title: Timing the provision of a pregnancy decision-aid: temporal patterns of preference for mode of birth during pregnancy.
abstract: OBJECTIVE
  To help identify the optimal timing for provision of pregnancy decision-aids, this paper examines temporal patterns in women's preference for mode of birth after previous cesarean, prior to a decision-aid intervention.
  
  
  METHODS
  Pregnant women (n=212) with one prior cesarean responded to surveys regarding their preference for elective repeat cesarean delivery (ERCD) or trial of labor (TOL) at 12-18 weeks and again at 28 weeks gestation. Patterns of adherence or change in preference were examined.
  
  
  RESULTS
  Women's preferences for birth were not set in early pregnancy. There was evidence of increasing uncertainty about preferred mode of birth during the first two trimesters of pregnancy (McNemar value=4.41, p=0.04), decrease in preference for TOL (McNemar value=3.79, p=0.05) and stability in preference for ERCD (McNemar value=0.31, p=0.58). Adherence to early pregnancy choice was associated with previous birth experience, maternal country of birth, emotional state and hospital site.
  
  
  CONCLUSIONS
  Women's growing uncertainty about mode of birth prior to 28 weeks indicates potential readiness for a decision-aid earlier in pregnancy.
  
  
  CONCLUSIONS
  Pregnancy decision-aids affecting mode of birth could be provided early in pregnancy to increase women's opportunity to improve knowledge, clarify personal values and reduce decision uncertainty.
authors.affiliation: Yale University School of Nursing, USA. Electronic address: allison.shorten@yale.edu.
authors.forename: Allison
authors.initials: A
authors.lastname: Shorten
authors.affiliation: Freelance Data Analyst and Research Consultant, USA.
authors.forename: Brett
authors.initials: B
authors.lastname: Shorten
mesh_terms: D000328:Adult; D017604:Cesarean Section, Repeat; D002755:Choice Behavior; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D057240:Patient Preference; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011262:Pregnancy Trimester, Second; D037841:Pregnant People / Q000523:psychology; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013997:Time Factors; D014219:Trial of Labor; D016064:Vaginal Birth after Cesarean
keywords: Birth choices; Birth preference pattern; Decision-aid; Previous cesarean; Trial of labor (TOL); Vaginal birth after cesarean (VBAC)