Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2007 Jun 23;334(7607):1305.
doi: 10.1136/bmj.39217.671019.55. Epub 2007 May 31.

Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial

Alan A Montgomery  1 , Clare L Emmett, Tom Fahey, Claire Jones, Ian Ricketts, Roshni R Patel, Tim J Peters, Deirdre J Murphy; DiAMOND Study Group
Affiliations
Randomized Controlled Trial

Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial

Alan A Montgomery et al. BMJ. .

Abstract

Objectives: To determine the effects of two computer based decision aids on decisional conflict and mode of delivery among pregnant women with a previous caesarean section.

Design: Randomised trial, conducted from May 2004 to August 2006.

Setting: Four maternity units in south west England, and Scotland.

Participants: 742 pregnant women with one previous lower segment caesarean section and delivery expected at >or=37 weeks. Non-English speakers were excluded.

Interventions: Usual care: standard care given by obstetric and midwifery staff. Information programme: women navigated through descriptions and probabilities of clinical outcomes for mother and baby associated with planned vaginal birth, elective caesarean section, and emergency caesarean section. Decision analysis: mode of delivery was recommended based on utility assessments performed by the woman combined with probabilities of clinical outcomes within a concealed decision tree. Both interventions were delivered via a laptop computer after brief instructions from a researcher.

Main outcome measures: Total score on decisional conflict scale, and mode of delivery.

Results: Women in the information programme (adjusted difference -6.2, 95% confidence interval -8.7 to -3.7) and the decision analysis (-4.0, -6.5 to -1.5) groups had reduced decisional conflict compared with women in the usual care group. The rate of vaginal birth was higher for women in the decision analysis group compared with the usual care group (37% v 30%, adjusted odds ratio 1.42, 0.94 to 2.14), but the rates were similar in the information programme and usual care groups.

Conclusions: Decision aids can help women who have had a previous caesarean section to decide on mode of delivery in a subsequent pregnancy. The decision analysis approach might substantially affect national rates of caesarean section. Trial Registration Current Controlled Trials ISRCTN84367722.

PubMed Disclaimer

Conflict of interest statement

Competing interests: None declared.

Figures

None
Fig Flow of women through the study
See this image and copyright information in PMC

Comment in

References

    1. Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. The national sentinel caesarean section audit report London: RCOG Press, 2001
    1. Information Centre for Health and Social Care. NHS maternity statistics, England: 2004-05 London: Information Centre, 2006
    1. Martin JA, Hamilton BE, Menacker F, Sutton PD, Matthews TJ. Preliminary births for 2004: infant and maternal health 2006. www.cdc.gov/nchs/products/pubs/pubd/hestats/prelimbirths04/prelimbirths0...
    1. Nassar N, Sullivan E. Australia's mothers and babies 1999 Sydney: Australian Institute of Health and Welfare National Perinatal Statistics Unit, 2001
    1. American College of Obstetricians and Gynecologists. Evaluation of cesarean delivery Washington, DC: ACOG, 2000

Publication types

Associated data