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

项目摘要 大多数有一次剖腹产经历的孕妇是剖宫产后试产的合适对象。 (TOLAC)，然而，只有大约20%的有过剖腹产经历的美国女性有TOLAC。到目前为止，重复剖腹产 剖腹产最常见的指征；因此，增加接触TOLAC的机会是一个重要的 降低剖宫产率的机制。然而，对于具体的体验如何，我们知之甚少 在第一次怀孕、分娩和产后阶段--特别是那些前瞻性测量的阶段--会影响 为以后的分娩制定分娩方式偏好，以及这些偏好如何转化为 交付模式决定。迫切需要更好地理解塑造女性的经历 交付模式偏好，以指导未来支持共享决策的研究测试方法 在这群人中取得的成就。这项研究将使用来自大规模预期队列的数据来解决 以下具体目标：1)确定第一次怀孕、分娩和产后的经历 第一次剖腹产后女性对分娩方式的偏好，下一次报告 以及2)检查分娩方式偏好和随后的试验之间的关系 在研究随访期内，第二胎妇女的产程和VBAC。这样做的结果 这项研究将为临床医生提供直接相关的信息，这些医生正试图了解女性的 第一次剖宫产(VBAC或再次剖宫产)后的分娩偏好和工作决策 考虑到患者的偏好和风险，与他们的患者讨论是否进行分娩试验。 这项研究将为未来开发支持共享的干预措施的研究增加证据基础 剖宫产后试产的决策。

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.