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Waddell A, Goodwin D, Spassova G, Sampson L, Candy A, Bragge P. "We will be the ones bearing the consequences": A qualitative study of barriers and facilitators to shared decision-making in hospital-based maternity care. Birth 2024; 51:581-594. [PMID: 38270268 DOI: 10.1111/birt.12812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND Pregnant women involved in decisions about their care report better health outcomes for themselves and their children. Shared decision-making (SDM) is a priority for health services; however, there is limited research on factors that help and hinder SDM in hospital-based maternity settings. The purpose of this study was to explore barriers and facilitators to SDM in a large tertiary maternity care service from the perspectives of multiple stakeholders. METHODS Qualitative semi-structured interviews were undertaken with 39 participants including women, clinicians, health service administrators and decision-makers, and government policymakers. The interview guide and thematic analysis were based on the Theoretical Domains Framework to identify barriers and facilitators to SDM. RESULTS Women expect to be included in decisions about their care. Health service administrators and decision-makers, government policymakers, and most clinicians want to include them in decisions. Key barriers to SDM included lack of care continuity, knowledge, and clinician skills, as well as professional role and decision-making factors. Key facilitators pertained to policy and guideline changes, increased knowledge, professional role factors, and social influences. CONCLUSION This study revealed common barriers and facilitators to SDM and highlighted the need to consider perspectives outside the patient-clinician dyad. It adds to the limited literature on barriers and facilitators to SDM in hospital care settings. Organizational- and system-wide changes to service delivery are necessary to facilitate SDM. These changes may be enabled by education and training, changes to policies and guidelines to include and support SDM, and adequately timed information provision to enable SDM conversations.
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Affiliation(s)
- Alex Waddell
- Safer Care Victoria, Victorian Department of Health, Melbourne, Victoria, Australia
- Monash Sustainable Development Institute, Monash University, Clayton, Victoria, Australia
| | - Denise Goodwin
- BehaviourWorks Australia, Monash University, Clayton, Victoria, Australia
| | - Gerri Spassova
- Department of Marketing, Monash Business School, Caulfield East, Victoria, Australia
| | | | - Alix Candy
- Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Peter Bragge
- Monash Sustainable Development Institute Evidence Review Service, Monash University, Clayton, Victoria, Australia
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Yu L, Sun X, Gong J, Liu M, Yu S, Liu L. Effectiveness of shared decision-making for mode of delivery after caesarean section: A systematic review and meta-analysis of randomized controlled trials. J Clin Nurs 2024; 33:3721-3736. [PMID: 38803111 DOI: 10.1111/jocn.17291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 04/25/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
AIM To review the content, format and effectiveness of shared decision-making interventions for mode of delivery after caesarean section for pregnant women. DESIGN Systematic review and meta-analysis. METHODS Six databases (PubMed, Web of science Core Collection, Cochrance Network, Embase, CINAHL, PsycINFO) were searched starting at the time of establishment of the database to May 2023. Following the PRISMAs and use Review Manager 5.3 software for meta-analysis. Two review authors independently assessed the quality of the studies using the risk of bias 2 tool. The protocol was registered in PROSPERO (CRD42023410536). RESULTS The search strategy obtained 1675 references. After abstract and full text screening, a total of seven studies were included. Shared decision-making interventions include decision aids and counselling that can help pregnant women analyse the pros and cons of various options and help them make decisions that are consistent with their values. The pooled results showed that shared decision-making intervention alleviated decisional conflicts regarding mode of delivery after caesarean section, but had no effect on knowledge and informed choice. CONCLUSION The results of our review suggest that shared decision-making is an effective intervention to improve the quality of decision-making about the mode of delivery of pregnant women after caesarean section. However, due to the low quality of the evidence, it is recommended that more studies be conducted in the future to improve the quality of the evidence. CORRELATION WITH CLINICAL PRACTICE This systematic review and meta-analysis provides evidence for the effectiveness of shared decision-making for mode of delivery after cesarean section and may provide a basis for the development of intervention to promote the participation of pregnant women in the decision-making process.
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Affiliation(s)
- Lin Yu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Xiaoting Sun
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Jianmei Gong
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Man Liu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
| | - Shengmiao Yu
- Outpatient Department, The Fourth Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Lei Liu
- School of Nursing, Liaoning University of Chinese Traditional Medicine, Shenyang, Liaoning, China
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Domingues RMSM, Dias MAB, do Carmo Leal M. Women's preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project. Reprod Health 2024; 20:188. [PMID: 38549093 PMCID: PMC10976663 DOI: 10.1186/s12978-024-01771-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/11/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND In 2015, a quality improvement project called "Adequate Childbirth Project" (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women's preference for vaginal birth (VB) at the end of pregnancy. METHODS Evaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women's preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women's preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram. RESULTS Four thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99-3.24) and multiparous women (OR 1.44 95% CI 0.97-2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22-24.50) and in multiparous women (OR 53.11 95% CI 37.31-75.60). CONCLUSIONS The PPA had a positive effect on women's preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy.
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Affiliation(s)
- Rosa Maria Soares Madeira Domingues
- Instituto Nacional de Infectologia Evandro Chagas/Fundação Oswaldo Cruz, Laboratório de Pesquisa Clínica em DST/Aids, Av. Brasil, 4365, Manguinhos, Rio de Janeiro, CEP 21040-360, Brazil.
