Exploring the value of waiting during labor

Abstract

Of the nearly four million births that occur each year in the United States, almost one in three is a cesarean delivery. Despite the increasing C-section rate over the years, there is no evidence that the increase has caused a decrease in neonatal or maternal mortality or morbidity. Bayesian decision analysis is used to model the decision between classifying a patient as "failure-to-progress," which is cause for a C-section, using current information (prior probability) or information gathered (posterior probability) as labor continues. The Bayesian decision models determine the conditions under which it is appropriate to gather additional information (i.e., take an observation) before deciding to end labor and perform a C-section based on the decision maker's belief about successful labor. During an observation period, the decision maker learns more about the patient and her medical state and the likelihood of a successful vaginal delivery is updated. This study determines the conditional value of information (conditional on the decision maker's prior belief) and determines the conditions under which information has positive value. This model can be used to facilitate shared decision making for labor and delivery through communicating beliefs, risk perceptions, and the associated actions.