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The Mayo Clinic web site provides information and services from the world's first and largest integrated, not-for-profit group medical practice.The Treatment Decision pages provide 'tools to walk you through the pros and cons of different options for treating a condition or managing your health, to help you choose the approach that's best for you'. One of these is for a pregnant women who has already had a baby by Caesarean section. The doctor says there is no absolute contraindication to considering a Vaginal Birth this time... i.e. for attempting a VBAC (Vaginal Birth After Caesarean). [ Healthwise offers a similar Pros and Cons aid.] While setting out the pros and cons very clearly in verbal form, these tools leave the woman to somehow 'take all the pros and cons into account' and 'make up their own mind'. Annalisa provides a way of tackling this complex task in a more structured and explicit way for those who wish to do so. Above all it ensures that the woman's preferences in relation to the various attributes and outcomes are considered separately from the evidence relating to them, before the two aspects of the decision are integrated into a ranking of the options. The Annalisa below picks up the main attributes mentioned in the Mayo VBAC tool - all phrased negatively - and provides some illustrative  Ratings and weightings. As with most files on CafeAnnalisa it is presented simply as a 'starter', to be modified and developed by the professionals and patient groups concerned. - Unplanned C-section
- Complications for mother
- Complications for baby
- Pain
- Loss of Participation in birth process
- Loss of bonding
- No choice of timing of birth
- Hospital stay
- Recovery time
- VBAC (with C-section if attempt fails}
- Repeat C-section
Personal belief judgments apart from Unplanned C-section which is between 20 and 40 % according to Mayo. A key feature of Annalisa is the ability to individualise the ratings to a particular woman, even if some average defaults were entered in a starting template. Personal value judgments. Slide 1 weights all 9 attributes equally. Other slides vary the weights to produce different results. As implied by Ratings and Weightings A decision analysis-based aid was one of 3 arms in a recent UK trial (compared with information leaflet, usual care). The DA-based aid was restricted to clinical outcomes and the probabilities used have not yet been published, nor any data on the utilities elicited from participants.. - AA Montgomery, CL Emmett, T Fahey, C Jones, I Ricketts, RR Patel, TJ Peters, DJ Murphy on behalf of DiAMOND Study Group (2007) Two decision aids for mode of delivery among women with previous caesarean section: randomised controlled trial BMJ Jun 23 334: 1305
- Alan A Montgomery and the DiAMOND Study Group (2004). The DiAMOND trial protocol: a randomised controlled trial of two decision aids for mode of delivery among women with a previous caesarean section BMC Pregnancy and Childbirth 4:25
- CL Emmett, ARG Shaw, AA Montgomery, DJ Murphy on behalf of the DiAMOND study group (2006) Women's experience of decision making about mode of delivery after a previous caesarean section: the role of health professionals and information about health risks
British Journal of Obstetrics and Gynaecology 1438-1445 - CL Emmett, DJ Murphy, R Patel, T fahey, C Jones, I Ricketts, et al. (2006) Decision making about mode of delivery after previous caesarean section: development and piloting of two-computer-based decision aids. Health Expectations 10 (2) : 161-172
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