| | - Marcos Augusto Bastos Dias
- Instituto Nacional da Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira/Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sérgio Arouca/ Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Johansson M, Alvan J, Pettersson A, Hildingsson I. Conflicting attitudes between clinicians and women regarding maternal requested caesarean section: a qualitative evidence synthesis. BMC Pregnancy Childbirth 2023; 23:210. [PMID: 36978038 PMCID: PMC10044365 DOI: 10.1186/s12884-023-05471-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 02/27/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Caesarean section (CS) can be a life-saving operation but might also negatively affect the health of both the woman and the baby. The aim of this study was to synthesize and contrast women's and clinicians' attitudes toward maternal-requested CS, and their experiences of the decision-making process around CS. METHODS The databases of CINAHL, MEDLINE, PsycInfo and Scopus were screened. All qualitative studies that answered the study question and that were assessed to have minor or moderate methodological limitations were included. Synthesised findings were assessed using GRADE-CERQual. RESULTS The Qualitative Evidence Synthesis included 14 qualitative studies (published 2000-2022), involving 242 women and 141 clinicians. From the women's perspectives, two themes arose: women regarded CS as the safest mode of birth; and women's rights to receive support and acceptance for a CS request. From the clinicians' perspectives, four themes emerged: clinicians were concerned about health risks associated with CS; demanding experience to consult women with a CS request; conflicting attitudes about women's rights to choose a CS; and the importance of respectful and constructive dialogue about birthing options. CONCLUSION Women and clinicians often had different perceptions regarding the right of a woman to choose CS, the risks associated with CS, and the kind of support that should be part of the decision-making process. While women expected to receive acceptance for their CS request, clinicians perceived that their role was to support the woman in the decision-making process through consultation and discussion. While clinicians thought it was important to show respect for a woman's birth preferences, they also felt the need to resist a woman's request for CS and encourage her to give birth vaginally due to the associated increases in health risks.
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Affiliation(s)
- Margareta Johansson
- Department of Women’s and Children’s Health, Uppsala University, Akademiska University Hospital, SE- 751 85 Uppsala, Sweden
| | - Jonatan Alvan
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Agneta Pettersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden
| | - Ingegerd Hildingsson
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1143-1193. [PMID: 36339636 PMCID: PMC9633231 DOI: 10.1055/a-1904-6546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Correspondence Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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6
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Hill E, Chinkam S, Cardenas L, Iverson RE. Labour after caesarean counselling documentation: a quality improvement intervention on labour and delivery. BMJ Open Qual 2021; 10:e001232. [PMID: 34716182 PMCID: PMC8559118 DOI: 10.1136/bmjoq-2020-001232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 07/28/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Most women who have had previous caesareans are eligible to have labour after caesarean (LAC), but only 11.9% do so. Studies show the majority of women have already decided about future mode of birth (FMOB) before a subsequent pregnancy. Hence, providing women with LAC counselling soon after birth may help women plan for future pregnancies. Prior to our intervention, our hospital had no method of ensuring that women received LAC counselling after caesarean section. The purpose of this QI initiative was to assess whether formal LAC documentation on labour and delivery (L&D) improves rates of LAC counselling post partum. METHODS Our three-part intervention included: (1) surgeon's assessment of LAC feasibility in the operative note, (2) written LAC education for women in discharge paperwork and (3) documentation of LAC counselling in the discharge summary. We implemented these changes on L&D in January 2019. We conducted phone surveys of 40 women after caesarean preintervention and postintervention. Surveys included questions regarding three primary outcomes: whether or not they had received LAC counselling either in the hospital or at a postpartum visit, and whether or not they would pursue LAC as FMOB. Surveys also assessed two secondary outcomes: (1) women's understanding of the indications for surgery and (2) their involvement in the decision process. We used a χ2 analysis to assess primary outcomes and a Fisher's exact test to assess secondary outcomes. We also surveyed providers about the culture of LAC counselling at our hospital. RESULTS After our intervention, there was a significant difference between the number of women reporting LAC postpartum counselling (30.77% vs 53.8%, p=0.04). There was also a significant difference in the number of women feeling involved in the decision-making process (68% vs 95%, p=0.03). Providers reported improved knowledge/confidence around LAC counselling (58%-100%). Providers universally stated that LAC counselling has become more ingrained in the culture on L&D. CONCLUSIONS Documentation of LAC counselling improved the consistency with which providers incorporated LAC counselling into postpartum care. Addressing FMOB at the time of pLTCS and documenting that counselling may be an effective first step in empowering women to pursue LAC in future pregnancies.
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Affiliation(s)
- Elena Hill
- Department of Family Medicine, Department of OBGYN, Boston Medical Center, Boston, Massachusetts, USA
| | - Somphit Chinkam
- Department of Family Medicine, Department of OBGYN, Boston Medical Center, Boston, Massachusetts, USA
| | - Lilia Cardenas
- Department of Family Medicine, Department of OBGYN, Boston Medical Center, Boston, Massachusetts, USA
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Koppes DM, van Hees MSF, Koenders VM, Oudijk MA, Bekker MN, Franssen MTM, Smits LJ, Hermens R, van Kuijk SMJ, Scheepers HC. Nationwide implementation of a decision aid on vaginal birth after cesarean: a before and after cohort study. J Perinat Med 2021; 49:783-790. [PMID: 34049425 DOI: 10.1515/jpm-2021-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/26/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Woman with a history of a previous cesarean section (CS) can choose between an elective repeat CS (ERCS) and a trial of labor (TOL), which can end in a vaginal birth after cesarean (VBAC) or an unplanned CS. Guidelines describe women's rights to make an informed decision between an ERCS or a TOL. However, the rates of TOL and vaginal birth after CS varies greatly between and within countries. The objective of this study is to asses nation-wide implementation of counselling with a decision aid (DA) including a prediction model, on intended delivery compared to care as usual. We hypothesize that this may result in a reduction in practice variation without an increase in cesarean rates or complications. METHODS In a multicenter controlled before and after cohort study we evaluate the effect of nation-wide implementation of a DA. Practice variation was defined as the standard deviation (SD) of TOL percentages. RESULTS A total of 27 hospitals and 1,364 women were included. A significant decrease was found in practice variation (SD TOL rates: 0.17 control group vs. 0.10 intervention group following decision aid implementation, p=0.011). There was no significant difference in the ERCS rate or overall CS rates. A 21% reduction in the combined maternal and perinatal adverse outcomes was seen. CONCLUSIONS Nationwide implementation of the DA showed a significant reduction in practice variation without an increase in the rate of cesarean section or complications, suggesting an improvement in equality of care.
