Delivery after caesarean: chances and choices

An increasing number of women is pregnant after a previous caesarean section. Temporary guidelines indicate these women have to be informed about their choice between a trial of labour or a planned repeat caesarean section. However, often women are insufficiently informed about their options. We developed a decision aid based on evidence-based information and the current guidelines to support shared decision making. A prediction model is included to predict the individual chance of a vaginal delivery in case of trial of labour. Care including the decision aid was compared to care as usual. The number of vaginal births was comparable. More patients chose a planned caesarean section in the decision-aid group. In the same group, more women had a vaginal birth after a trial of labour. Consequently, less emergency caesarean sections were performed, showing better risk selection. Patients reported they felt more involved in decision making when the decision aid was used.