1. Heaman, Maureen PhD, RN

Article Content

Shorten, A., Shorten, B., Keogh, J., West, S., & Morris, J. (2005). Birth, 32(4), 252-261.


The purpose of this study was to determine whether a decision-aid booklet for women who have experienced a previous cesarean birth would facilitate informed decision making about birth options during a subsequent pregnancy. The booklet was constructed using the Ottawa Decision Support Framework ( and incorporated evidence-based information, values clarification exercises, and probability illustrations (Shorten, Chamberlain, Shorten, & Kariminia, 2004). The investigators conducted a prospective randomized controlled trial in Australia, using two sites with differing prestudy rates of uptake of trial of labor (TOL) (20% at site 1 and 80% at site 2). Pregnant women were randomly assigned to an intervention group who received the decision-aid booklet at 28 weeks' gestation (n = 115), or a control group who received usual care (n = 112). The results indicated that the decision aid was effective in improving knowledge of risks and benefits of TOL versus elective cesarean birth and in reducing decisional conflict among women in the intervention group compared with the control group. However, women's preferences for mode of birth were not related to whether or not they received the intervention, but were influenced significantly by the study site. At site 1, if women preferred elective cesarean section, most experienced this outcome, whereas at site 2, if women preferred TOL, most underwent this option. The investigators concluded that this finding "emphasizes the potential impact of organizational culture and clinical practice patterns on women's decision making and the inhibiting effect this could have on true consumer choice" (p. 259). Although decision aids are appropriate tools in assisting women to make difficult decisions (O'Connor, Jacobsen, & Stacey, 2002), further research is needed to develop the capacity for organizations and their practitioners to provide genuine support for informed choices by pregnant women and to enhance the power of women in decision making within the provider-patient relationship.


Maureen Heaman




O'Connor, A. M., Jacobsen, J. F., & Stacey, D. (2002). An evidence-based approach to managing women's decisional conflict. Journal of Obstetric, Gynecologic and Neonatal Nursing, 31(5), 570-581. [Context Link]


Shorten, A., Chamberlain, M., Shorten, B., & Kariminia, A. (2004). Making choices for childbirth: Development and testing of a decision-aid for women who have experienced previous caesarean. Patient Education and Counseling, 52 (3), 307-313. [Context Link]