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Affiliation(s)
- Dorothea M Koppes
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | - Merel S F van Hees
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Obstetrics and Gynecology, GROW-School for Oncology and Developmental Biology, Maastricht, The Netherlands
| | | | - Martijn A Oudijk
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Mireille N Bekker
- Department of Obstetrics and Gynecology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Maureen T M Franssen
- Department of Obstetrics and Gynecology, University Medical Center Groningen, Groningen, The Netherlands
| | - Luc J Smits
- Department of Epidemiology, Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Rosella Hermens
- Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Hubertina C Scheepers
- Department of Obstetrics and Gynecology, Maastricht University Medical Center+, Maastricht, The Netherlands
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López-Toribio M, Bravo P, Llupià A. Exploring women's experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain. BMC Pregnancy Childbirth 2021; 21:631. [PMID: 34535117 PMCID: PMC8447503 DOI: 10.1186/s12884-021-04070-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 08/13/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Women's engagement in healthcare decision-making during childbirth has been increasingly emphasised as a priority in maternity care, since it increases satisfaction with the childbirth experience and provides health benefits for women and newborns. The birth plan was developed as a tool to facilitate communication between health professionals and women in Spain, but their value in routine practice has been questioned. Besides, little is known about women's experiences of participation in decision-making in the Spanish context. Thus, this study aimed to explore women's experiences of participation in shared decision-making during hospital childbirth. METHODS An exploratory qualitative study using focus groups was carried out in one maternity unit of a large reference hospital in Barcelona, Spain. Participants were first-time mothers aged 18 years or older who had had a live birth at the same hospital in the previous 12 months. Data collected were transcribed verbatim and analysed using a six-phase inductive thematic analysis process. RESULTS Twenty-three women participated in three focus groups. Three major themes emerged from the data: "Women's low participation in shared decision-making", "Lack of information provision for shared decision-making", and "Suggestions to improve women's participation in shared decision-making". The women who were willing to take an active role in decision-making encountered barriers to achieving this and some women did not feel prepared to do so. The birth plan was experienced as a deficient method to promote women's participation, as health professionals did not use them. Participants described the information given as insufficient and not offered at a timely or useful point where it could aid their decision-making. Potential improvements identified that could promote women's participation were having a mutually respectful relationship with their providers, the support of partners and other members of the family and receiving continuity of a coordinated and personalised perinatal care. CONCLUSION Enhancing women's involvement in shared decision-making requires the acquisition of skills by health professionals and women. The development and implementation of interventions that encompass a training programme for health professionals and women, accompanied by an effective tool to promote women's participation in shared decision-making during childbirth, is highly recommended.
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Affiliation(s)
- María López-Toribio
- Preventive Medicine and Epidemiology Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Paulina Bravo
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile.
- Centro Núcleo Milenio Autoridad y Asimetrías de Poder / Millennium Nucleus Center Authority and Power Asymmetries, Santiago, Chile.
| | - Anna Llupià
- Preventive Medicine and Epidemiology Department, Hospital Clínic, Barcelona, Spain
- Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
- Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
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9
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Harrison MS. Functions and Forms Framework: a Methodology for Mechanistic Deconstruction and Adaptation? J Gen Intern Med 2021; 36:2809-2811. [PMID: 33469751 PMCID: PMC8390705 DOI: 10.1007/s11606-020-06533-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Margo S Harrison
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, CO, USA.
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10
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Li X, Meng M, Zhao J, Zhang X, Yang D, Fang J, Wang J, Han L, Hao Y. Shared Decision-Making in Breast Reconstruction for Breast Cancer Patients: A Scoping Review. Patient Prefer Adherence 2021; 15:2763-2781. [PMID: 34916786 PMCID: PMC8670888 DOI: 10.2147/ppa.s335080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022] Open
Abstract
For most breast cancer (BC) patients who have undergone a mastectomy, the decision whether to proceed with breast reconstruction (BR) is complicated and requires deliberation. Shared decision-making (SDM) helps to address those needs and promote informed value-based decisions. However, little is known about the SDM status for BR in BC patients. This scoping review describes: 1) basic characteristics of studies on BR SDM in BC patients; 2) factors influencing BR SDM in BC patients; 3) experience and perception of BR SDM in BC patients; and 4) outcome measures reported. This review was performed in accordance with the Arksey and O'Malley methodology. A total of 5 English and 4 Chinese databases were searched, as well as different sources from grey literature. The data extraction form was developed by referring to the objectives and the Ottawa Decision Support Framework (ODSF). Data was analyzed using thematic analysis, framework analysis and descriptive statistics, with findings presented in the tables and diagrams. A total of 1481 records were retrieved and 42 of these included after screening. In 21 (21/42, 50%) of the studies, patient decision aids (PDAs) were utilized, and in 17 (17/42, 40.48%) of the studies, the factors influencing the implementation of SDM were explored. Of these 17 studies, the factors influencing the implementation of SDM were categorized into the following: the patient level (17/17, 100%), the healthcare level (2/17, 11.76%) and the organizational and system level (7/17, 41.18%). A total of 8 (19.05%) of the 42 studies focused on patients' experiences and perceptions of SDM, and all studies used qualitative research methods. Of these 8 studies, a total of 7 (7/8, 87.50%) focused on patients' experiences of SDM participation, and 4 (4/8, 50.00%) focused on patients' perceptions of SDM. A total of 24 studies (24/42, 57.14%) involved quantitative outcome measures, where 49 items were divided into three classifications according to the outcomes of ODSF: the quality of the decision (17/24, 70.83%), the quality of the decision-making process (20/24, 83.33%), and impact (13/24, 54.17%). Although researchers have paid less attention to other research points in the field of SDM, compared to the design and application of SDM interventional tools, the research team still presents some equally noteworthy points through scoping review. For instance, the various factors influencing BC patients' participation in SDM for BR (especially at the healthcare provider level and at the organizational system level), patients' experiences and perceptions. Systematic reviews (SRs) should be conducted to quantify the impact of these different factors on BR SDM. Implementation of scientific theories and methods can inform the exploration and integration of these factors.
