Patient decision aid for trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery: a quasi-experimental pre-post study

Abstract

Objective To assess the impact of a web-based decision aid on patient-centered decision making outcomes among women considering a trial of labor after cesarean (TOLAC) versus planned repeat cesarean delivery. Methods The Birth Decision Aid Study (B-READY) was a quasi-experimental pre-post study of two sequential cohorts. From June 18, 2018 to July 31, 2019, 50 women were enrolled in routine care, followed by 50 women who were enrolled in the decision aid group. Inclusion criteria were singleton pregnancies between 19/0 to 36/6 weeks, ≤2 prior cesareans, and no contraindications to TOLAC. The decision aid group viewed the online Healthwise® “Pregnancy: Birth Options After Cesarean” program. Both groups received the same birth options counseling and completed the same online assessment. Primary patient-centered outcomes were knowledge about birth options and shared decision making at online assessment, and informed, patient-centered decision making about her preferred mode of delivery at delivery admission. Results Among 100 women participated in this study (50 per group), the mean gestational age at enrollment was 31 weeks, and 71% or 63/89 women who consented to delivery data abstraction had a cesarean delivery. Women in the patient decision aid group gained more knowledge (defined as score ≥ 75%) about birth options compared to those in the routine care group (72% vs. 32%; adjusted odds ratio, AOR: 6.15 [95% CI: 2.34 to 16.14]), and were more likely to make an informed, patient-centered decision (60% vs. 26%; AOR: 3.30 [95% CI: 1.20 to 9.04]. Women in both groups reported similar involvement in shared decision making, as well as satisfaction and values. More than 90% of decision aid users reported it was a useful tool and would recommend it to other TOLAC-eligible women. Conclusions A web-based birth options patient-centered decision aid for TOLAC eligible women can be integrated into prenatal Telehealth and may improve the quality of decision making about mode of delivery. Trial registration The study was registered with ClinincalTrials.gov and the ID# was NCT04053413. Registered 12 August 2019 – Retrospectively registered.

Association between Diabetes in Pregnancy and Shoulder Dystocia by Infant Birth Weight in an Era of Cesarean Delivery for Suspected Macrosomia

“…34 In addition, this meta-analysis concluded that treatment of gestational diabetes could reduce the risk of macrosomia by half (relative risk: 0.50) and, in turn, shoulder dystocia (relative risk: 0.42). 34 With regard to mode of delivery, shared decision making is reasonable, 35 including a discussion of the risks and benefits of labor and vaginal birth and risk of shoulder dystocia. The low frequency of shoulder dystocia-related trauma even at high infant birth weights and the high frequency of cesarean deliveries for individuals with suspected high birth weight infants prenatally likely results in many unnecessary cesarean births, regardless of diabetes status.…”

Preferred mode of delivery and its associated factors in pregnant women with a previous cesarean scar at a tertiary care hospital in Ethiopia: institutional-based cross-sectional study

“…Because of shared decision-making, only 60–80% of TOLAC patients have successful VBAC. Another issue that contributes to difficulties in selecting a mode of delivery after CS is that women do not understand the advantages and disadvantages of each mode of delivery; this can be attributed to a lack of counseling [ 9 , 35 , 39 ]. Therefore, mothers should be counseled, the development of a decision model is critical, and the information provided should be updated scientifically [ 12 , 40 ].…”