Decision aid for women with a breech presentation at term

A decision aid was developed for pregnant women diagnosed with a breech presentation (when a baby presents with feet or buttocks rather than head-first) in late pregnancy to inform them about safe and effective options for the management of breech presentation. The decision aid comprised a 24-page workbook, a 30 minute audio-CD and worksheet and was designed in a format that could be taken home and reviewed with a partner. The effectiveness of the decision aid compared with usual care was evaluated in a randomised controlled trial in four Australian obstetric hospitals. In the trial, women were randomised to either receive the decision aid in addition to usual care or to receive usual care only - with standard counselling from their usual pregnancy care provider. Approximately 200 women were randomised to the study and we found women reviewing the decision aid experienced significantly lower decisional conflict- uncertainty (mean difference -8.92; 95%CI -13.18, -4.66), increased knowledge (mean difference 8.40; 95%CI 3.10, 13.71), no increase in anxiety and reported greater satisfaction with decision-making and overall experience of pregnancy and childbirth. Overall, we found the decision aid to be an effective and acceptable tool for pregnant women that provides an important adjunct to standard counselling for the management of breech presentation.

Investigators: Natasha Nassar, Christine Roberts, Alex Barratt, Camille Raynes-Greenow, Brian Peat, David Henderson-Smart

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