Delivery mode preferences and trial of labor after a first cesarean delivery

项目摘要 大多数有一次剖宫产史的孕妇都适合剖宫产后试产 （TOLAC），但只有约20%的美国妇女与先前剖宫产有TOLAC。重复剖腹产是目前 最常见的剖宫产指征;因此，增加TOLAC的使用是一个重要的 降低剖宫产率的机制。然而，人们对特定的经历如何影响 在第一次怀孕，分娩和产后期间-特别是那些前瞻性测量-影响 发展分娩方式的偏好，为随后的出生，以及如何将这些偏好转化为 交付模式决定。迫切需要更好地了解塑造妇女 交付模式偏好，以指导未来的研究测试方法，支持共同决策 在这个人口中。这项研究将使用来自大规模前瞻性队列的数据来解决 以下具体目标：1）确定如何在第一次怀孕，分娩和产后期间的经验， 形妇女对分娩方式的偏好后，第一胎剖宫产，报告在未来 妊娠;以及2）检查分娩方式偏好与随后试验的关系 在研究随访期间，第二胎妇女的分娩和VBAC。的结果 这项研究将为寻求了解妇女生殖方式的临床医生提供直接相关的信息， 首次剖宫产后的分娩偏好（VBAC或重复剖宫产），并努力做出决定 与患者讨论是否进行试产，同时考虑偏好和风险。 这项研究将增加证据基础，为未来的研究开发干预措施，以支持共享 关于剖腹产后试产的决策。

PROJECT ABSTRACT Most pregnant women with one prior cesarean birth are appropriate candidates for trial of labor after cesarean (TOLAC), yet only about 20% of U.S. women with a prior cesarean have a TOLAC. Repeat cesarean is by far the most common indication for cesarean delivery; therefore, increasing access to TOLAC is an important mechanism for reducing the rate of cesarean delivery. However, little is known about how specific experiences in the first pregnancy, birth, and postpartum period – particularly those measured prospectively – impact the development of delivery mode preferences for a subsequent birth, and how these preferences translate into delivery mode decisions. There is a critical need to better understand the experiences shaping women's delivery mode preferences in order to guide future research testing approaches to support shared decision making in this population. This study will use data from a large-scale, prospective cohort to address the following specific aims: 1) To determine how experiences in the first pregnancy, birth and postpartum period shape women's preferences for delivery mode after a first birth by cesarean, reported during the next pregnancy; and 2) To examine the relationship between delivery mode preferences and subsequent trial of labor and VBAC among women who had a second birth during the study follow-up period. The results of this study will provide information directly relevant to clinicians who are seeking to understand women's mode of delivery preference after first delivery by cesarean (VBAC or repeat cesarean) and to work toward decisions with their patients about whether or not to have a trial of labor, taking into account both preference and risks. This research will add to the evidence base for future studies developing interventions to support shared decision making regarding trial of labor after cesarean.