","article-title":"Intrapartum risk factors for newborn encephalopathy: the Western Australian case-control study","volume":"317","author":"N Badawi","year":"1998","journal-title":"BMJ"},{"issue":"7635","key":"pone.0310560.ref030","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1136\/bmj.39405.539282.BE","article-title":"Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study","volume":"336","author":"AK Hansen","year":"2008","journal-title":"BMJ"},{"key":"pone.0310560.ref031","volume-title":"Australia\u2019s Children: Asthma Prevalence Among Children","author":"Australian Institute of Health and Welfare","year":"2022"},{"key":"pone.0310560.ref032","volume-title":"Australia\u2019s Children: Overweight and Obesity","author":"Australian Institute of Health and Welfare","year":"2022"},{"key":"pone.0310560.ref033","volume-title":"National Core Maternity Indicators","author":"Australian Institute of Health and Welfare","year":"2023"},{"issue":"4","key":"pone.0310560.ref034","doi-asserted-by":"crossref","first-page":"459","DOI":"10.1016\/j.ijresmar.2005.09.003","article-title":"Quick and easy choice sets: Constructing optimal and nearly optimal stated choice experiments","volume":"22","author":"DJ Street","year":"2005","journal-title":"International Journal of Research in Marketing"},{"key":"pone.0310560.ref035","article-title":"AlgDesign V1.2.1 (software package).","author":"RE Wheeler","year":"2022","journal-title":"The Comprehensive R Archive Network"},{"key":"pone.0310560.ref036","volume-title":"R: A language and environment for statistical computing.","author":"R Core Team","year":"2022"},{"key":"pone.0310560.ref037","volume-title":"Qualtrics XM (software).","author":"Qualtrics","year":"2023"},{"issue":"1","key":"pone.0310560.ref038","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1111\/j.1365-2648.2007.04569.x","article-title":"The qualitative content analysis process.","volume":"62","author":"S Elo","year":"2008","journal-title":"J Adv Nurs"},{"issue":"10","key":"pone.0310560.ref039","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1002\/hec.984","article-title":"Effects coding in discrete choice experiments.","volume":"14","author":"M Bech","year":"2005","journal-title":"Health Econ"},{"issue":"2","key":"pone.0310560.ref040","doi-asserted-by":"crossref","first-page":"86","DOI":"10.3173\/air.17.86","article-title":"Design and Analysis of Choice Experiments Using R: A Brief Introduction.","volume":"17","author":"H Aizaki","year":"2008","journal-title":"Agricultural Information Research."},{"issue":"3","key":"pone.0310560.ref041","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1093\/humrep\/dez295","article-title":"Reduced pregnancy and live birth rates after in vitro fertilization in women with previous Caesarean section: a retrospective cohort study","volume":"35","author":"J Vissers","year":"2020","journal-title":"Hum Reprod"},{"issue":"1","key":"pone.0310560.ref042","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1111\/j.1523-536X.2007.00205.x","article-title":"Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an \"intention-to-treat\" model.","volume":"35","author":"MF MacDorman","year":"2008","journal-title":"Birth."},{"issue":"5","key":"pone.0310560.ref043","doi-asserted-by":"crossref","first-page":"745","DOI":"10.1111\/1471-0528.13592","article-title":"Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data.","volume":"123","author":"J Ye","year":"2016","journal-title":"BJOG."},{"key":"pone.0310560.ref044","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/s12978-015-0043-6","article-title":"What is the optimal rate of caesarean section at population level? A systematic review of ecologic studies.","volume":"12","author":"AP Betran","year":"2015","journal-title":"Reprod Health."},{"issue":"3","key":"pone.0310560.ref045","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1177\/14777509231183365","article-title":"\u2018Maternal request\u2019 caesarean sections and medical necessity.","volume":"18","author":"RC Brown","year":"2023","journal-title":"Clinical Ethics"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310560","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T18:34:52Z","timestamp":1731004492000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0310560"}},"subtitle":[],"editor":[{"given":"Natasha L.","family":"Pritchard","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,11,7]]},"references-count":45,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11,7]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0310560","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,11,7]]}}}