BMJ, doi: 10.1136/bmj.39217.671019.55, (Published 31 May 2007)

research-article

Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial

¹ Department of Community Based Medicine, University of Bristol, Bristol BS8 2AA, ² Department of General Practice, Royal College of Surgeons in Ireland, Mercer's Medical Centre, Dublin 2, Republic of Ireland, and Tayside Centre for General Practice, University of Dundee, Dundee, ³ School of Computing, University of Dundee, Queen Mother Building, Dundee, ⁴ Academic Unit of Obstetrics and Gynaecology, University of Bristol, St Michael's Hospital, Bristol, ⁵ Academic Department of Obstetrics and Gynaecology, Trinity College Dublin, Coombe Women's Hospital, Dublin 8, Republic of Ireland, and Department of Obstetrics and Gynaecology, University of Dundee, Ninewells Hospital, Dundee

Objectives 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.

Design Randomised trial, conducted from May 2004 to August 2006.

Setting Four maternity units in south west England, and Scotland.

Participants 742 pregnant women with one previous lower segment caesarean section and delivery expected at 37 weeks. Non-English speakers were excluded.

Interventions 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.

Main outcome measures 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 [controlled-trials.com] .

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