Vaginal or cesarean birth? Application of an advocacy organization-driven research translation model.
BACKGROUND
Research translation models are needed to demonstrate a process for identifying and communicating high-quality scientific evidence that enables informed involvement of relevant stakeholders, including informed consumer participation in healthcare decision making.


OBJECTIVE
To describe the rationale for, and elements of, a research translation model, as it is being applied to inform and support diverse end users with respect to decisions relating to vaginal versus cesarean birth.


METHODS
The Maternity Center Association (MCA), the oldest national United States organization advocating on behalf of mothers and babies, identified the need to clarify and translate into practice best evidence about relative harms of cesarean and vaginal birth. MCA developed a model that included engaging leading stakeholder groups, conducting a systematic review to fill research gaps, and initiating an education and advocacy campaign to reach consumers, health professionals, and the general public with review results and related information and guidance. International standards for systematic reviews and evidence about effective professional practice, use of decision aids, and risk communication were used.


RESULTS
Dozens of harms that differ by mode of delivery, with nearly all favoring vaginal birth, were found during review. Without clear, compelling, and well-supported justification for cesarean section, vaginal birth is the safest way for women to give birth and babies to be born. Despite modest resource expenditure, the implemented model is bringing review results to many individuals and organizations, incorporating elements that have been shown to be effective. The next step is to formally evaluate the decision aid in clinical settings.


CONCLUSIONS
Advocacy organizations are uniquely positioned to carry out research translation. Given the importance of research translation and the challenges of carrying out this work, programs and policies should be established to support and evaluate advocacy organizations in this role.
Sakala
Carol
C
Childbirth Connection (formerly Maternity Center Association), New York, NY, USA.
Mayberry
Linda J
LJ
D002585:Cesarean Section; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D033181:Information Dissemination; D007373:Interinstitutional Relations; D008962:Models, Theoretical; D010344:Patient Advocacy; D011247:Pregnancy; D012107:Research Design; D012985:Software Design; D014481:United States; D014837:Voluntary Health Agencies