Development and pilot-testing of a decision aid for women with a breech-presenting baby

Abstract

Objective: To develop a decision aid for pregnant women with a breech presentation at term, and to assess its acceptability.

Methods: The external cephalic version (ECV) decision aid was developed using the Ottawa Decision Support Framework and a systematic review of the evidence to provide probabilistic information about the benefits and risks of options. It incorporates a workbook supplemented by a CD and worksheet, and these were evaluated in a pilot study using self-administered questionnaires.

Participants: 19 women with a breech presentation attending antenatal clinics at a local obstetric hospital and 11 recently pregnant women.

Findings: Of 30 women surveyed, nearly all found the decision aid clear and easy to understand, and thought that enough information was provided for them to make a decision. Women experienced increased knowledge, reduced decisional conflict, increased satisfaction and participation in decision making without increased anxiety. Participants also found the tool helpful and would recommend it to others.

Key conclusions: The ECV decision aid was well accepted and helpful for pregnant women with a breech presenting baby. We are currently evaluating the decision aid in a randomised trial to assess cognitive, affective and health outcomes.