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MFM Faculty Author JAMA Editorial On Shared Decision-making/Attempted Trial of Labor

Wednesday, June 3, 2020
Swamy, Grotegut

The Dept. of Ob/Gyn’s Vice Chair for Research and Faculty Development, Geeta Swamy, MD, and Maternal-Fetal Medicine specialist Chad Grotegut, MD, MHSc, MBA, authored an editorial in the June 2, 2020 Journal of the American Medical Association titled “Can a Structured, Electronic Approach to Shared Decision-making Increase Attempted Trial of Labor?” The editorial accompanies the JAMA lead article.

The cesarean delivery rate in the US has risen dramatically over the last 50 years from approximately 5% in 1970 to approximately 32% in 2018. Women who undergo cesarean delivery in their first pregnancy are faced with the decision on whether to have another cesarean delivery in their next pregnancy. The American College of Obstetrics and Gynecology (ACOG) recommends collaborative shared decision-making in regard to planned vaginal birth after a prior cesarean delivery, weighing the risks of surgical complications from cesarean vs. rare, but highly morbid, complications of a failed trial of labor such as hemorrhage and uterine rupture.

The PROCEED trial tested a shared decision support tool aimed and increasing the number of women who attempted a trial of labor. Although the decision support tool did not increase the rate of trial of labor, the editorial noted that the study population was skewed to a higher educational level and sociodemographic status, with good understanding of health-related information. Further, a shared decision support tool could be quite helpful in counseling first-time pregnant women about delivery planning as well as other complex decisions during the course of maternal-fetal care. 

Link for editorial