TY - JOUR
T1 - Nationwide implementation of a decision aid on vaginal birth after cesarean
T2 - A before and after cohort study
AU - Koppes, Dorothea M.
AU - Van Hees, Merel S.F.
AU - Koenders, Vivienne M.
AU - Oudijk, Martijn A.
AU - Bekker, Mireille N.
AU - Franssen, Maureen T.M.
AU - Smits, Luc J.
AU - Hermens, Rosella
AU - Van Kuijk, Sander M.J.
AU - Scheepers, Hubertina C.
N1 - 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.
PY - 2021/9/27
Y1 - 2021/9/27
N2 - 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. 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.
AB - 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. 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.
KW - cesarean delivery
KW - decision aid
KW - practice variation
KW - trial of labor
KW - vaginal birth after cesarean
UR - https://www.scopus.com/pages/publications/85108122871
U2 - 10.1515/jpm-2021-0007
DO - 10.1515/jpm-2021-0007
M3 - Article
C2 - 34049425
AN - SCOPUS:85108122871
SN - 0300-5577
VL - 49
SP - 783
EP - 790
JO - Journal of Perinatal Medicine
JF - Journal of Perinatal Medicine
IS - 7
ER -