DOI 10.1515/jpm-2013-0236 J. Perinat. Med. 2013; x(x): xxx–xxx Shikma Bar-On, Yael Benyamini, Mindy Ebrahimoff and Ariel Many* Mother knows best? Comparing primiparous parturients’ expectations and predictions with actual birth outcomes Abstract Objective: The literature provides no clear evidence linking maternal optimism/pessimism to birth outcomes. Our objective was to determine whether maternal expecta- tions and predictions regarding mode of delivery and epi- dural 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 anesthe- sia 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. Larger- scale studies to determine whether pre-partum psycholog- ical interventions may contribute to the process of labor and improve obstetric outcomes are warranted Keywords: Arrest disorders of labor; mode of delivery; optimism; pessimism; prediction. *Corresponding author: Ariel Many, MD, MHA, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel, Tel.: +972-3-6925603, Fax: +972-3-69252755, E-mail: arielm@tlvmc.gov.il Shikma Bar-On and Mindy Ebrahimoff: Department of Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Yael Benyamini: Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel Introduction Dispositional optimism and pessimism, defined as gen- eralized positive (or negative) outcome expectations [9], have been linked to diverse health outcomes, includ- ing all-cause mortality, progression of atherosclerosis, cancer outcomes, immune function, post-surgical recov- ery, health behaviors (e.g., treatment adherence), and subjective reporting of physical symptoms such as pain [2, 6]. Similar findings have also been reported in relation to women’s health. Women with higher levels of dispo- sitional optimism have been found to have lower levels of stress and anxiety during pregnancy compared with women with lower levels of optimism [5]. Pessimism was found to predict fertility treatment failure, independent of other risk factors [2]. Moreover, women dealing with the stress of high-risk pregnancies who were least optimistic delivered infants who weighed significantly less, control- ling for gestational age, which suggests that maternal emotional stress influences the well-being of the offspring [4]. Similar findings were reported from studies investi- gating situated optimism, defined as subjective positive expectations of specific outcomes. For example, cardiac patients’ expectations for their recovery predicted long- term survival and functioning [1]. It would therefore seem reasonable to hypothesize that if both dispositional and situated optimism (specific optimistic expectations) lead to better health outcomes, there should be a positive cor- relation between situated optimism regarding mode of delivery and the achievement of a vaginal delivery (VD) rather than a cesarean section (CS). Caregivers in labor and delivery wards sometimes encounter pessimism among pregnant women approach- ing delivery concerning their chances of achieving a VD. They often encourage women to be optimistic and to think positively. However, existing literature does not provide conclusive evidence that a woman’s mindset during preg- nancy influences her mode of delivery. The aim of our study was to determine whether mater- nal expectations and predictions regarding the mode