title: Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial.
abstract: 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.
authors.affiliation: Department of Community Based Medicine, University of Bristol, Bristol BS8 2AA. alan.a.montgomery@bristol.ac.uk
authors.forename: Alan A
authors.initials: AA
authors.lastname: Montgomery
authors.forename: Clare L
authors.initials: CL
authors.lastname: Emmett
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.forename: Claire
authors.initials: C
authors.lastname: Jones
authors.forename: Ian
authors.initials: I
authors.lastname: Ricketts
authors.forename: Roshni R
authors.initials: RR
authors.lastname: Patel
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
authors.forename: Deirdre J
authors.initials: DJ
authors.lastname: Murphy
mesh_terms: 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