Healthcare professionals’ views on two computer‐based decision aids for women choosing mode of delivery after previous caesarean section: a qualitative study

• Published in: BJOG : an international journal of obstetrics and gynaecology 2009-06, Vol.116 (7), p.906-914
• Main Authors: Rees, KM, Shaw, ARG, Bennert, K, Emmett, CL, Montgomery, AA
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Biological and medical sciences; Caesarean section; Cesarean section; Cesarean Section - psychology; Childbirth & labor; Choice Behavior; decision aids; Decision Making; Delivery. Postpartum. Lactation; Educational materials; Female; Focus Groups; Gynecology. Andrology. Obstetrics; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; Medical personnel; Medical sciences; Middle Aged; Opinions; Pregnancy; qualitative study; Randomized Controlled Trials as Topic; vaginal birth after caesarean; Vaginal Birth after Cesarean - psychology; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids
• ISSN: 1470-0328; 1471-0528
• DOI: 10.1111/j.1471-0528.2009.02121.x

Objective  To explore healthcare professionals’ views about decision aids, developed by the DiAMOND study group, for women choosing mode of delivery after a previous caesarean section. Design/Methods  A qualitative focus group study. Data were analysed thematically. Setting  Two city maternity units, surrounding community midwife units and general practitioner (GP) practices in southwest England. Sample  Twenty‐eight healthcare professionals, comprising obstetricians, hospital and community midwives and GPs, who participated in six focus groups. Results  Participants were generally positive about the decision aids. Most thought they should be implemented during early pregnancy in the community, but should be accessible throughout pregnancy, with any arising questions discussed with an obstetrician nearer to term. Perceived barriers to implementation included service issues (e.g. time pressure, cost and access), computer issues (e.g. computer literacy) and people issues (e.g. women’s prior delivery preferences and clinician preference). Facilitators to implementation included access to more standardised and reliable information and empowerment of the user. Self‐accessing the aids, increased awareness of decision aids among healthcare professionals and incorporation of aids into usual care were suggested as possible ways to improve implementation success. Conclusions  This study gives insight into healthcare professionals’ views on the role of decision aids for women choosing a mode of delivery after a prior caesarean section. It highlights potential obstacles to their implementation and ways to address these. Such aids could be a useful adjunct to current antenatal care.