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

首次剖宫产后的分娩方式偏好和试产

• 批准号: 9896382
• 负责人: Laura B Attanasio
• 金额: $ 8.31万
• 依托单位: UNIVERSITY OF MASSACHUSETTS AMHERST
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-05-01 至 2022-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9896382
• 关键词: Address; Affect; Age; Attitude; Birth; Cesarean section; Child; Childbirth; Consensus; Data; Data Sources; Development; Emergency department visit; Event; Feeling; First Births; Follow-Up Studies; Fright; Funding; Future; Goals; Guidelines; Health; Health Status; Hospitals; Hypertension; Intervention; Labor Pain; Lead; Measures; National Institute of Child Health and Human Development; Participant; Patients; Pennsylvania; Perception; Population; Postpartum Depression; Postpartum Period; Pregnancy; Pregnant Women; Prospective cohort; Provider; Psychosocial Factor; Recovery; Reporting; Research; Risk; Safety; Schedule; Shapes; Testing; Third Pregnancy Trimester; Time; Translating; Trial of Labor; United States; United States National Institutes of Health; Unnecessary Surgery; Vaginal Birth after Cesarean; Woman; Work; evidence base; experience; follow-up; hospital readmission; infant morbidity/mortality; longitudinal dataset; maternal morbidity; perinatal period; preference; prevent; prospective; shared decision making

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.

项目摘要 大多数曾经有过一次剖腹产史的孕妇都是剖腹产后试产的合适人选 (TOLAC)，但只有约 20% 曾进行过剖腹产的美国女性拥有 TOLAC。再次剖腹产是目前为止 剖腹产最常见的指征；因此，增加 TOLAC 的获取是一个重要的 降低剖宫产率的机制。然而，具体经历如何，人们知之甚少。 在第一次怀孕、分娩和产后期——尤其是那些前瞻性测量——会影响 后续出生的分娩方式偏好的发展，以及这些偏好如何转化为 交付模式决策。迫切需要更好地了解塑造女性的经历 交付模式偏好，以指导未来的研究测试方法以支持共同决策 在这个人群中制造。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) 确定第一次怀孕、分娩和产后期的经历如何 塑造女性在剖腹产第一胎后对分娩方式的偏好，在下一次报告中报告 怀孕; 2) 检查交付方式偏好与后续试用之间的关系 研究随访期间生育第二胎的妇女的分娩和 VBAC。这样做的结果 研究将为寻求了解女性性行为模式的临床医生提供直接相关的信息 首次剖腹产（VBAC 或重复剖腹产）后的分娩偏好并努力做出决定 与患者讨论是否进行试产，同时考虑偏好和风险。 这项研究将为未来研究制定干预措施以支持共享 关于剖宫产后试产的决定。