Decision Making, Shared, Scar; Previous Cesarean Section, Vaginal Birth After Cesarean
Conditions
Brief summary
This is pilot quasi-experimental study of women with one or two prior cesarean deliveries who are now pregnant and eligible for a trial of labor after cesarean delivery, to assess whether a decision aid, providing knowledge about trial of labor (VBAC) and planned repeat cesarean delivery can improve the birth options decision-making process for patients. Participants are screened for eligibility through electronic health records. Once an individual is screened eligible, and email invite is sent providing information about the study and assessing the interest in participation. An on-line consent is completed and women are entered sequentially into the usual care group and then through further recruitment, another sample of women are entered into the decision aid group. The primary outcome is satisfaction with the shared decision-making process with their provider.
Detailed description
Once a potential participant is screened eligible, completes the on-line informed consent, they are officially enrolled in the study and sent a link confirming their enrollment and the study group in which they have been assigned. Participants are sequentially enrolled in the study with enrollment first into the usual care group. Once enrollment in the usual care group is complete, enrollment into the decision aid group will occur. The study includes two non-randomized groups: Arm 1 (Usual care group): Women in this group will undergo usual care and complete the survey questions on knowledge of risks and benefits of TOLAC (also referred to as VBAC) and planned repeat cesarean (PRCS), certainty of their decision, and involvement in the decision for trial of labor (TOLAC) or repeat cesarean delivery. Arm 2: (Decision aid group- group receiving the decision tool): Women in this group will receive a decision aid prior to undergoing counseling by their physician. Following completion of the decision aid and physician counseling, they will complete a series of survey questions to assess their knowledge of the risks and benefits of TOLAC and PRCS, certainty of their decision, and involvement in the decision for repeat cesarean or TOLAC. The decision aid group will be compared with women who do not receive the decision aid (usual care group).
Interventions
OTHERDecision Aid
The decision aid is a series of web pages that includes videos, questions, and evidence-based information. The decision aid is designed to help women think about what matters to them and what questions they may have for their doctor or midwife. At the end, they receive a summary of which way they are leaning and what matters most to them.
Sponsors
Healthwise
University of North Carolina, Chapel Hill
Study design
Allocation
NON_RANDOMIZED
Intervention model
SEQUENTIAL
Primary purpose
HEALTH_SERVICES_RESEARCH
Masking
NONE
Eligibility
Sex/Gender
FEMALE
Age
21 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Gestational age between 19/0 and 36/6 weeks * History of 1 or 2 prior cesarean deliveries
Exclusion criteria
* No contraindications to trial of labor after cesarean (TOLAC) * No history of prior TOLAC
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Shared Decision Making (SDM) Process score | Up to 6 months prior to delivery | This is a measure of the patient's involvement in the decision. 1 point is assigned for discussing the pros 'a lot' or 'some'; 1 point is assigned for discussing the cons 'a lot' or 'some'; 1 point is assigned for responding 'yes' if the provider explained the options; and 1 point is assigned for responding 'yes' that the provider asked the patient what treatment she wanted. The tool's score range is 0-4. A higher score indicates more involvement in the decision. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Number of Participants (by category) With the Intent to Deliver by Repeat Cesarean Section or by Vaginal Delivery | Date of Admission | Intended mode of delivery (repeat cesarean or vaginal) prior to actual delivery |
| Number of Participants (by category) who Delivered by Repeat Cesarean or Vaginal Delivery | Up to 72 hours after delivery | Actual method of delivery (repeat cesarean or vaginal delivery) |
| Maternal or Fetal Complications at Delivery | Up to 72 hours after delivery | Number of complication events: maternal postpartum hemorrhage, infection, fetal admission to neonatal intensive care unit. |
| Number of Participants (by Category) who desired Repeat Cesarean, Vaginal Delivery or Are Undecided after completion of the study survey | Up to 6 months prior to delivery | Participant responses are: 1) repeat cesarean delivery, 2) vaginal delivery and 3) undecided |
Countries
United States
Outcome results
None listed