A Randomized Comparative Trial of Two Decision Tools for Pregnant Women with Prior Cesareans

Objective: Evaluate tools to help pregnant women with prior cesareans make informed decisions about having trials of labor. Design: Randomized comparative trial. Setting: A research assistant with a laptop met the women in quiet locations at clinics and at health fairs. Participants: Pregnant women (N = 131) who had one prior cesarean and were eligible for vaginal birth after cesarean (VBAC) participated one time between 2005 and 2007. Methods: Women were randomized to receive either an evidence-based, interactive decision aid or two evidence-based educational brochures about cesarean delivery and VBAC. Effect on the decision-making process was assessed before and after the interventions. Results: Compared to baseline, women in both groups felt more informed (F = 23.8, p <.001), were more clear about their birth priorities (F = 9.7, p =.002), felt more supported (F = 9.8, p =.002, and overall reported less conflict (F = 18.1, p < 0.001) after receiving either intervention. Women in their third trimesters reported greater clarity around birth priorities after using the interactive decision aid than women given brochures (F = 9.8, p =.003). Conclusion: Although both decision tools significantly reduced conflict around the birth decision compared to baseline, more work is needed to understand which format, the interactive decision aid or paper brochures, are more effective early and late in pregnancy.