Developing an Internet-Based Decision Aid for Women Choosing Between Vaginal Birth After Cesarean and Planned Repeat Cesarean

Introduction: In response to the call to develop strategies to engage women and providers in shared decision making, this article outlines a framework and process used to create an Internet-based decision aid about birth choices after previous cesarean. Recognizing the potential benefits of mobile health information technology, a paper-based decision aid was transformed into a secure, interactive Web site to meet the diverse needs of women and providers in this often challenging health care decision.

Methods: An iterative and participatory research approach was used, engaging targeted users (pregnant women and pregnancy care providers) in the design and development process.

Results: Women recommended that features and functions of the decision aid should include individualized information, trustworthy evidence, a secure and private site, quizzes to check knowledge, and a way to share values and preferences with their providers. Providers recommended individualized information for women, a process for women to share and document values and preferences with providers, and balanced, straightforward and complete information about the risks and benefits of each option.

Discussion: There is great potential for direct linkage between Internet-based decision aids and the electronic medical record. Work is currently underway to integrate and evaluate the Internet-based decision aid within busy practice settings to support shared decision making. This article is part of a special series of articles that address midwifery innovations in clinical practice, education, interprofessional collaboration, health policy, and global health.