Chen Shu Wen, Yang Cherg Chia, Te Jimmy C, Tsai Yi Ling, Shorten Brett, Shorten Allison
National Taipei University of Nursing and Health Science, School of Nursing, Taiwan.
Saint Paul's Hospital, Taiwan.
Midwifery. 2021 Apr;95:102920. doi: 10.1016/j.midw.2020.102920. Epub 2021 Jan 8.
Taiwan has a high national caesarean rate coupled with a low vaginal birth after caesarean (VBAC) rate. Studies suggest that women do not receive sufficient information about birth choices after caesarean in Taiwan and shared decision making (SDM) is not an expectation. This pilot study aimed to test the feasibility of using a birth choices decision aid to improve women's opportunity for engagement in SDM about birth after cesarean.
A two-phase sequential mixed methods pilot study was conducted in a regional hospital in northern Taiwan. Phase I involved a randomized pre-test and post-test experimental design. Participants with one previous caesarean section (CS) were recruited at 14-24 weeks. A total of 65 women completed a baseline survey and were randomly allocated to either the intervention (birth choice decision aid booklet) or usual care (general maternal health booklet) group. A follow up survey at 37-38 weeks measured change in decisional conflict, knowledge, and birth mode preference. Birth outcomes and satisfaction were assessed one month after birth. Phase II consisted of postnatal interviews with women at one month after birth, to explore women's decision making experiences, using a constant comparative analytic technique and thematic analysis.
Decisional conflict was relatively low at baseline for all women. Although there were reductions in decisional conflict at follow up, differences between groups were not statistically significant. Women's early preferences regarding mode of birth influenced their knowledge-seeking behaviors and expectations or intention for engaging in SDM during pregnancy. Improvements in knowledge for the decision aid group were larger than for the usual care group, although differences between groups were not statistically significant. Four themes related to key factors in decision making were clarity, safety and risk, consistency, and support.
A cultural shift is needed to align expectations and relationships towards SDM for birth in Taiwan. Simulation-based strategies and tailored communication skills should be explored to enhance skills in decision coaching for providers. Use of interactive multimedia technology may provide opportunities to increase engagement with tools and support women during decision consultations. Midwife-led continuity of care models may also be beneficial in empowering women to actively share decisions and achieve the birth that is best for them.
台湾地区剖宫产率较高，而剖宫产后阴道分娩（VBAC）率较低。研究表明，台湾地区的女性在剖宫产后未获得足够的分娩选择信息，共同决策（SDM）也未得到重视。本试点研究旨在测试使用分娩选择决策辅助工具来增加女性参与剖宫产后分娩共同决策机会的可行性。
在台湾北部的一家地区医院进行了一项两阶段的序贯混合方法试点研究。第一阶段采用随机前测和后测实验设计。在孕14 - 24周招募有过一次剖宫产史的参与者。共有65名女性完成了基线调查，并被随机分配到干预组（分娩选择决策辅助手册）或常规护理组（一般孕产妇健康手册）。在孕37 - 38周进行的随访调查测量了决策冲突、知识和分娩方式偏好的变化。在产后一个月评估分娩结局和满意度。第二阶段包括在产后一个月对女性进行访谈，采用持续比较分析技术和主题分析来探索女性的决策经历。
所有女性在基线时的决策冲突相对较低。尽管随访时决策冲突有所减少，但两组之间的差异无统计学意义。女性对分娩方式的早期偏好影响了她们在孕期的知识寻求行为以及参与共同决策的期望或意图。决策辅助组的知识改善幅度大于常规护理组，尽管两组之间的差异无统计学意义。与决策关键因素相关的四个主题是清晰度、安全性和风险、一致性以及支持。
台湾地区需要文化转变，以调整对分娩共同决策的期望和关系。应探索基于模拟的策略和量身定制的沟通技巧，以提高医疗服务提供者的决策指导技能。交互式多媒体技术的使用可能为增加对工具的参与度以及在决策咨询期间支持女性提供机会。由助产士主导的连续性护理模式也可能有助于增强女性积极分享决策并实现最适合她们的分娩的能力。
