Forty-one percent of women had at least one birth complication. The most common complications were fetal distress (41%), preterm membrane rupture (26%), umbilical cord issues such as prolapsed, entanglement or nuchal cords (17%), and delayed labor (7%). With regard to Research Question 1, (is optimism or pessimism associated with unplanned cesarean section delivery?), bivariate analyses comparing optimism and pessimism against unplanned cesarean section indicated that both were significant: optimism (P = .047, 95% CI. 012, 1.81), pessimism (P = .003; 95% CI −2.42, −.529) (See Table 4 ). In addition, labor duration (P = .004, 95% CI 1. 009, 5.16) and the presence of birth complications (P = .01, Chi Square = 6.65) were also found to be significant. No other demographic or clinical factors were significantly associated with unplanned cesarean section. Table 5 Model 1, illustrates the findings with regard to Research Question 2 (which is more strongly associated with unplanned cesarean section delivery, optimism or pessimism?).