Grant: Travel Awards - Institute Community Support

Objective: To develop and test a patient education pamphlet aimed at increasing women's knowledge of and intention to plan vaginal birth after caesarean (VBAC). We also evaluated how patients perceived the pamphlet's content, appearance, format, delivery, and comprehensibility. Methods: The pamphlet was developed in partnership with Health Authorities and was compliant with the Society of Obstetrician and Gynaecologists of Canada professional practice guidelines for VBAC. Focus groups were conducted in four British Columbia sites with an ethnically diverse sample of women who had had a caesarean and were pregnant or considering pregnancy. The focus group consisted of: (1) a 5-item knowledge pre-test and single question on intention to plan a VBAC; (2) reading the pamphlet; (3) knowledge and intention post-test; and (4) moderated discussion. Focus group transcripts were analyzed using thematic analysis. Results: 17 women participated in 4 focus groups. Post-test knowledge scores increased for all 5 items, but women's intentions to plan a VBAC did not change. Participants found the pamphlet to be usable and comprehensible and recommended sharing it with other women as well as family members. Thematic analysis of focus group transcripts revealed that, while women valued and preferred vaginal birth, all feared the "unknown" of vaginal delivery and some perceived that their care provider or family would not support VBAC. Conclusion: The pamphlet increased women's knowledge of the risks and benefits of mode of delivery and may be an effective tool for informing women of their options for birth after caesarean. The pamphlet did not impact women's intentions to plan a VBAC. Our findings may encourage the development of interventions to reduce women's fear of vaginal birth and to educate women's family members about the risks and benefits of VBAC. Improving women's knowledge of their options is a necessary first step in improving care and outcomes after caesarean.