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Affiliation(s)
- Xuejing Li
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Meiqi Meng
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junqiang Zhao
- School of Nursing, University of Ottawa, Ottawa, Ontario, Canada
- Center for Research on Health and Nursing, University of Ottawa, Ottawa, Ontario, Canada
| | - Xiaoyan Zhang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Dan Yang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Jiaxin Fang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Junxin Wang
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
| | - Liu Han
- Beijing University of Chinese Medicine Third Affiliated Hospital, Beijing, People’s Republic of China
| | - Yufang Hao
- School of Nursing, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Collaborating Center of Joanna Briggs Institute, Beijing, People’s Republic of China
- Beijing University of Chinese Medicine Best Practice Spotlight Organization, Beijing, People’s Republic of China
- Correspondence: Yufang Hao Liangxiang High Education Park, Fangshan District, Beijing, 102488, People’s Republic of ChinaTel +86-13552850210 Email
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Validation of a Vaginal Birth after Cesarean Delivery Prediction Model in Teaching Hospitals of Addis Ababa University: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1540460. [PMID: 33015154 PMCID: PMC7520680 DOI: 10.1155/2020/1540460] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 08/31/2020] [Accepted: 09/08/2020] [Indexed: 11/03/2022]
Abstract
Background External validation of a vaginal birth after cesarean delivery (VBAC) prediction model is important before implementation in other settings. The primary aim of this study is to validate the Grobman prenatal VBAC calculator in the Ethiopian setting. Secondarily, the study was aimed at developing and comparing a new VBAC model that includes both the prenatal and intrapartum variables. Methods A cross-sectional survey was conducted, complemented by a medical chart review of 268 women admitted at three teaching hospitals of Addis Ababa University and who underwent a trial of labor after one prior cesarean birth. Maternal age, prepregnancy BMI, prior vaginal delivery, prior VBAC, and prior cesarean delivery indication type were included in the Grobman model. Observed delivery outcomes were recorded and then compared with the outcomes predicted by the calculator. We assessed the predictive abilities of the Grobman model and the new model using a receiver operating characteristic (ROC) curve. Multivariate logistic regression analysis was conducted to identify variables associated with successful VBAC. Results Out of the 268 participants, 186 (69.4%) (95% CI 57.5-81.3) had successful VBAC. The area under the ROC curve (AUC) of the Grobman model was 0.75 (95% CI 0.69-0.81). Notably, the novel model including both the prenatal and intrapartum variables had a better predictive value than the original model, with an AUC of 0.87 (95% CI 0.81-0.93). Prior VBAC, prepregnancy BMI, fetal membrane status, and fetal station at admission were predictors of VBAC in the newly developed logistic regression model. Conclusions The success rate of VBAC was similar to other sub-Saharan African countries. The Grobman model performed adequately in the study setting; however, the model including both the prenatal and intrapartum variables was more predictive. Thus, intrapartum predictors used in the new model should be considered during intrapartum counseling.
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Vankan E, Schoorel E, van Kuijk S, Nijhuis J, Hermens R, Scheepers H. The effect of the use of a decision aid with individual risk estimation on the mode of delivery after a caesarean section: A prospective cohort study. PLoS One 2019; 14:e0222499. [PMID: 31557177 PMCID: PMC6763212 DOI: 10.1371/journal.pone.0222499] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE After one previous caesarean section (CS), pregnant women can deliver by elective repeat CS or have a trial of labor which can end in a vaginal birth after caesarean (VBAC) or an unplanned CS. Despite guidelines describing women's rights to make an informed choice, trial of labor and VBAC rates vary greatly worldwide. Many women are inadequately informed due to caregivers' fear of an increase in CS rates in a high VBAC rate setting. We compared counseling with a decision aid (DA) including a prediction model on VBAC to care as usual. We hypothesize that counselling with the DA does not decrease VBAC rates. In addition, we aimed to study the effects on unplanned CS rate, patient involvement in decision-making and elective repeat CS rates. METHODS We performed a prospective cohort study. From 2012 to 2014, 483 women in six hospitals, where the DA was used (intervention group), were compared with 441 women in six matched hospitals (control group). Women with one previous CS, pregnant of a singleton in cephalic presentation, delivering after 37 weeks 0 days were eligible for inclusion. RESULTS There was no significant difference in VBAC rates between the intervention (45%) and control group (46%) (adjusted odds ratio 0,92 (95% Confidence interval 0.69-1.23)). In the intervention group more women (42%) chose an elective repeat CS compared to the control group (31%) (adjusted odds ratio 1.6 (95% Confidence interval 1.18-2.17)). Of women choosing trial of labor, in the intervention group 77% delivered vaginally compared to 67% in the control group, resulting in an unplanned CS adjusted odds ratio of 0,57 (0.40-0.82) in the intervention group. In the intervention group, more women reported to be involved in decision-making (98% vs. 68%, P< 0.001). CONCLUSIONS Implementing a decision aid with a prediction model for risk selection suggests unchanged VBAC rates, but 40% reduction in unplanned CS rates, increase in elective repeat CS and improved patient involvement in decision-making.
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Affiliation(s)
- Emy Vankan
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Ellen Schoorel
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Sander van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Jan Nijhuis
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
| | - Rosella Hermens
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences (RIHS), Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands
| | - Hubertina Scheepers
- GROW-School for Oncology and Developmental Biology, Department of Obstetrics and Gynaecology, Maastricht University Medical Centre+, Maastricht, The Netherlands
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Wingert A, Johnson C, Featherstone R, Sebastianski M, Hartling L, Douglas Wilson R. Adjunct clinical interventions that influence vaginal birth after cesarean rates: systematic review. BMC Pregnancy Childbirth 2018; 18:452. [PMID: 30463530 PMCID: PMC6249876 DOI: 10.1186/s12884-018-2065-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/18/2018] [Indexed: 11/30/2022] Open
Abstract
Background Rates of cesarean deliveries have been increasing, and contributes to the rising number of elective cesarean deliveries in subsequent pregnancies with associated maternal and neonatal risks. Multiple guidelines recommend that women be offered a trial of labor after a cesarean (TOLAC). The objective of the study is to systematically review the literature on adjunct clinical interventions that influence vaginal birth after cesarean (VBAC) rates. Methods We searched Ovid Medline, Ovid Embase, Wiley Cochrane Library, CINAHL via EBSCOhost; and Ovid PsycINFO. Additional studies were identified by searching for clinical trial records, conference proceedings and dissertations. Limits were applied for language (English and French) and year of publication (1985 to present). Two reviewers independently screened comparative studies (randomized or non-randomized controlled trials, and observational designs) according to a priori eligibility criteria: women with prior cesarean sections; any adjunct clinical intervention or exposure intended to increase the VBAC rate; any comparator; and, outcomes reporting changes in TOLAC or VBAC rates. One reviewer extracted data and a second reviewer verified for accuracy. Two reviewers independently conducted methodological quality assessments using the Mixed Methods Appraisal Tool (MMAT). Results Twenty-three studies of overall moderate to good methodological quality examined adjunct clinical interventions affecting TOLAC and/or VBAC rates: system-level interventions (three studies), provider-level interventions (three studies), guidelines or information for providers (seven studies), provider characteristics (four studies), and patient-level interventions (six studies). Provider-level interventions (opinion leader education, laborist, and obstetrician second opinion for cesarean sections) and provider characteristics (midwifery antenatal care, physicians on night float call schedules, and deliveries by family physicians) were associated with increased rates of VBAC. Few studies employing heterogeneous designs, sample sizes, interventions and comparators limited confidence in the effects. Studies of system-level and patient-level interventions, and guidelines/information for providers reported mixed findings. Conclusions Limited evidence indicates some provider-level interventions and provider characteristics may increase rates of attempted and successful TOLACs and/or VBACs, whereas other adjunct clinical interventions such as system-level interventions, patient-level interventions, and guidelines/information for healthcare providers show mixed findings. Electronic supplementary material The online version of this article (10.1186/s12884-018-2065-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aireen Wingert
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Cydney Johnson
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Robin Featherstone
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, AB, Canada
| | - Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, AB, Canada
| | - Lisa Hartling
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, AB, Canada.,Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, University of Alberta, Edmonton, AB, Canada
| | - R Douglas Wilson
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, 1403 - 29 Street NW, Calgary, AB, T2N 2T9, Canada.
