Pregnancy Clinical Trial
Official title:
Measuring Preferences for Childbirth After Cesarean
The objective of this proposed 18-month exploratory research study is to help pregnant women weigh risks and benefits in a childbirth decision using the Preferences-Assessment Computer Module. Our hypothesis is that, after using this computer module, women will be more aware of the potential risks and benefits of VBAC and of elective repeat cesarean and will have greater clarity about their preferences related to these risks and benefits.
As cesarean birth rates continue to climb, the number of women (currently about 420,000
annually) facing the decision of whether to have a repeat cesarean or to attempt a vaginal
birth after cesarean (VBAC) will also increase. The objective of this proposed 18-month
exploratory research study is to help pregnant women weigh risks and benefits in a childbirth
decision using the Preferences Assessment Computer Module developed by the principal
investigator. The long-term objective of the proposed research is to understand and improve
the decision-making process of these women by creating a computerized childbirth decision
aid. Such decision aids provide value when the decision is complex, when the outcome is
uncertain, and when people vary in how they prioritize preferences; childbirth decisions for
women with a prior cesarean meet all these criteria.
No study to date quantifies how women weigh the complexities of various
considerations—medical and otherwise—in the delivery decision. The proposed research is
significant, therefore, in that it will provide a much-needed method to help women prioritize
and weigh their preferences related to childbirth decisions. More broadly, it responds to the
recent NIH and AHRQ initiatives to promote the development of computerized decision aids to
improve the quality of medical decisions.
A new investigator will lead a well-qualified, multi-disciplined team that has expertise in
decision analysis, obstetric medicine, and research methodology in pursuit of the following
specific aims:
1. To validate a precise method to measure childbirth preferences. During the initial phase
of this study, we will verify the accuracy of the Preferences Assessment Computer
Module, measure internal consistency and assess content validity in a cross-sectional
study.
2. To test whether women who use the Preferences Assessment Computer Module will have
increased clarity about their preferences—and about the implication of those
preferences—in comparison to women in a control group. We will conduct a randomized
controlled trial of pregnant women with a prior cesarean.
This Preferences Assessment Computer Module is appropriate to address not only VBAC
decisions, but also decisions related to elective cesareans and induction. In short, the
proposed research will advance the field by improving the quality of the decision-making
process for childbirth.
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