Eight-dimension review score against the
quality rubric
. Each dimension scored 1–5.
D1 Source verification
5/5
D2 Source authority & independence
4/5
D3 Regret-rate accuracy
3/5
D4 Source comparability
3/5
D5 Gilovich pattern
5/5
D6 Prose quality
5/5
D7 Caveat completeness
5/5
D8 Sample quality
5/5
Average4.38/5
Action regret
Cesarean delivery
19%
19% of cesarean-delivery women were dissatisfied with the birth experience (dissatisfaction proxy)
Women who delivered by cesarean section in Scotland, recruited via postal survey (mixed planned and unplanned)
retrospective, variable time since delivery
Inaction regret
Vaginal delivery
7.0%
7% of women had a negative birth experience at 1 year postpartum (negative experience proxy)
Swedish women recruited at all antenatal clinics nationally, assessed 1 year after delivery (predominantly vaginal births given ~15% national C-section rate)
1 year after delivery
% who regret this choice
Cesarean deliveryVaginal delivery
19%7.0%
action dominates — Action dominates — most regret acting.
Related decisions
Semantically similar decisions — same territory, different trade-offs.
Cesarean delivery carries roughly three times the negative-experience rate of
spontaneous vaginal delivery across the available survey and outcomes literature:
19% of cesarean-delivery women in a large Scottish postal study reported dissatisfaction
with their birth (Porter et al. 2007, n=1,661), compared to 7% of women in a national
Swedish cohort who rated their birth — predominantly vaginal — as a negative experience
one year later (Waldenström et al. 2004, n=2,541). The PTSD literature corroborates the
direction: spontaneous vaginal birth produces the lowest postpartum PTSD rates of any
delivery mode (1.8% at 6+ months, Ginter 2022 integrative review), while emergency
cesarean sits at the top (4.8%), with elective cesarean and instrumental vaginal between
them.
The critical within-group caveat is that unplanned cesareans drive most of the negative
signal. Konheim-Kalkstein & Miron-Shatz (2021) found 73% regret among 227 US women
with unplanned cesareans as their only birth — but the regret was predominantly
inaction-flavored, centering on not having advocated for themselves during labor, rather
than regretting the surgical procedure itself. Women who chose a planned elective
cesarean fared far better: Coates et al. (2021) found 85% were satisfied with their
decision-making process. The 19% average action-side rate masks a distribution that
runs from roughly 15% for planned cesarean to 73% for unplanned — depending almost
entirely on whether the procedure was chosen or imposed by circumstances.
Long-term data push the gap wider. A 2017 follow-up of a US prospective cohort found
that at 10 or more years after delivery, women who delivered vaginally reported
statistically higher fulfillment and lower distress scores than those who delivered by
cesarean section. This trajectory fits the Gilovich inaction-versus-action pattern:
the shorter-term satisfaction advantage of elective cesarean (control, predictability,
pain management) tends to erode at decade-scale follow-up, while the physical and
psychological outcomes of uncomplicated vaginal birth accumulate in the positive
direction. The absence of direct “regret about not having a cesarean” survey data
from vaginal-delivery populations is itself informative: the construct is rarely
studied because the experience is relatively rarely reported.
Sources: action
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]Birth / Porter, van Teijlingen, Yip & Bhattacharya — Satisfaction with cesarean section: qualitative analysis of open-ended questions in a large postal survey
Peer-reviewed
81% of cesarean-delivery women were satisfied with the birth experience; 19% were not satisfied
Excerpt
“"Eighty-one percent of women were satisfied with the experience. Thirty-six percent rated at least one aspect of their caesarean section as distressing. Forty-two percent provided written descriptions of distressing experiences, of which 66% described psychological or communication-related issues."
”
Source data from
2007-06-01
Accessed
2026-05-04
Calculation
Porter et al. (2007) conducted a postal survey of all women in Grampian, Scotland who delivered by cesarean in a 2-year period; 1,661 responded (75% response rate). Satisfaction item was binary; 81% reported satisfied, leaving 19% as the dissatisfied/negative-experience proportion used as the regret proxy. Mixed planned and unplanned cesareans; emergency cesarean carries substantially higher dissatisfaction rates (see Konheim-Kalkstein below for unplanned-only data). The 19% figure is the primary action-side rate because it covers the full cesarian population, not only emergency cases.
Independence
Population-based postal survey in Scotland; independent of the US-based Konheim-Kalkstein study below.
[2]Journal of Health Psychology / Konheim-Kalkstein & Miron-Shatz — 'If only I had . . .': Regrets from women with an unplanned cesarean delivery
Peer-reviewed
73% of women with unplanned cesarean as their only birth reported regret; regret centered on inaction, particularly not advocating for the self
Excerpt
“"Seventy-three percent of women reported regret which mostly centered on inaction, particularly not advocating for the self. Those with regrets reported lower birth satisfaction (t(220) = 4.84, p < .001). Only emotional support was associated with lower likelihood of experiencing regret (p < .001)."
