TY - JOUR
T1 - Caesarean section or vaginal delivery for low-risk pregnancy? Helping women make an informed choice in low- and middle-income countries
AU - QUALI-DEC consortium
AU - Dumont, Alexandre
AU - de Loenzien, Myriam
AU - Nhu, Hung Mac Quo
AU - Dugas, Marylène
AU - Kabore, Charles
AU - Lumbiganon, Pisake
AU - Torloni, Maria Regina
AU - Gialdini, Celina
AU - Carroli, Guillermo
AU - Hanson, Claudia
AU - Betrán, Ana Pilar
AU - Molsted-Alvesson, Helle
AU - Annerstedt, Kristi Sidney
AU - Robson, Michael
AU - Opiyo, Newton
AU - Bohren, Meghan
AU - Campodonico, Liana
AU - Carroli, Berenise
AU - Garcia Camacho, Gabriela
AU - Giordano, Daniel
AU - Gamerro, Hugo
AU - Romero, Mariana
AU - Boriboonhirunsarn, Dittakarn
AU - Jampathong, Nampet
AU - Kongwattanakul, Kiattisak
AU - Ratinthorn, Ameporn
AU - Musigavong, Olarik
AU - Escuriet, Ramon
AU - Canet, Olga
AU - Fadima, Yaya Bocoum
AU - Tiendrébéogo, Simon
AU - Roger, Zerbo
AU - Truong, Thao
AU - Ngo, Tran Minh Thien
AU - Toan, Bui Duc
AU - Trang, Huynh Nguyen Khanh
AU - Tuyet, Hoang Thi Diem
AU - Lombard, Laurence
AU - Ravit, Marion
AU - Visan, Delia
AU - Zamboni, Karen
N1 - Publisher Copyright:
© 2022 Dumont et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2022/11
Y1 - 2022/11
N2 - Women’s fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burkina Faso. The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials. We conducted a systematic review to determine the short- and long-term maternal and offspring risks and benefits of planned caesarean section compared to planned vaginal delivery. We carried out individual interviews and focus group discussions with key informants to capture informational needs for decision-making, and to assess the acceptability of the DAT in participating hospitals. The DAT meets 20 of the 22 Patient Decision Aid Standards for decision support. It includes low- to moderate-certainty evidence-based information on the risks and benefits of both modes of birth, and helps pregnant women clarify their personal values. It has been well accepted by women and health care providers. Adaptations have been made in each country to fit the context and to facilitate its implementation in current practice, including the development of an App. DAT is a simple method to improve communication and facilitate shared decision-making for planned modes of birth. It is expected to build trust and foster more effective, satisfactory dialogue between pregnant women and providers. It can be easily adapted and updated as new evidence emerges. We encourage further studies in LMICs to assess the impact of DAT on quality decision-making for the appropriate use of caesarean section in these settings.
AB - Women’s fear and uncertainty about vaginal delivery and lack of empowerment in decision-making generate decision conflict and is one of the main determinants of high caesarean section rates in low- and middle-income countries (LMICs). This study aims to develop a decision analysis tool (DAT) to help pregnant women make an informed choice about the planned mode of delivery and to evaluate its acceptability in Vietnam, Thailand, Argentina, and Burkina Faso. The DAT targets low-risk pregnant women with a healthy, singleton foetus, without any medical or obstetric disorder, no previous caesarean scarring, and eligibility for labour trials. We conducted a systematic review to determine the short- and long-term maternal and offspring risks and benefits of planned caesarean section compared to planned vaginal delivery. We carried out individual interviews and focus group discussions with key informants to capture informational needs for decision-making, and to assess the acceptability of the DAT in participating hospitals. The DAT meets 20 of the 22 Patient Decision Aid Standards for decision support. It includes low- to moderate-certainty evidence-based information on the risks and benefits of both modes of birth, and helps pregnant women clarify their personal values. It has been well accepted by women and health care providers. Adaptations have been made in each country to fit the context and to facilitate its implementation in current practice, including the development of an App. DAT is a simple method to improve communication and facilitate shared decision-making for planned modes of birth. It is expected to build trust and foster more effective, satisfactory dialogue between pregnant women and providers. It can be easily adapted and updated as new evidence emerges. We encourage further studies in LMICs to assess the impact of DAT on quality decision-making for the appropriate use of caesarean section in these settings.
UR - http://www.scopus.com/inward/record.url?scp=85151626270&partnerID=8YFLogxK
U2 - 10.1371/journal.pgph.0001264
DO - 10.1371/journal.pgph.0001264
M3 - Article
AN - SCOPUS:85151626270
SN - 2767-3375
VL - 2
JO - PLOS Global Public Health
JF - PLOS Global Public Health
IS - 11
M1 - e0001264
ER -