A comparative study of patient and provider priorities for cesarean delivery anesthesia care

Patient priorities for anesthesia during a cesarean delivery are not well defined. Previous studies have explored patient preferences for cesarean delivery anesthesia but have not evaluated patient-centered endpoints unrelated to the physical experience which are known to be important to patients' birth experiences, such as being treated with respect, communication, and emotional support. The purpose of this study was to compare patients' and providers' priorities for cesarean delivery anesthesia care.

This prospective cross-sectional quantitative survey study included patients with recent cesarean deliveries and clinical providers who provide clinical care for cesarean deliveries. Eleven patient-centered factor related to cesarean delivery anesthesia experience were identified based on previously reported findings and results of semi-structured interviews. Participants then completed a forced ranking survey for these 11 factor, ranked in order from most important to least important aspect of cesarean anesthesia care. They also ranked most desired to least desired anesthesia side effects (e.g. pruritus, nausea, pain). Participants also rated their perceived importance of the factor ranked highest and lowest on a 0-10 numeric rating scale (0 = not important at all and 10 = most important imaginable). Rankings from patient and provider groups were compared using Plackett-Luce method using tree-based recursive partitioning.

One hundred forty-four respondents (127 patients, 17 providers) were included in the analysis. "Physical safety of the baby" was ranked highest among patients and was higher than the rank assigned by providers (P < 0.001). Although mothers with vs. without self-reported birth trauma each highly prioritized safety of baby, the relative priority placed on this factor was higher among mothers with self-reported birth trauma. For anesthesia-related side effects, patients and providers agreed that memory loss, spinal headaches, and pain or discomfort during surgery, represented high-priority concerns to avoid; drowsiness, shivering, and pruritus were considered lower-priority. There were ranking differences between in-person and digital recruited patients.

Patients and providers have discordant views on priorities during cesarean delivery, and similar views on priorities for anesthesia-related side effects. A self-reported history of birth trauma, but not pain during cesarean delivery, is associated with high prioritization of physical safety of mother and baby over other cesarean experience priorities. Future clinical care improvements and research are needed to help patients and providers balance the outcomes most important to patients during and after cesarean delivery.