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


METHODS
Randomised trial, conducted from May 2004 to August 2006.


METHODS
Four maternity units in south west England, and Scotland.


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


METHODS
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.


METHODS
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.
Montgomery
Alan A
AA
Department of Community Based Medicine, University of Bristol, Bristol BS8 2AA. alan.a.montgomery@bristol.ac.uk
Emmett
Clare L
CL
Fahey
Tom
T
Jones
Claire
C
Ricketts
Ian
I
Patel
Roshni R
RR
Peters
Tim J
TJ
Murphy
Deirdre J
DJ
D000328:Adult; D001007:Anxiety / Q000517:prevention & control; D002585:Cesarean Section / Q000523:psychology*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D017060:Patient Satisfaction; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D016064:Vaginal Birth after Cesarean / Q000523:psychology