The effect of an antenatal decision aid booklet on rate of vaginal birth after caesarean (VBAC) in women with previous caesarean section.

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In 2010, the caesarean section rate at National Women’s in Auckland was 32%. The majority of caesareans were performed for women who have had a previous caesarean section. The alternative to a repeat caesarean is a Vaginal Birth after Caesarean (VBAC). Both methods of delivery have advantages and disadvantages, and current national guidelines recommend individualized decision-making. At National Women’s, only 40% of women try for a VBAC, and about 2 out of 3 women who try for VBAC will have a vaginal birth. The aim of this project is to increase the proportion of women with previous caesarean who have a vaginal birth. The clinical trial is aimed at women with previous caesarean who are in the first half of their pregnancy and deciding whether to plan a VBAC or repeat caesarean. They currently receive counselling about this decision by a midwife and obstetrician at the Positive Birth After Caesarean (PBAC) Clinic. Women will be randomized to use a newly developed decision aid booklet, or a patient education leaflet (routine care), as the basis for their counselling. All women will be asked prior to their consultation to complete questionnaires about knowledge and preferences about their birth options.We hypothesize that pregnant women who use the decision aid will have higher rates of vaginal birth, higher levels of knowledge, and lower levels of decisional conflict. Rates of vaginal birth will be determined using the perinatal database at the hospital. Levels of knowledge, decisional conflict and anxiety will be determined using validated published questionnaires. The overarching goal of the project is to improve quality of care at our hospital for the large number of women who have had a caesarean delivery.

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