How communication about risk and role affects women’s decisions about birth after caesarean

•Communication effects on birth after caesarean decisions were experimentally tested.•Receiving selective information increased odds of choosing repeat caesarean.•Receiving relative risk information increased odds of choosing repeat caesarean.•Communication about patient role in decision making did not affect preference.•Perceived risk of options explained effects of selective information and risk format. This study investigated how health care provider communication of risk information, and women’s role in decision-making, influenced women’s preferences for mode of birth after a previous caesarean birth. Women (N = 669) were randomised to one of eight conditions in a 2 (selectivity of risk information) × 2 (format of risk information) × 2 (role in decision making) experimental design. After exposure to a hypothetical decision scenario that varied information communicated by an obstetrician to a pregnant woman with a previous caesarean birth across the three factors, women were asked to decide their preferred hypothetical childbirth preference. Women provided with selective information (incomplete/biased toward repeat caesarean) and relative risk formats (ratio of incidence being compared e.g. 2.5 times higher), perceived lower risk for caesarean and were significantly more likely to prefer repeat caesarean birth than those provided with non-selective information (complete/unbiased) and absolute risk formats (incidence rate e.g. 0.01 per 100). Role in decision-making did not significantly influence childbirth preferences Modifiable aspects of healthcare provider communication may influence women’s decision-making about childbirth preferences Optimised communication about risks of all options may have an impact on over-use of repeat CS.