Shared decision making on mode of delivery following a prior cesarean delivery in Dar es Salaam, Tanzania

Background:  Shared decision-making between clinicians and
pregnant women with prior cesarean on the subsequent mode of delivery
improves trial of labor rates, and reduces the number of repeat cesarean
sections and their related complications. However, this practice is
insufficient worldwide and the factors influencing it are still unknown.
The study aimed at determining the proportion of pregnant women involved
in shared decision-making and its associated factors in Dar es Salaam.
Methods: A cross-sectional analytical study among 350 pregnant women with
one prior cesarean section. Data was collected using a structured
questionnaire and SPSS 23 was used for analysis. A score of 80 or higher
on the nine-item Shared Decision-Making Questionnaire (SDM-Q9) was used to
calculate the proportion of women, and the associated factors were
obtained using a logistic 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: To promote the practice of shared
decision-making in our setting, encouragement of socially vulnerable
pregnant women's participation in decision-making by health care
professionals, encouragement of companion participation during antenatal
care and promotion of personal continuity of care to improve familiarity
to clinicians are needed.