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Rubashkin N, Warnock R, Diamond-Smith N. A systematic review of person-centered care interventions to improve quality of facility-based delivery. Reprod Health 2018; 15:169. [PMID: 30305129 PMCID: PMC6180507 DOI: 10.1186/s12978-018-0588-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/14/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION We conducted a systematic review to summarize the global evidence on person-centered care (PCC) interventions in delivery facilities in order to: (1) map the PCC objectives of past interventions (2) to explore the impact of PCC objectives on PCC and clinical outcomes. METHODS We developed a search strategy based on a current definition of PCC. We searched for English-language, peer-reviewed and original research articles in multiple databases from 1990 to 2016 and conducted hand searches of the Cochrane library and gray literature. We used systematic review methodology that enabled us to extract and synthesize quantitative and qualitative data. We categorized interventions according to their primary and secondary PCC objectives. We categorized outcomes into person-centered and clinical (labor and delivery, perinatal, maternal mental health). RESULTS Our initial search strategy yielded 9378 abstracts; we conducted full-text reviews of 32 quantitative, 6 qualitative, 2 mixed-methods studies, and 7 systematic reviews (N = 47). Past interventions pursued these primary PCC objectives: autonomy, supportive care, social support, the health facility environment, and dignity. An intervention's primary and secondary PCC objectives frequently did not align with the measured person-centered outcomes. Generally, PCC interventions either improved or made no difference to person-centered outcomes. There was no clear relationship between PCC objectives and clinical outcomes. CONCLUSIONS This systematic review presents a comprehensive analysis of facility-based delivery interventions using a current definition of person-centered care. Current definitions of PCC propose new domains of inquiry but may leave out previous domains.
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Affiliation(s)
- Nicholas Rubashkin
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, USA
| | - Ruby Warnock
- Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, Zuckerberg San Francisco General, University of California, San Francisco, 1001 Potrero Avenue, 6D, San Francisco, CA 94110 USA
| | - Nadia Diamond-Smith
- Institute for Global Health Sciences, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, Mission Hall, Box 1224, 550 16th Street, Third Floor, San Francisco, CA 94158 USA
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Baijens SWE, Huppelschoten AG, Van Dillen J, Aarts JWM. Improving shared decision-making in a clinical obstetric ward by using the three questions intervention, a pilot study. BMC Pregnancy Childbirth 2018; 18:283. [PMID: 29973187 PMCID: PMC6031181 DOI: 10.1186/s12884-018-1921-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 06/26/2018] [Indexed: 11/26/2022] Open
Abstract
Background Shared decision-making (SDM) is an important aspect of modern health care. Many studies evaluated different interventions to improve SDM, however, none in an inpatient clinical setting. A tool that has been proven effective in an outpatient department is the three questions intervention. These questions are created for patients to get optimal information from their medical team and to make an informed medical decision. In this study, we evaluated the feasibility and effectiveness of this simple intervention on SDM in the obstetric inpatient department of a university hospital in the Netherlands. Method This is a clinical pilot before and after study, using mixed methods with quantitative and qualitative data collection. The three questions were stated on a card; (i.e. 1) What are my options; 2) What are the possible benefits and harms of those options; 3) How likely are each of those benefits and harms to happen to me?). The study period lasted 6 weeks in which all patients admitted to the obstetric ward were asked to participate in the study. In the first 3 weeks patients did not receive the three questions intervention (pre-intervention group). In the final 3 weeks all patients included received the intervention (intervention group). The main quantitative outcome measure was the level of SDM measured using the SDM-Q9 questionnaire at discharge (range 0–100). In addition, interviews with four patients of the intervention group were conducted and qualitatively analyzed. Results Thirty-three patients were included in the pre-intervention group, 29 patients in the intervention group. The mean score of the SDM-Q9 in the pre-intervention group was 65.5 (SD 22.83) and in the intervention group 63.2 (SD 20.21), a not statistically significant difference. In the interviews, patients reported the three questions to be very useful. They used the questions mainly as a prompt and encouragement to ask more specific questions. Discussion No difference in SDM was found between the two groups, possibly because of a small sample size. Yet the intervention appeared to be feasible and simple to use in an inpatient department. Further studies are needed to evaluate the impact of implementation of these three questions on a larger scale. Electronic supplementary material The online version of this article (10.1186/s12884-018-1921-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S W E Baijens
- Gynaecology and Obstetrics Department, Meander Medical Hospital, Maatweg 3, 3813 TZ, Amersfoort, the Netherlands
| | - A G Huppelschoten
- Gynaecology and Obstetrics Department, Jeroen Bosch Hospital, Henri Dunantstraat 1, 5223 GZ, 's-Hertogenbosch, the Netherlands
| | - J Van Dillen
- Gynaecology and Obstetrics Department, Radboudumc, Geert Grooteplein Zuid, 10 6525 GA, Nijmegen, the Netherlands.
| | - J W M Aarts
- Gynaecology and Obstetrics Department, Radboudumc, Geert Grooteplein Zuid, 10 6525 GA, Nijmegen, the Netherlands
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Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education. Reprod Health 2017; 14:116. [PMID: 28893291 PMCID: PMC5594573 DOI: 10.1186/s12978-017-0354-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/26/2017] [Indexed: 01/22/2023] Open
Abstract
Background Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions. Methods Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18–25 years, who were born in the survey country and did not study health sciences (n = 1390). Results One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased. Conclusion Education sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women’s capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.
