title: Web-based education and attitude to delivery by caesarean section in nulliparous women.
abstract: OBJECTIVE
  To measure the effect of a web-based educational tool on baseline knowledge of the risks and benefits of delivery by Caesarean section in healthy nulliparous women.
  
  
  METHODS
  We constructed a web-based educational tool to provide evidence-based information on the potential benefits and risks of CS for healthy nulliparous women in the second trimester. We included women with an uncomplicated singleton pregnancy who were receiving antenatal care at Mount Sinai Hospital. Eligible women logged into the website to undertake a pre-test survey. After completing this survey, they received access to the educational tool, followed by a link to a second survey. The surveys collected baseline demographics and assessed participants' knowledge of the perceived safety and risks of vaginal delivery and CS, their sources of information, and the influence of these sources on their views.
  
  
  RESULTS
  Seventy-three participants completed both surveys. Participants had a high baseline preference (84%) for vaginal delivery. The mean score for knowledge about vaginal delivery and CS increased significantly between the surveys, from 47% to 76% (P < 0. 001). There was no significant change in preference for mode of delivery between the two surveys. In both surveys, more participants responded that they were a "little fearful" or "not fearful at all" of vaginal deliveries. In the second survey, significantly more responded that they were "very fearful" or "fearful" of CS (P < 0.05). Increased knowledge about specific risks of vaginal delivery did not deter participants from preferring a vaginal delivery. However, knowledge of risks associated with CS made them more likely to have "very favourable" or "somewhat favourable" views of vaginal delivery. Ethnicity and country of birth were not found to have a significant effect on preferred mode of delivery.
  
  
  CONCLUSIONS
  We demonstrated that a web-based educational tool significantly increased knowledge of the risks and benefits of vaginal delivery and CS. However, the educational intervention did not significantly change preferences.
authors.affiliation: Undergraduate Medicine Program, Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Anjali
authors.initials: A
authors.lastname: Kulkarni
authors.affiliation: Undergraduate Medicine Program, Faculty of Medicine, Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON.
authors.forename: Emily
authors.initials: E
authors.lastname: Wright
authors.affiliation: Division of Maternal-Fetal Medicine Division, Department of Obstetrics and Gynaecology, Mount Sinai Hospital; University of Toronto, Toronto ON.
authors.forename: John
authors.initials: J
authors.lastname: Kingdom
mesh_terms: D000328:Adult; D002170:Canada; D002585:Cesarean Section / Q000193:education / Q000523:psychology; D002755:Choice Behavior; D003625:Data Collection; D005239:Fear; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D020407:Internet; D009321:Natural Childbirth / Q000193:education / Q000523:psychology; D010298:Parity; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods; D064186:Prenatal Education / Q000379:methods / Q000706:statistics & numerical data
keywords: Caesarean section; attitude; safety; web-based patient education