Researchers have developed a computerised decision analysis programme that might help cut the number birth by caesarean section as it helps decide on the type of birth that is most appropriate for women.
The programme was developed by a team of researchers led by Dr Montgomery at the Universities of Bristol and Dundee.
AdvertisementAs part of the study, researchers recruited 742 women at four maternity units in the UK where the rates of caesarean section ranged from 22 to 25 percent. Each woman had had one previous caesarean section. They were split into three randomised groups.
The first group were given the usual care a woman would expect from obstetric and midwifery staff.
The second group had access to a computer based information programme that gave them descriptions and the risks of likely clinical outcomes of a normal delivery, an elective caesarean section and an emergency caesarean section.
The third group had access to a more complex computer based decision analysis programme. They were given descriptions of the outcomes associated with a planned normal birth, elective caesarean section and emergency caesarean section.
Women were then asked to consider the value they attached to each possible outcome using a ratings system. From that the programme produced a recommended 'preferred option' that the woman could print out and discuss with her midwife.
Researchers noted a higher proportion of the decision analysis group (37 percent) had a vaginal birth compared with the usual care group (30 percent) and the information programme group (29percent).
The women in the two intervention groups also had lower anxiety scores and higher knowledge scores than those in the usual care group. Satisfaction was also higher in the decision-analysis group.
Researchers found that computer based decision aids could reduce decisional conflict among pregnant women with one previous caesarean section.
"This is an important finding, as detailed descriptions and probability information about obstetric complications might be considered as potentially alarming," the researchers said.
"Ongoing parallel qualitative work indicates that explicit consideration of personal values attached to potential outcomes challenges women's perceptions of the optimal decision and this may influence their resolve to achieve a vaginal birth," they said.
"Although the content was carefully designed to not favour one mode of delivery over another, even a small absolute change in decisions could have a substantial impact on national rates of caesarean section," researchers added.
The findings of the study were published on bmj.com.
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