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Predicting Successful Trial of Labor After Cesarean Delivery: Evaluation of Two Scoring Systems. J Obstet Gynaecol India 2017; 68:276-282. [PMID: 30065542 DOI: 10.1007/s13224-017-1031-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/22/2017] [Indexed: 10/19/2022] Open
Abstract
Background Attempting vaginal birth after cesarean section (VBAC) places women at an increased risk of complications. Trial of labor after cesarean (TOLAC) calculators aim to predict the chance of successful vaginal birth after cesarean (VBAC) based on the patient's preexisting demographic and clinical factors. Objective To assess the rate of successful TOLAC using two calculators: FLAMM and the Grobman calculator, and to compare the performance of the two calculators in the successful prediction of VBAC. Methods Prospective cohort study in subjects with previous one caesarean section using well-defined inclusion and exclusion criteria. Results A total of 280 subjects with previous one cesarean section were enrolled. One hundred thirty-nine subjects consented for TOLAC, 90 (67%) underwent successful trial of vaginal birth, and 49 (32.8) required cesarean section. Cervical dilatation (p < 0.0001) and effacement (p < 0.0001), and any prior vaginal delivery (p < 0.02) were significantly associated with a successful outcome. At a cutoff score of 5, the sensitivity of the FLAMM score was 72% and specificity was 76%. For the Grobman calculator, the best sensitivity (69%) and specificity (67%) were seen at a cutoff score of 85%. Conclusion Both prediction models, the FLAMM and the "close to delivery" nomogram, recommended by Grobman et al. are easy to use and could successfully estimate the chances of vaginal birth in previous caesarean, in this small cohort. The decision for women opting for TOLAC can be individualized, and patient-specific chances of success can be predicted by the use of these prediction models.
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Lazo-Porras M, Bayer AM, Acuña-Villaorduña A, Zeballos-Palacios C, Cardenas-Montero D, Reyes-Diaz M, Naranjo-Caceres M, Malaga G. Perspectives, Decision Making, and Final Mode of Delivery in Pregnant Women With a Previous C-Section in a General Hospital in Peru: Prospective Analysis. MDM Policy Pract 2017; 2:2381468317724409. [PMID: 30288428 PMCID: PMC6125051 DOI: 10.1177/2381468317724409] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 06/29/2017] [Indexed: 11/26/2022] Open
Abstract
Objective: Explore the perspectives, decision-making process, and final mode of delivery among pregnant women with a previous C-section (Cesarean section) in a general public sector hospital in Lima, Peru. Methods: A qualitative prospective study using semistructured interviews at two time points in the outpatient obstetrics and gynecology clinic of a public sector, university-affiliated reference hospital in Lima, Peru. Seventeen adult pregnant women with a prior C-section who were deemed by their attending obstetrician to be candidates for a trial of labor were interviewed. The first interview was between 37 and 38 weeks of pregnancy, and the second interview was 24 to 48 hours after delivery. MAIN OUTCOME MEASURES Predelivery decision-making process and final mode of delivery. Results: Among the 17 participants, about half (9) of the participants stated that the physician explained that they had two approaches for delivery, a trial of labor after C-section (TOLAC) or elective repeated C-section (ERCD). Two women stated that their respective providers explained only one option, either an ERCD or TOLAC. However, 6 women did not receive any information from their providers about their delivery options. Of the 10 participants that decided TOLAC, 8 ended up having a C-section, and of the 7 patients that had planned an ERCD, 1 ended up having a vaginal delivery. Conclusion: Many participants affirmed that they made the decision about their approach of delivery. However, most of the participants that decided a TOLAC ended up having a C-section because of complications during the final weeks of pregnancy or during labor.
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Affiliation(s)
- Maria Lazo-Porras
- Maria Lazo-Porras, MD, CONEVID Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, San Martin de Porres, Lima, Peru; e-mail:
| | - Angela M. Bayer
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Ana Acuña-Villaorduña
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Claudia Zeballos-Palacios
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Deborah Cardenas-Montero
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Michael Reyes-Diaz
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - Monica Naranjo-Caceres
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
| | - German Malaga
- Unidad de Conocimiento y Evidencia, Universidad Peruana Cayetano Heredia, Lima, Peru (MLP, AAV, CZP, DCM, MRD, GM)
- Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru (AMB)
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA (AMB)
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA (CZP)
- Hospital Nacional Cayetano Heredia, Lima, Peru (MNC, GM)
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Nilsson C, van Limbeek E, Vehvilainen-Julkunen K, Lundgren I. Vaginal Birth After Cesarean: Views of Women From Countries With High VBAC Rates. QUALITATIVE HEALTH RESEARCH 2017; 27:325-340. [PMID: 26531882 DOI: 10.1177/1049732315612041] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Despite the consequences for women's health, a repeat cesarean section (CS) birth after a previous CS is common in Western countries. Vaginal Birth After Cesarean (VBAC) is recommended for most women, yet VBAC rates are decreasing and vary across maternity organizations and countries. We investigated women's views on factors of importance for improving the rate of VBAC in countries where VBAC rates are high. We interviewed 22 women who had experienced VBAC in Finland, the Netherlands, and Sweden. We used content analysis, which revealed five categories: receiving information from supportive clinicians, receiving professional support from a calm and confident midwife/obstetrician during childbirth, knowing the advantages of VBAC, letting go of the previous childbirth in preparation for the new birth, and viewing VBAC as the first alternative for all involved when no complications are present. These findings reflect not only women's needs but also sociocultural factors influencing their views on VBAC.
