List of abbreviations AOR: adjusted odd ratio; ARDS: acute respiratory distress syndrome; CAP: community-acquired pneumonia; CI: confidence interval; HA-LRT superinfections: hospital-acquired lower respiratory tract superinfections; ICU: intensive care unit; LOD score: logistic organ dysfunction score; LOS: length of stay; MOF: multiple organ failure; MV: mechanical ventilation; PSI: pneumonia severity index; SAPS: simplified acute physiology score; SOFA: sepsis-related organ failure assessment; SD: standard deviation. Is Generalized Maternal Optimism or Pessimism During Pregnancy Associated with Unplanned Cesarean Section Deliveries in China? This research examines whether maternal optimism/pessimism is associated with unplanned Cesarean section deliveries in China. If so, does the association remain after controlling for clinical factors associated with C-sections? A sample of 227 mostly primiparous women in the third trimester of pregnancy was surveyed in a large tertiary care hospital in Beijing, China. Post-delivery data were collected from medical records. In bivariate analysis, both optimism and pessimism were related to unplanned c-section. However, when optimism and pessimism were entered into a regression model together, optimism was no longer statistically significant. Pessimism remained significant, even when adjusting for clinical factors such as previous abortion, previous miscarriage, pregnancy complications, infant gestational age, infant birthweight, labor duration, birth complications, and self-rated difficulty of the pregnancy. This research suggests that maternal mindset during pregnancy has a role in mode of delivery. However, more research is needed to elucidate potential causal pathways and test potential interventions. Worldwide, Cesarean section rates are increasing [1] [2] [3] . Despite recommendations that cesarean section rates not exceed 15% [4, 5] , many countries have rates double or even triple that threshold [3] . China-home to one-fifth of the world's population and 12 percent of all births annually [6, 7] -is no different. Data from hospital-based studies in urban China showed c-section rates ranging from 26% to 63% during the late 1990s [8] , while a more recent WHO study combining urban and rural populations reported overall c-section rates of 46.2% [3] .