Using Interactive Health Information Technology to Support Women’s Choices for Birth After Cesarean

Despite evidence that vaginal birth after Caesarean (VBAC) is safe, fewer than 10 percent of women eligible for a VBAC choose one. Opportunities for women to participate actively in decisions about birth depend on the ability of providers to support shared decision making (SDM), the availability of effective decision support tools for women, and effective ways to integrate decision support tools into busy clinical practice settings. For effective SDM about VBAC, women need balanced and consistent information to help them weigh the benefits and potential harms of both options, and to develop a plan with clinicians about the type of birth that is best for them.

This project designed and assessed the feasibility of implementing a new web-based Birth Choices decision aid to support SDM about VBAC. The tool provided multiple interactives features including: (1) evidence-based educational content describing risks and benefits of birth options, (2) a VBAC success calculator with personal risk factor assessment, (3) user control over information sequence and depth, (4) integrated quiz questions and answers, and (5) a values clarification exercise including questions about goals and birth preferences to facilitate discussion with the provider.

The specific aims of this project were as follows:

• Translate the best-practice Birth Choices paper-based decision aid into an interactive computer-based decision aid to support women making decisions about mode of birth after prior Caesarean.
• Assess the feasibility of integrating the Birth Choices interactive decision aid into busy urban outpatient pregnancy care settings using a shared decision making model.

A two-phased sequential mixed-methods design was used. In the first phase, an iterative and participatory research approach engaged targeted users in decision aid design and development. Phase two assessed the feasibility of integrating Birth Choices into two busy urban outpatient settings, finding that it was efficacious. Additionally, the feasibility of translating and adapting the tool to meet the needs of ethnically diverse pregnant women was established. Future research will include identification of strategies to facilitate patient access, consistent utilization, and seamless integration into the system of care.