Best-practice personalized program for birth options after cesarean

Photo of Allison Shorten

By Laura Gasque

University of Alabama at Birmingham School of Nursing Professor and Chair of the Department of Acute, Chronic and Continuing Care Allison Shorten, PhD, RN, FACM, FNAP, FAAN, is an author on a recent publication in The Lancet that focuses on assessing a multifaceted program for reducing major perinatal morbidity among women with a previous cesarean delivery. The cluster randomized trial included 40 hospitals across Quebec with more than 21,000 women who delivered during the study period.

"Led by Nils Chaillet, the PRISMA program, designed for women who have experienced one previous cesarean, provides: 1) clinical tools designed to identify maternal risk factors during pregnancy, personalize information about delivery options, and assist women with decision-making about mode of delivery; and 2) clinical tools for health care professionals that promote best practices in care during labor and birth,” Shorten said.

Personalized and informed decision-making is central to this study and something Shorten is passionate about in her research. Shorten is internationally recognized for her decision-aid development and research about birth after cesarean. She developed the first best practice, evidence-based decision-aid for women with previous cesarean, called Birth Choices. Shorten's decision-aid was translated and adapted specifically for the PRISMA program, and contributed to the trial as one of the clinical tools used to assist women to gain understanding and consider their birth options during pregnancy, as they made decisions with their medical provider about what method of birth was best for them.Pregnant women sitting in a waiting room while touching their stomach.

"This study makes an important contribution to the evidence about the potential benefits of a multifaceted clinical intervention for childbirth after cesarean,” Shorten said. “When combined, the clinical tools contributed to optimizing birth choices for women and were shown to be effective in reducing major complications for the mother and baby, without increasing risk of cesarean delivery or rupture of the uterus."

Shorten’s career includes three decades of work in interprofessional education and research to improve quality and safety in health care. She also leads the Women and Children’s Health Initiative (WACHI) in the UAB School of Nursing and is committed to implementing evidence-based care to improve health outcomes for women and their families.

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