Making Choices for Childbirth: 
A Randomized Controlled Trial of a Decision‐aid for Informed Birth after Cesarean^a

Abstract

A decision-aid for women facing choices about birth after cesarean section is effective in improving knowledge and reducing decisional conflict. However, little evidence suggested that this process led to an informed choice. Strategies are required to better equip organizations and practitioners to empower women so that they can translate informed preferences into practice. Further work needs to examine ways to enhance women's power in decision-making within the doctor-patient relationship.

Women-centred interventions to increase vaginal birth after caesarean section (VBAC): A systematic review

“…Midwifery 28, 591-599. Cromi, A., Ghezzi, F., Uccella, S., Agosti, M., Serati, M., Marchitelli, G., Bolis, P. Two studies (Shorten et al, 2005;Montgomery et al, 2007) evaluated the effectiveness of decision aids for mode of birth in women with a previous CS and one evaluated the effectiveness of an antenatal education programme (Fraser et al, 1997). …”

“…Although the study was rated as methodologically strong, implementation issues meant that the decision aid could not be provided through the internet, but had to be accessed through a computer held by the researcher, which may have limited the participants' access and affected the results. The study by Shorten et al (2005) had a smaller sample size (n=227) but a high response rate (90%), and overall received a 'strong' methodological quality rating. Fraser et al's study (1997) had the largest sample size (n=1301), but the withdrawal of 26 women's data for various reasons led to an increased risk of selection bias.…”

“…The primary outcomes were women's decisional conflict and mode of birth. Shorten et al (2005) evaluated the effectiveness of a decision-aid booklet for pregnant women with one previous caesarean section. Women allocated to the intervention group received a 'decision-aid booklet' at 28 weeks gestation containing evidence-based information.…”

“…Interventions evaluated in the studies included decision-aids with information and explicit probabilities of outcomes with value exercises (Shorten et al, 2005), information and explicit probabilities of outcomes without value exercises (Montgomery et al, 2007), information and value exercises without explicit probabilities (Mongomery et al, 2007) and an antenatal education programme (Fraser et al, 1997). We did not therefore regard interventions to be sufficiently similar to ensure meaningful conclusions from a statistically pooled result.…”

“…Compared with usual care, women in both intervention groups had significantly lower decisional conflict scores (information group −6.2, 95% CI −8.7 to −3.7; decision analysis group −4.0, 95% CI −6.5 to −1.5). Shorten et al (2005) evaluated the effectiveness of a decision-aid booklet with usual care.…”