Table 1 Contents of two sessions of shared decision making (SDM) counseling
Stages of three-talk model of SDM | Essential elements | Consultant responsibilities | ||
|---|---|---|---|---|
Stage 1. Choice talk | Problem presentation | According to the history of cesarean section, evaluation the mode of delivery in the current pregnancy | ||
Available options | It is time to think about what mode of delivery you will choose in the future: vaginal delivery or cesarean section | |||
Stage 2. Option talk | Evaluation of mothers and companions’ information regarding the mode of delivery in women with previous cesarean section | Before making any decision, ask them to explain their information about the mode of delivery in women with previous cesarean section (Try to deeply understand their main narrations) | - Checking information -Examining a clear understanding of information (Is their information correct or misunderstood?) | - Providing more information - Answering questions -Providing evidence if necessary |
Stage 3. Decision talk | 1- Discussing the pros/cons /risks/and family expenses | Using participants’ explanations and narratives to understand and extract points related to: physical, psychological, financial, and social impact of vaginal delivery/cesarean section on both family and newborn | - Checking information -Examining a clear understanding of information (Is their information correct or misunderstood?) | -Providing more information -Answering questions -Providing evidence if necessary -Interviews with people with successful vaginal birth after cesarean section |
2- Modification of values/preferences of mother and companions | Using the participant’s explanations and narratives to extract and clarify what is most important to them. | 1. Listing the most important values, concerns, and worries of mother and companions 2. Helping them to have accurate and realistic preferences | -The consultant helps them to predict what they prefer to happen in the future. Moreover, how do they feel the short-term and long-term consequences | |
3. Asking about mothers’ decisions and companions | They are asked: Are you ready to decide? Or do you need more time? | Sometimes they explicitly need more time. The counselor examines the reasons and asks if they have any further questions. Are there any other things that people have heard or read about on the Internet and should be discussed? | 1.Providing an opportunity to talk to a gynecologist about new advances in delivery methods 2- Presenting the opinion of the American College of Obstetricians and Gynecologists about the method of delivery after cesarean section 3.Providing evidence if necessary | |
4. Discussing patient’s abilities and companions | They are asked: Are you sure you made up your mind? | Sometimes they delay the decision. The counselor should look into their reasons and whether they have more questions. | 1.Providing more information 2. Answering questions 3.Providing evidence if necessary | |
5. Follow-up | Follow-up 8 weeks after delivery to review the decision |  |  | |