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Randomized Controlled Trial
. 2019 Oct;59(5):684-692.
doi: 10.1111/ajo.12955. Epub 2019 Feb 18.

Birth choices for women in a 'Positive Birth after Caesarean' clinic: Randomised trial of alternative shared decision support strategies

Michelle R Wise  1 , Lynn Sadler  2 , Brett Shorten  3 , Kelly van der Westhuizen  2 , Allison Shorten  4
Affiliations
Randomized Controlled Trial

Birth choices for women in a 'Positive Birth after Caesarean' clinic: Randomised trial of alternative shared decision support strategies

Michelle R Wise et al. Aust N Z J Obstet Gynaecol. 2019 Oct.

Abstract

Background: Systematic approaches to information giving and decision support for women with previous caesarean sections are needed.

Aim: To evaluate decision support within a 'real-world' shared decision-making model.

Methods: A pragmatic comparative effectiveness randomised trial in the Positive Birth After Caesarean Clinic. Women with one previous caesarean and singleton pregnancy <25 weeks were randomly allocated to standard Positive Birth After Caesarean care, or standard Positive Birth After Caesarean care plus a decision aid booklet. Main outcome measure was mode of birth, with secondary measures of knowledge, decisional conflict, birth choice, adherence to birth choice, perception of decision support, and satisfaction.

Results: Of 297 participants, rate of attempted vaginal birth after caesarean increased and was similar for both groups (61% vs 57%, P = 0.5). Knowledge scores increased more for women in the additional decision aid group (2.0 vs 1.6 points, P = 0.2). Decisional conflict score reduction was similar between groups (P = 0.5). Women initially unsure of their birth preference who received the additional decision aid had greater reduction in decisional conflict score (P = 0.04) and were more likely to plan vaginal birth after caesarean (49% vs 33%, P = 0.2). Adherence to birth choice and birth satisfaction was similar between groups. Women in the additional decision aid group rated their decision support tool higher (P < 0.01).

Conclusions: In a 'real world' shared decision-making model, an additional decision aid conferred some benefits in factors associated with preparation for shared decision-making. Decision aids may provide particular benefit for women who are initially unsure and need assistance in the deliberation phase.

Keywords: birth choice; decision aid; informed decision-making; trial of labour; vaginal birth after caesarean.

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References

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