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20
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Munro S, Dewar K, Wilcox E, Klein MC, Janssen PA. Evaluation of a Patient Education Pamphlet for Women Considering Vaginal Birth After Cesarean. J Perinat Educ 2017; 26:37-48. [PMID: 30643376 DOI: 10.1891/1058-1243.26.1.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We evaluated a patient education pamphlet on vaginal birth after cesarean (VBAC). Focus groups with 17 women in 4 communities involved a 5-item knowledge pretest and question on intention to plan VBAC, reading the pamphlet, a knowledge posttest, and a moderated discussion. Forming a preference for birth after cesarean was characterized by (a) consolidating information from social sources, (b) seeking certainty in your next birth, and (c) questioning your ability to have a vaginal birth. Participants preferred vaginal birth, but all feared the uncertainty of labor. Knowledge scores increased for all participants, but intentions to plan a VBAC did not change. Our findings may encourage the development of interventions to reduce women's fear of vaginal birth.
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McGoldrick EL, Crawford T, Brown JA, Groom KM, Crowther CA. Consumers attitudes and beliefs towards the receipt of antenatal corticosteroids and use of clinical practice guidelines. BMC Pregnancy Childbirth 2016; 16:259. [PMID: 27596254 PMCID: PMC5011343 DOI: 10.1186/s12884-016-1043-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 08/20/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Active participation of consumers in health care decision making, policy and clinical research is increasingly encouraged by governments, influential bodies and funders. Identifying the best way to achieve this is difficult due to the paucity of evidence. Consumers have mixed feelings towards clinical practice guidelines (CPG) demonstrating scepticism towards their purpose and applicability to their needs. There is no information pertaining to consumers' views and attitudes on the receipt of antenatal corticosteroids (ACS). The aim of this study was to examine the barriers and enablers to receiving ACS and use of CPG amongst consumers. METHODS Consumers were recruited from neonatal units across three district health boards (DHBs) in Auckland, New Zealand. Participants completed a semi-structured interview or questionnaire. The questions posed and analyses were informed by the Theoretical Domains Framework (TDF). Barriers and enablers were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on use of CPG and receipt of ACS. RESULTS Twenty four consumers participated in the study. Six domains were identified as barriers to receipt of ACS and use of CPG. Key barriers to receipt of ACS included: difficulty retaining information conveyed, requiring further information in a variety of formats, and time constraints faced by consumers and health professionals in the provision and understanding of information to facilitate decision making. Barriers to use of CPG included: uncertainty about applicability of guideline use among consumers and scepticism about health professionals adhering too rigidly to guidelines. Enablers to receipt of ACS included: optimism toward ACS use, a strong knowledge of why ACS were administered, improved resilience in their pregnancy and confidence in their decision making following receipt of information about ACS. Enablers to use of CPG included: validation and standardisation of decision making among health professionals providing care and facilitating the best care for women and their babies. CONCLUSIONS Key barriers and enablers exist among consumers regarding receipt of ACS and use of CPG. These need to be addressed or modified in any intervention strategy to facilitate implementation of the ACS CPG.
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Affiliation(s)
- E L McGoldrick
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - T Crawford
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - J A Brown
- Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - K M Groom
- Department of Obstetrics and Gynaecology, The University of Auckland, Auckland, New Zealand
- National Womens Health, Auckland City Hospital, Auckland, New Zealand
| | - C A Crowther
- Liggins Institute, The University of Auckland, Auckland, New Zealand.
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Filippi V, Ganaba R, Calvert C, Murray SF, Storeng KT. After surgery: the effects of life-saving caesarean sections in Burkina Faso. BMC Pregnancy Childbirth 2015; 15:348. [PMID: 26694035 PMCID: PMC4688946 DOI: 10.1186/s12884-015-0778-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 12/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background In African countries, caesarean sections are usually performed to save mothers and babies’ lives, sometimes in extremis and at considerable costs. Little is known about the health and lives of women once discharged after such surgery. We investigated the long-term effects of life-saving caesarean section on health, economic and social outcomes in Burkina Faso. Methods We conducted a 4 year prospective cohort study of women and their babies using mixed methods. The quantitative sample was selected in seven hospitals and included 950 women: 100 women with a caesarean section associated with near-miss complication (life-saving caesareans); 173 women with a vaginal birth associated with near-miss complication; and 677 women with uncomplicated vaginal childbirth. Structured interviews were conducted at 3 months, 6 months, 12 months and 3 and 4 years postpartum. These were supplemented by medical record data on delivery and physical examinations at 6 and 12 months postpartum. The lives and experiences of 21 women were documented ethnographically. Data were analysed with multivariable logistic regressions, using survival analysis and thematic analysis. Results The physical effects of life-saving caesareans appeared to be similar to women who had an uncomplicated childbirth, although 55 % of women with life-saving caesareans had another caesarean in their next pregnancy. The negative effects were generally economic, social and reproductive when compared to vaginal births, including increased debts (AOR = 3.91 (1.46–10.48) and sexual violence (AOR = 4.71 (1.04–21.3)) and lower fertility (AOR = 0.44 (0.24–0.80)) 4 years after life-saving caesareans. In the short and medium term, women with life-saving caesareans appeared to suffer increased psychological distress compared to uncomplicated births. They were more likely to use contraceptives (AOR = 5.95 (1.53–23.06); 3 months). Mortality of the index child was increased in both near-miss groups, independent of delivery mode. Ethnographic data suggest that these consequences are significant for Burkinabe women, whose well-being and social standing are mostly determined by their fertility, marriage strength and family links. Conclusions Life-saving caesareans have broad consequences beyond clinical sequelae. The recent policy to subsidise emergency obstetric care costs implemented in Burkina Faso should help avoid the majority of catastrophic costs, shown to be problematic for women undergoing emergency caesarean section.
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Affiliation(s)
| | | | - Clara Calvert
- London School of Hygiene and Tropical Medicine, London, UK.