”
Source data from
2019-12-03
Accessed
2026-05-04
Calculation
Konheim-Kalkstein & Miron-Shatz (2021) surveyed 227 US women with unplanned cesarean as their only birth. The 73% regret rate is specific to unplanned cesareans; the regret was predominantly inaction-flavored (wishing they had advocated for themselves differently, not necessarily regretting the surgical procedure per se). This rate is cited as secondary context for within-group variation — emergency/unplanned cesareans carry a far higher regret burden than the 19% mixed-sample figure. The action-side regret_rate uses 0.19 (Porter 2007) as the more representative overall population figure.
Independence
Separate US online survey study; independent of Porter's Scottish postal survey in population, country, timing, and methodology.
Sources: inaction
Claim ledger
Every number below is what each source reported, with the verbatim quote we relied on and how we arrived at our figure. Click any link to verify directly.
[1]Birth / Waldenström, Hildingsson, Rubertsson & Rådestad — A Negative Birth Experience: Prevalence and Risk Factors in a National Sample
Peer-reviewed
7% of women had a negative birth experience assessed at 1 year postpartum; risk factors included emergency operative delivery, induction, pain, and lack of control
Excerpt
“"Seven percent of the women had a negative birth experience. Risk factors for a negative birth experience included not being treated with respect, lack of emotional support from midwives, emergency cesarean section, instrumental delivery, induction, too much pain, and labor complications."
”
Source data from
2004-03-01
Accessed
2026-05-04
Calculation
Waldenström et al. (2004) recruited 3,061 women at all Swedish antenatal clinics over one calendar year; 2,541 completed the 1-year postal follow-up. At the time of the study, Sweden's national cesarean rate was approximately 15%, meaning the vast majority of participants (approximately 85%) delivered vaginally. The 7% negative-birth-experience rate is therefore broadly representative of vaginal delivery experience. "Negative birth experience" was measured by a validated single-item scale at 1 year; this is a proxy for regret rather than a direct measure of it. Risk factors list emergency cesarean as a distinct category, confirming the vaginal-birth sample dominates the non-negative group.
Independence
National population-based Swedish cohort; fully independent of the UK Porter survey and US Konheim-Kalkstein study in country, era, and methodology.
[2]International Journal of Environmental Research and Public Health / Ginter et al. — The Impact of Mode of Birth on Childbirth-Related PTSD Symptoms beyond 6 Months Postpartum: An Integrative Review
Peer-reviewed
“"CB-PTS/D rates by mode at ≥6 months postpartum from the largest cohort included: spontaneous vaginal 1.8%, operative vaginal 4.2%, elective cesarean 3.1%, emergency cesarean 4.8%."
”
Source data from
2022-07-11
Accessed
2026-05-04
Calculation
Ginter et al. (2022) integrative review of 26 quantitative and 2 qualitative studies on childbirth-related PTSD by mode of delivery. Spontaneous vaginal birth consistently showed the lowest PTSD rate (1.8%), substantially below emergency cesarean (4.8%) and even elective cesarean (3.1%). These rates support the directional finding that vaginal delivery results in fewer negative psychological outcomes than cesarean (especially emergency) delivery. The PTSD rate (1.8%) is lower than the Waldenström negative-birth-experience rate (7%) because PTSD is a more restrictive clinical construct than general negative experience; both are cited to triangulate the inaction-side estimate.
Independence
Systematic integrative review of 28 studies spanning multiple countries and decades; independent of Waldenström, Porter, and Konheim-Kalkstein.
Caveats
The two sides of this entry measure related but distinct constructs across different populations and eras: the action side uses "dissatisfaction" from a Scottish postal survey of mixed planned/unplanned cesareans (Porter 2007); the inaction side uses "negative birth experience" from a national Swedish prospective cohort (Waldenström 2004). These are proxies for regret, not direct regret-scale measurements. The 19% vs 7% gap direction is consistent with the PTSD literature (Ginter 2022: emergency C-section 4.8%, spontaneous vaginal 1.8%), with additional support from the Carter et al. (2022) Birth meta-analysis showing cesarean carries higher PTSD burden. The key within-group caveat is that unplanned/emergency cesarean drives the negative experience signal: Konheim-Kalkstein (2021) found 73% regret specifically among women with unplanned cesareans — far higher than the 19% mixed-cesarean average. Planned elective cesarean satisfaction is substantially higher (~85% satisfied with decision, Coates 2021). The regret_delta of 0.12 represents the population- average gap, which masks significant subgroup variation. Waldenström's Swedish sample from the early 2000s may not fully represent current high-income country obstetric experience given changes in pain management, shared decision-making, and supportive care. Notably, a 2017 long-term follow-up (Tully et al., AJOG) found that at 10+ years, women who delivered vaginally reported greater fulfillment and less distress than those who delivered by cesarean, consistent with the inaction-dominates pattern in longer timeframes.
