A new patient-centered decision support tool developed in conjunction with Northwestern Medicine scientists aims to help pregnant women decide whether they prefer to undergo trial-of-labor or a repeat cesarean delivery after having a prior cesarean, according to a study published in JAMA.
The number of women who choose to have a cesarean delivery has steadily increased over the last 20 years. The issue, however, is that there is no standardized approach of when, how or what to discuss with a woman about her preferred approach to delivery, other than that the topic should be discussed at some point during her pregnancy, according to William Grobman, MD, MBA, the Arthur Hale Curtis, MD, Professor of Obstetrics and Gynecology and senior author of the study.
“This decision support tool could hopefully help clarify for women what is their most desired choice for delivery, a choice that is best for them, in a more standardized and patient centered way than they might get from ad hoc counseling,” said Grobman, who is also vice chair for Clinical Operations in the Department of Obstetrics and Gynecology.
The investigators used patient input and best practices, including explicit consideration of patient values and preferences, to develop a decision support tool that offers consistent and reliable information regarding the processes and potential outcomes of trial of labor after cesarean delivery and scheduled repeat cesarean delivery.
To determine the efficacy of the tool, the investigators analyzed 1,485 women participants from clinics in Boston, Chicago and San Francisco who had one prior cesarean delivery and no contraindication to trial of labor. The participants were then randomized into two groups, with one group given access to the decision support tool prior to 25 weeks gestation and the other group serving as a control who received standard care.
Overall, the use of a decision support tool did not significantly change the rate of trial of labor, pointing to the need for further research to assess the efficacy of the tool in other clinical settings and when implemented at other times during a woman’s pregnancy, according to Grobman.
“The next step is to keep trying to find ways that we can make sure that the information we give to individual women is patient centered, culturally appropriate and optimizes their ability to access healthcare and achieve the health outcomes that they want,” Grobman said.
This work was supported by the National Institutes of Health.
