One reason for the increasing rate of cesarean sections may be patients’ fear of the personal and neonatal morbidity associated with vaginal delivery (VD). VD may be associated with significant short-and long-term complications. Cesarean delivery carries the risk of significant morbidities along with an increased risk of maternal mortality. Discussion of the risks of both is required when deciding upon the method of delivery. This cross-sectional survey quantified the risk of morbidity from VD that pregnant women would accept before asking for an elective cesarean section; these views were compared with those of obstetric providers. After an extensive literature review of the complications associated with VD, verbal scripts were created to ask nulliparas about various clinical scenarios and their consequences, including pain, prolonged labor, instrumented delivery, emergency cesarean section, perineal pain, superficial and deep perineal tears, sexual dysfunction, long-term urinary incontinence, vaginal prolapse, and fecal incontinence. A detailed explanation of cesarean section and its possible complications (major abdominal surgery, anesthetic requirements, wound pain, longer hospital stay, etc) was developed to mimic the information given by a clinician when obtaining informed consent. These scripts were used for a face-to-face interviewer-administered questionnaire for pregnant women to determine the maximum level of risk of each complication that they would tolerate fromVD before choosing an elective cesarean section. The values were recorded on a scale of 0% to 100%. Demographic data, obstetric history, and mode of delivery desired were also recorded. Research assistants were trained to administer the questionnaires. Nulliparous women with singleton uncomplicated pregnancies at or before the gestational age of 26 weeks were recruited. A self-administered questionnaire including the same complications of VD was mailed to clinicians and was completed under the assumption that they or their partner were pregnant. The participant’s responses indicating the maximal level of risk that they would accept before requesting cesarean delivery were converted to utility scores of 0 to 1 for each complication. Scores that were higher, that is, closer to 1, indicated a greater acceptance of risk. Among 193 pregnant women who were potential participants, 102 were willing or able to participate; their mean age was 31 years and mean gestational age 22 weeks. Eighty-four midwives, 166 obstetricians, 12 urogynecologists, and 79 colorectal surgeons also completed the questionnaire. At the time of participation, 93% of the patients planned to have a VD, 2% were considering an elective cesarean delivery, and 5% were undecided. Midwives and obstetricians were more likely to opt for a spontaneous VD compared with colorectal surgeons and urogynecologists. There was a statistically significant difference in the proportion of each group who would opt for an elective cesarean delivery; pregnant women 2% [95% confidence interval (CI), 0.3-7.6], midwives 11%, (95% CI, 5.3-19.8), obstetricians 21%, (95% CI, 15.3-28.2), colorectal surgeons 41% (95% CI, 31.1-52.4), and urogynecologists 42% (95% CI, 16.571.4). The patients were most concerned about severe anal incontinence, with a score of 0.32, indicating that they would take the least risk of this outcome occurring compared to other potential adverse outcomes before they would want a cesarean section. The higher scores for perineal discomfort (0.94), labor pain (0.92), superficial tears (0.92), and prolonged labor (0.87) indicated that they would accept an extremely high risk of these outcomes. No significant associations were found between the patient’s education level, medical insurance coverage, and mean utility scores. Women who opted for a cesarean section or were undecided reported significantly lower levels of acceptable risk in 7 of the 17 variables compared to women who opted for VD. The views of the midwives were closest to those of the patients, and they were always prepared to take greater risks compared to other medical providers to achieve a VD. Colorectal surgeons accepted the least amount of risk among all provider groups. For example, severe anal incontinence was ranked first by all four groups of clinicians, but the mean utility scores for this outcome were 0.05 or less for obstetricians, urogynecologists, and colorectal surgeons, and 0.15 for midwives and 0.32 for patients. The risk of emergency cesarean section was ranked fourth by pregnant women but at least ninth by the clinicians. Pregnant women seemed willing to accept significantly higher risks of complications of VD than the clinicians providing their care. All groups were most risk averse for severe anal and urinary incontinence. Whether the views of women change after delivery is the subject of a study currently being conducted. Mother Fetus, Neonate