More research is needed to elucidate the relationship between pessimism and pregnancy outcomes. Is this study replicable? Is the finding real, or is it masking some other yet to be determined variable? Is a negative outlook merely associated with a risk of unplanned cesarean section delivery, or can a causal pathway be identified? In addition, is it possible to change women's levels of pessimism? And would interventions to decrease pessimism translate to reduced rates of c-sections?