Mother knows best? Comparing primiparous parturients' expectations and predictions with actual birth outcomes

Objective: The literature provides no clear evidence linking maternal optimism/pessimism to birth outcomes. Our objective was to determine whether maternal expectations and predictions regarding mode of delivery and epidural anesthesia aligned with birth outcomes. Methods: Primiparous, low-risk pregnant women at term filled in questionnaires in which they rated their chances of a vaginal delivery (VD) or a cesarean section (CS), and their intention to receive epidural anesthesia. Their responses were compared to actual outcomes. Results: Pre-birth perceptions of odds of delivery by a CS were significantly higher (P = 0.04) among women who eventually had a vacuum extraction (VE) or CS as a result of an arrest disorder, compared with women who had a VD and those who had a CS or a VE due to non-reassuring fetal heart monitor. Intention to receive epidural anesthesia was significantly lower (P < 0.001) among women who gave birth without it. Conclusion: The pessimistic pre-birth perceptions of women of high odds for a CS may be related to an increased risk of arrest disorders of labor. However, the prenatal assessments of primiparous women are poor predictors of their demand for epidural anesthesia during labor. Largerscale studies to determine whether pre-partum psychological interventions may contribute to the process of labor and improve obstetric outcomes are warranted.