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Licensed Unlicensed Requires Authentication Published by De Gruyter June 18, 2019

Socio-cultural and clinician determinants in the maternal decision-making process in the choice for trial of labor vs. elective repeated cesarean section: a questionnaire comparison between Italian settings

  • Stefania Triunfo EMAIL logo , Claudia Minciotti , Barbara Burlon , Franca Giovannangeli , Michelangela Danza , Saverio Tateo and Antonio Lanzone



To identify socio-cultural and clinician determinants in the decision-making process in the choice for trial of labor after cesarean (TOLAC) or elective repeat cesarean section (ERCS) in delivering women.


A tailored questionnaire focused on epidemiological, socio-cultural and obstetric data was administered to 133 patients; of these, 95 were admitted for assistance at birth at Fondazione Policlinico Universitario “A. Gemelli” (FPG) IRCCS, Rome, and 38 at S. Chiara Hospital (SCH), Trento, Italy. Descriptive analysis and logistic regression modeling were performed.


Vaginal birth after cesarean (VBAC) rates were higher at SCH than at FPG (68.4% vs. 23.2%; P < 0.05). Maternal age in the TOLAC/VBAC group was significantly higher at SCH than at FPG (37.1 vs. 34.9 years, P < 0.05). High levels of education and no-working condition corresponded to a lower rate of VBAC. Proposal on delivery mode after a previous CS was missed in the majority of cases. Participation in prenatal course was significantly less among women in the ERCS groups. Using logistic regression, the following determinants were found to be statistically significant in the decision-making process: maternal age [odds ratio (OR) = 0.968 (95% confidence interval [CI] 0.941–0.999); P = 0.019], education level [OR = 0.618 (95% CI 0.419–0.995); P = 0.043], information received after the previous CS [OR = 0.401 (95% CI 0.195–1.252); P = 0.029], participation in antenatal courses [OR = 0.534 (95% CI 0.407–1.223); P = 0.045] and self-determination in attempting TOLAC [OR = 0.756 (95% CI 0.522–1.077); P = 0.037].


In the attempt to promote person-centered care, increases in TOLAC/VBAC rates could be achieved by focusing on individual maternal needs. An ad hoc strategy for making birth safer should begin from accurate information at the time of the previous CS.

Corresponding author: Stefania Triunfo, MD, PhD, Department of Obstetrics and Gynaecology, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, Università Cattolica del Sacro Cuore, Largo A. Gemelli 8, 00168 Rome, Italy; and Università Cattolica del Sacro Cuore, Rome, Italy

  1. Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Data sharing statement: All data included in the present paper are available.


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Received: 2019-02-12
Accepted: 2019-05-11
Published Online: 2019-06-18
Published in Print: 2019-08-27

© 2019 Walter de Gruyter GmbH, Berlin/Boston

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