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

The growing number of primary cesarean deliveries in the United States has placed an increasing number of women in a decision dilemma for subsequent pregnancies. Opportunities for women to attempt vaginal birth after cesarean (VBAC) have declined despite consistent evidence that it is a safe option for most women. Women need balanced and consistent information to help them weigh the potential benefits and harms of birth options, and to develop a plan with providers about the type of birth that is best for them. This is where decision-aids and Shared Decision Making come into play. 

This important study will identify how interactive decision-aids can be used in practice to provide patient-centered pregnancy care. Leading the study is Dr. Allison Shorten, the author of Birth Choices, an effective paper-based decision-aid originally developed, tested and implemented in Australia. This study will expand the reach and capability of the Birth Choices decision-aid to support US women by adapting it to a US-specific health IT framework, and build the decision-aid’s capacity to be interactive to further improve the quality of women’s decision experiences. Information technology will enable women to interact with the information, tailor information to their individual history and health factors, help them to communicate personal values and preferences with providers, and ultimately have shared decisions documented in their electronic medical record. 

Phase one will involve an iterative and participatory approach, engaging targeted users (pregnant women and pregnancy care providers) in the decision-aid design. Phase two will involve testing the feasibility of integrating the interactive decision-aid using shared decision making in two busy, demographically diverse outpatient pregnancy care settings in New Haven, CT. Results will inform future research about integrated interactive decision-aids for pregnancy.