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
. 2021 Feb 17;21(1):144.
doi: 10.1186/s12884-021-03615-w.

Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial

Fatemeh Hadizadeh-Talasaz  1 , Faezeh Ghoreyshi  2 , Fatemeh Mohammadzadeh  3 , Roghaieh Rahmani  4
Affiliations
Randomized Controlled Trial

Effect of shared decision making on mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section: a randomized clinical trial

Fatemeh Hadizadeh-Talasaz et al. BMC Pregnancy Childbirth. .

Abstract

Background: The promotion of vaginal birth after cesarean section (VBAC) is the best method for the reduction of repeated cesarean sections. Nonetheless, the decisional conflict which often results from inadequate patient involvement in decision making, may lead to delayed decision making and regret about the choices that were made. The present study aimed to determine the effect of shared decision making on the mode of delivery and decisional conflict and regret in pregnant women with previous cesarean section.

Methods: This randomized clinical trial was conducted on 78 pregnant women with a previous cesarean section referring to community health centers in Torbat-e Jam, Iran, in 2019. They were randomly assigned to two groups of intervention and control. During weeks 24-30 of pregnancy, the Decisional Conflict Scale (DCS) was completed by pregnant mothers. Apart from the routine care, the experimental group received a counseling session which was held based on the three-talk model of shared decision making. This session was moderated by a midwife; moreover, a complementary counseling session was administered by a gynecologist. During weeks 35-37 of pregnancy, DCS was completed, and the Decision Regret Scale (DRS) was filled out for both groups at the 8th weeks postpartum and they were asked about the mode of delivery. Data were analyzed in SPSS software (version 19) using the Mann-Whitney, Chi-squared and Fisher's exact tests. p-value less than 0.05 was considered statistically significant.

Results: After the intervention, the decisional conflict score was significantly lower in the shared decision making (SDM) group, compared to that in the control group (14.90 ± 9.65 vs. 25.41 ± 13.38; P < 0.001). Moreover, in the SDM group, the rate of vaginal birth was significantly higher than that in the control group (P < 0.001). Two month after the delivery, the mean score of decision regret was lower in the SDM group, in comparison to that in the control group (15.67 ± 23.37 vs. 27. 30± 26.75; P = 0.007).

Conclusions: Based on the results of the study, shared counseling can be effective in the reduction of decisional conflict and regret, as well as rate enhancement of VBAC. Therefore, it can be concluded that this counseling method can be used in prenatal care to reduce the rate of repeated cesarean section.

Trial registration: IRCT20190506043499N1; Name of the registry: Iranian Registry of Clinical Trials; Registered 10. August 2019. URL of registry: https://en.irct.ir/trial/39538. Date of enrolment of the first participant to the trial: August 2019.

Keywords: Conflict; Regret; Repeated cesarean section; Shared decision making; Vaginal birth after cesarean.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study participants
See this image and copyright information in PMC

References

    1. Denham SH, Humphrey T, de Labrusse C, Dougall N. Mode of birth after caesarean section: individual prediction scores using Scottish population data. BMC Pregnancy Childbirth. 2019;19(1):84. doi: 10.1186/s12884-019-2226-6. - DOI - PMC - PubMed
    1. Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section - an online survey investigating women's preferences in Western Switzerland. Midwifery. 2017;50:219–227. doi: 10.1016/j.midw.2017.04.005. - DOI - PubMed
    1. Vankan E, Schoorel E, van Kuijk S, Nijhuis J, Hermens R, Scheepers H, et al. The effect of the use of a decision aid with individual risk estimation on the mode of delivery after a caesarean section: a prospective cohort study. PLoS ONE. 2019;14(9):e0222499. doi: 10.1371/journal.pone.0222499. - DOI - PMC - PubMed
    1. Lundgren I, Morano S, Nilsson C, Sinclair M, Begley C. Cultural perspectives on vaginal birth after previous caesarean section in countries with high and low rates - a hermeneutic study. Women Birth. 2020;33(4):e339–e347. doi: 10.1016/j.wombi.2019.07.300. - DOI - PubMed
    1. MJK O. Recent trends in vaginal birth after cesarean delivery: United States, 2016–2018. NCHS data brief, no 359. Hyattsville: National Center for Health Statistics; 2020. - PubMed

Publication types

LinkOut - more resources