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Grylka-Baeschlin S, Petersen A, Karch A, Gross MM. Labour duration and timing of interventions in women planning vaginal birth after caesarean section. Midwifery 2015; 34:221-229. [PMID: 26681573 DOI: 10.1016/j.midw.2015.11.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE understanding the labour characteristics of women attempting vaginal birth after caesarean (VBAC) may suggest how to improve intrapartum management and may enhance success rates. Promoting VBAC is a relevant factor in decreasing overall caesarean section (c-section) rates. However, the labour processes of women attempting VBAC are not well investigated. The aim of this paper is to compare multiparae planning a first VBAC (pVBAC) with primiparae and with multiparae planning a second vaginal birth, all starting to give birth vaginally, with regard to (a) perinatal characteristics, (b) the timing of intrapartal spontaneous rupture of membranes (SROM) and of interventions, and (c) labour duration, with respect to the first and second stages. SETTING cohort study of women planning vaginal birth in 47 obstetric units in Lower Saxony, Germany. PARTICIPANTS 1897 primiparae, 211 multiparae with one previous c-section and 1149 multiparae with one previous vaginal birth. MEASUREMENTS secondary analysis of data from an existing cohort study. Kaplan-Meier estimates, log rank test, Wilcoxon test and shared frailty Cox regression models including time-varying covariates were used to compare the timing of interventions and labour duration between the subsamples. Analyses were done with the statistics programme Stata 13. FINDINGS perinatal and labour characteristics of multiparae with pVBAC mainly resembled those of primiparae and differed from those of multiparae planning a second vaginal birth. However, compared to primiparae, multiparae with pVBAC received oxytocin less often (48.82 versus 56.95%, p=0.024) and gave birth vaginally significantly less often (69.19 versus 83.40%, p<0.001). The timing of intrapartal SROM (2.67 versus 3.42 hours, p=0.112) and of interventions (amniotomy: 5.50 versus 5.83 hours, p=0.198; oxytocin: 5.75 versus 6.00 hours, p=0.596; epidural: 4.00 versus 4.67 hours, p=0.416; opioids: 3.83 versus 3.78, p=0.851) was similar to that in primiparae although timings of all interventions but not of SROM differed significantly from that in multiparae with second vaginal birth (SROM: 2.67 versus 2.67 hours, p=0.481; amniotomy: 5.50 versus 3.93 hours, p<0.001; oxytocin: 5.75 versus 4.25 hours, p<0.001; epidural: 4.00 versus 3.50 hours, p=0.009; 3.83 versus. 2.75 hours, p=0.026). Overall and first-stage labour duration were comparable to primiparae (overall labour duration: 8.83 versus 8.57 hours, HR=0.998, 95% CI=0.830-1.201, p=0.987; first stage: 7.42 versus 7.00 hours, HR=0.916, 95% CI=0.774-1.083, p=0.303) but significantly longer than in other multiparae (overall labour duration: 8.83 versus 4.63 hours, HR=0.319, 95% CI=0.265-0.385, p<0.001; first stage: 7.42 versus 4.25 hours, HR=0.402, 95% CI=0.339-0.478, p<0.001). However, the second stage of labour was significantly shorter in multiparae with pVBAC than in primiparae (0.55 versus 0.77 hours, HR=1.341, 95% CI=1.049-1.714, p=0.019), but longer than in multiparae with second vaginal birth (0.55 versus 0.22 hours, HR=0.334, 95% CI=0.262-0.426, p<0.001). KEY CONCLUSION labour patterns of multiparous women planning a VBAC differ from those of primiparae and other multiparous women. Multiparae with pVBAC should be considered as a distinct group of parturients. IMPLICATION FOR PRACTICE expectations regarding labour progression for multiparae with first pVBAC should be similar to those for primiparae. However, the chance that the second stage of labour might be shorter than in primiparae is relevant and motivating information for pregnant women with a previous c-section in deciding the planned mode of birth.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany; PhD Programme 'Epidemiology', Braunschweig-Hannover, Germany.
| | - Antje Petersen
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffenstr. 7, D-38124 Braunschweig, Germany.
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany.
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Shorten A, Fagerlin A, Illuzzi J, Kennedy HP, Lakehomer H, Pettker CM, Saran A, Witteman H, Whittemore R. Developing an Internet-Based Decision Aid for Women Choosing Between Vaginal Birth After Cesarean and Planned Repeat Cesarean. J Midwifery Womens Health 2015; 60:390-400. [DOI: 10.1111/jmwh.12298] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Aslani A, Tara F, Ghalighi L, Pournik O, Ensing S, Abu-Hanna A, Eslami S. Impact of computer-based pregnancy-induced hypertension and diabetes decision AIDS on empowering pregnant women. Healthc Inform Res 2014; 20:266-71. [PMID: 25405062 PMCID: PMC4231176 DOI: 10.4258/hir.2014.20.4.266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Revised: 08/29/2014] [Accepted: 09/10/2014] [Indexed: 11/23/2022] Open
Abstract
Objectives We designed a computer-based decision aid (CDA) for use by pregnant women at home to investigate and participate in solving their pregnancy problems related to pregnancy-induced hypertension (PIH) and gestational diabetes (GD). The system cannot and is not intended to replace visits to physicians; rather it can help women focus on the most important symptoms and provides guidance on when to see a doctor. Methods The study is a randomized controlled trial, which is performed among Iranian pregnant women. For subjects, 420 healthy pregnant women have been recruited from two private and two public prenatal centers. The intervention group will receive the CDA for use at home, and the control group will receive care as usual. The CDA relies on knowledge extracted from the national guidelines on PIH and GD. Results The two primary outcomes for the study are self-efficacy and knowledge. Self-efficacy will be measured by the Stanford self-efficacy scale and knowledge will be evaluated by 15 binary (true/false) questions provided by the researchers. Secondary outcomes include type and frequency of doctor and/or medical center visits; blood pressure and blood sugar changes based on the national guidelines and according to pregnancy records, and anxiety will be assessed by the state component of the short Spielberger anxiety scale. Conclusions This paper describes the design of a CDA and a protocol for a randomized controlled trial to study the effects of the CDA on self-efficacy and knowledge of pregnant women pertaining to PIH and GD. Differences in the primary outcomes will be analyzed using 'intention-to-treat' principles.
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Affiliation(s)
- Azam Aslani
- Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Tara
- Research Center for Patient Safety, Mashhad University of Medical Sciences, Mashhad, Iran. ; Department of Obstetrics and Gynecology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lila Ghalighi
- Mental Health Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Omid Pournik
- Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sabine Ensing
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Ameen Abu-Hanna
- Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Saeid Eslami
- Department of Medical Informatics, Mashhad University of Medical Sciences, Mashhad, Iran. ; Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands. ; Pharmaceutical Research Center, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
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O’Reilly A, Choby D, Séjourné N, Callahan S. Feelings of control, unconditional self-acceptance and maternal self-esteem in women who had delivered by caesarean. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2014.930111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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