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Randomized Controlled Trial
. 2014 Sep-Oct;43(5):568-579.
doi: 10.1111/1552-6909.12485. Epub 2014 Aug 14.

A randomized comparative trial of two decision tools for pregnant women with prior cesareans

Karen B Eden, Nancy A Perrin, Kimberly K Vesco, Jeanne-Marie Guise
Randomized Controlled Trial

A randomized comparative trial of two decision tools for pregnant women with prior cesareans

Karen B Eden et al. J Obstet Gynecol Neonatal Nurs. 2014 Sep-Oct.

Abstract

Objective: Evaluate tools to help pregnant women with prior cesareans make informed decisions about having trials of labor.

Design: Randomized comparative trial.

Setting: A research assistant with a laptop met the women in quiet locations at clinics and at health fairs.

Participants: Pregnant women (N = 131) who had one prior cesarean and were eligible for vaginal birth after cesarean (VBAC) participated one time between 2005 and 2007.

Methods: Women were randomized to receive either an evidence-based, interactive decision aid or two evidence-based educational brochures about cesarean delivery and VBAC. Effect on the decision-making process was assessed before and after the interventions.

Results: Compared to baseline, women in both groups felt more informed (F = 23.8, p < .001), were more clear about their birth priorities (F = 9.7, p = .002), felt more supported (F = 9.8, p = .002, and overall reported less conflict (F = 18.1, p < 0.001) after receiving either intervention. Women in their third trimesters reported greater clarity around birth priorities after using the interactive decision aid than women given brochures (F = 9.8, p = .003).

Conclusion: Although both decision tools significantly reduced conflict around the birth decision compared to baseline, more work is needed to understand which format, the interactive decision aid or paper brochures, are more effective early and late in pregnancy.

Keywords: VBAC; decision aid; decision support techniques; pregnancy; women's preferences.

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Figures

Figure 1:
Figure 1:
Decision Model: These criteria were used in the priority setting (sliding bar) activity.
Figure 2:
Figure 2:
Sample Comparison in Priority Setting Activity: The woman was asked which of these two items was most important. She could slide the bar toward the most important item. As she slid the bar toward an item, the numbers increased. If she left the bar in the middle, she considered both items equally important.
Figure 3:
Figure 3:
Pictograph: This figure depicts the number of women out of 1000 with a risk in future pregnancies (e.g., placenta accreta).
Figure 4:
Figure 4:
Participant Flow: This is a flow diagram for the randomized comparative trial of a VBAC decision aid versus brochures.
See this image and copyright information in PMC

References

    1. American College of Obstetricians and Gynecologists (ACOG). (2005). Cesarean birth: woman education pamphlet. Washington DC: The American College of Obstetricians and Gynecologists, ISSN 1074–8602.
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