Nationwide implementation of a decision aid on vaginal birth after cesarean: A before and after cohort study
Koppes, Dorothea M.; Van Hees, Merel S.F.; Koenders, Vivienne M.; Oudijk, Martijn A.; Bekker, Mireille N.; Franssen, Maureen T.M.; Smits, Luc J.; Hermens, Rosella; Van Kuijk, Sander M.J.; Scheepers, Hubertina C.
(2021) Journal of Perinatal Medicine, volume 49, issue 7, pp. 783 - 790
(Article)
Abstract
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
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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. 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. 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. 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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Keywords: cesarean delivery, decision aid, practice variation, trial of labor, vaginal birth after cesarean, Obstetrics and Gynaecology, Pediatrics, Perinatology, and Child Health, Journal Article
ISSN: 0300-5577
Publisher: Walter de Gruyter GmbH & Co. KG
Note: Funding Information: Research funding: The Dutch organization for healthcare research and innovation (ZonMW) provided a grant to conduct this research. For the provided grand no external peer review was needed. The grant is used as a reimbursement. ZonMW had no interference in the publication process. Participating hospitals received a, predefined amount of money, per patient with a maximum amount of patients per hospital. Reference number: 1710030061. Publisher Copyright: © 2021 2021 Walter de Gruyter GmbH, Berlin/Boston.
(Peer reviewed)