Shared decision making on mode of delivery among pregnant women with one prior caesarean section at Regional Referral Hospitals in Dar es Salaam

Abstract

Background: Tanzania has been facing high rates of caesarean section with one of the commonest indication being prior caesarean section. A trial of labour after one caesarean has been advocated in order to reduce the caesarean section rates and its associated complication after a thorough counselling of women on available modes of delivery with their risks and benefits. Though this practice of shared decision making has been shown to positively influence trial of labour and improve quality of care, it has been reported to be inadequate in both developed and developing countries and factors influencing it are still unclear. Aim: To determine the proportion of women involved in shared decision making and its associated factors among pregnant women with one prior caesarean section in Dar es Salaam. Methods: A cross-sectional analytical study was conducted at antenatal clinics located in Amana, Temeke and Mwananyamala hospitals. A sample size of 350 pregnant women with one prior caesarean section having a singleton pregnancy and no contraindication to vaginal delivery were included. Data was collected for duration of three months from August to November 2020 using a structured questionnaire after informed consent had been sought and data analysis was done using SPSS 20. The proportion of women was determined by using a score of 80 and above as obtained from 9-item Shared Decision-Making Questionnaire (SDM-Q9) and associated factors were obtained through multivariable linear regression model. A P-value of <0.05 was considered significant. Results: The proportion of pregnant women involved in shared decision making was 38%. Factors that were significantly associated with sharing decision making were; having low level of education (AOR 0.55 95% CI 0.33-0.91), being married/having partner (AOR 2.58 95% CI 1.43-4.63), having a companion who had active participation (AOR 3.31 95% CI 1.03-10.6) and being familiar with the clinician (AOR 5.01 95% CI 1.30-19.2). Conclusion: The practice of shared decision making on mode of delivery among pregnant women with prior caesarean has been found to be low despite promotion of patient centred care in medical practice. Women education level, marital status, their companion participation in clinics and their familiarity to clinicians has been shown to influence positively on their involvement in shared decision making. Recommendations: Concerted efforts are needed to improve the implementation of SDM as a quality of care and support patient- centered care. Encourage companion involvement during antenatal care and promotion of personal continuity of care which improve familiarity of patients to clinicians. Promotion of SDM should also target clinician‘s attitudes and encourage them to involve socially vulnerable population.