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Background To determine whether the mode of delivery was different between women who attended childbirth education ( CBE) class, had a birth plan, or both compared with those who did not attend CBE class or have a birth plan. Methods This is a retrospective cross-sectional study of women who delivered singleton gestations > 24 weeks at our institution between August 2011 and June 2014. Based on a self-report at the time of admission for labor, women were stratified into four categories: those who attended a CBE class, those with a birth plan, both, and those with neither CBE or birth plan. The primary outcome was the mode of delivery. Multivariate logistic regression analyses adjusting for clinical covariates were performed. Results In this study, 14,630 deliveries met the inclusion criteria: 31.9 percent of the women attended CBE class, 12.0 percent had a birth plan, and 8.8 percent had both. Women who attended CBE or had a birth plan were older ( p < 0.001), more likely to be nulliparous ( p < 0.001), had a lower body mass index ( p < 0.001), and were less likely to be African-American ( p < 0.001). After adjusting for significant covariates, women who participated in either option or both had higher odds of a vaginal delivery ( CBE: OR 1.26 [95% CI 1.15-1.39]; birth plan: OR 1.98 [95% CI 1.56-2.51]; and both: OR 1.69 [95% CI 1.46-1.95]) compared with controls. Conclusion Attending CBE class and/or having a birth plan were associated with a vaginal delivery. These findings suggest that patient education and birth preparation may influence the mode of delivery. CBE and birth plans could be used as quality improvement tools to potentially decrease cesarean rates. [ABSTRACT FROM AUTHOR]

Focuses on the decline of cesarean rate in the U.S. for the period 1998 and 1994. Indication of primary cesarean delivery; Source of payment for the surgical operation; Percentage of caesareans attributed to dystocia and fetal distress.