Ammentorp J, Wolderslund M, Timmermann C How participatory action research changed our view of the challenges of shared decision-making training. Patient Educ Couns. 2018; 101:(4)639-646

Attanasio LB, Kozhimannil KB, Kjerulff KH. Factors influencing women's perceptions of shared decision making during labor and delivery: results from a large-scale cohort study of first childbirth. Patient Educ Couns. 2018; 101:(6)1130-1136

Barry MJ, Edgman-Levitan S. Shared decision making–pinnacle of patient-centered care. N Engl J Med. 2012; 366:(9)780-781

Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section – An online survey investigating women's preferences in Western Switzerland. Midwifery. 2017; 50:219-227

Brunton RJ, Dryer R, Saliba A, Kohlhoff J. The initial development of the pregnancy-related anxiety scale. Women Birth. 2019; 32:(1)e118-e130

Dugas M, Shorten A, Dubé E, Wassef M, Bujold E, Chaillet N. Decision aid tools to support women's decision making in pregnancy and birth: A systematic review and meta-analysis. Soc Sci Med. 2012; 74:(12)1968-1978

Dweck CS. Motivational processes affecting learning. Am Psychol. 1986; 41:(10)1040-1048

Elwyn G, Frosch D, Thomson R Shared decision making: a model for clinical practice. J Gen Intern Med. 2012; 27:(10)1361-1367

Elwyn G, Lloyd A, Joseph-Williams N Option Grids: shared decision making made easier. Patient Educ Couns. 2013; 90:(2)207-212

Emmett CL, Shaw ARG, Montgomery AA, Murphy DJ 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. BJOG. 2006; 113:(12)1438-1445

Festinger L. A theory of cognitive dissonance.Evanston (IL): Row, Peterson; 1957

Fleming SE, Donovan-Batson C, Burduli E, Barbosa-Leiker C, Hollins Martin CJ, Martin CR. Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey. Midwifery. 2016; 41:9-15

Foureur M, Turkmani S, Clack DC Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians. Women Birth. 2017; 30:(1)3-8

Goldberg H. Informed decision making in maternity care. J Perinat Educ. 2009; 18:(1)32-40

Gungor I, Beji NK. Development and psychometric testing of the scales for measuring maternal satisfaction in normal and caesarean birth. Midwifery. 2012; 28:(3)348-357

Heider R. The psychology of interpersonal relations.New York (NY): Wiley; 1958

Horey D, Kealy M, Davey MA, Small R, Crowther CA. Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean. Cochrane Database Syst Rev. 2013; (7)

International Confederation of Midwives. Philosophy and Model of Midwifery Care. 2014. (accessed 20 June 2019)

Ip WY, Chung TKH, Tang CSK. The Chinese childbirth self-efficacy inventory: the development of a short form. J Clin Nurs. 2008; 17:(3)333-340

Keller JM. Motivation and instructional design: A theoretical perspective. Journal of Instructional Development. 1979; 2:(4)26-34

Keller J. Motivational Design for Learning and Performance: The ARCS Model Approach.New York (NY): Springer; 2010

Keller JM. Motivation, learning and technology: Applying the ARCS-V motivation model. Participatory Educational Research. 2016; 3:(2)1-13

Kildea S, Simcock G, Liu A Continuity of midwifery carer moderates the effects of prenatal maternal stress on postnatal maternal wellbeing: the Queensland flood study. Arch Womens Ment Health. 2018; 21:(2)203-214

Konheim-Kalkstein YL, Whyte R, Miron-Shatz T, Stellmack MA. What are VBAC women seeking and sharing? A content analysis of online discussion boards. Birth. 2015; 42:(3)277-282

Lundgren I, Begley C, Gross MM, Bondas T, Brondas T. ‘Groping through the fog’: a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section). BMC Pregnancy Childbirth. 2012; 12:(1)

Macdonald H, Loder E. Too much medicine: the challenge of finding common ground. BMJ. 2015; 350

McKenna JA, Symon AG. Water VBAC: exploring a new frontier for women's autonomy. Midwifery. 2014; 30:(1)e20-e25

McInnes RJ, Martin CJH, MacArthur J. Midwifery continuity of carer: developing a realist evaluation framework to evaluate the implementation of strategic change in Scotland. Midwifery. 2018; 66:103-110

Michie S, van Stralen MM, West R. The behaviour change wheel: A new method for characterising and designing behaviour change interventions. Implement Sci. 2011; 6:(1)

Miller S, Abalos E, Chamillard M Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet. 2016; 388:(10056)2176-2192

Miller YD, Holdaway W. How communication about risk and role affects women's decisions about birth after caesarean. Patient Educ Couns. 2019; 102:(1)68-76

Moulton B, King JS. Aligning ethics with medical decision-making: the quest for informed patient choice. J Law Med Ethics. 2010; 38:(1)85-97

Deciding whether to offer caesarean section.London: NICE; 2018

Caesarean section [CG132].London: NICE; 2019

Newman P, McDowell A, Goode J Chapter 10 Coaching and Shared Decision Making. In: Coulter A, Griffiths J. East Anglia: The Health Coaching Coalition; 2016

Nilsson C, Lalor J, Begley C Vaginal birth after caesarean: views of women from countries with low VBAC rates. Women Birth. 2017; 30:(6)481-490

Pan R, An L, Zhang W, Li W. Application of predictive model for vaginal birth after caesarean delivery. Int J Nurs Sci. 2018; 5:(1)15-17

Preis H, Gozlan M, Dan U, Benyamini Y. A quantitative investigation into women's basic beliefs about birth and planned birth choices. Midwifery. 2018; 63:46-51

Pilgrim D. Key concepts in mental health, 4th edn. Los Angeles (CA): Sage; 2017

Birth after previous caesarean birth. [Green-top Guideline No. 45].London: RCOG; 2015

Ruiter RAC, Kessels LTE, Peters GJY, Kok G. Sixty years of fear appeal research: current state of the evidence. Int J Psychol. 2014; 49:(2)63-70

Sansone C, Harackiewicz JM. Intrinsic and extrinsic motivation: The search for optimal motivation and performance.San Diego (CA): Academic Press; 2000

Scaffidi RM, Posmontier B, Bloch JR, Wittmann-Price R. The relationship between personal knowledge and decision self-efficacy in choosing trial of labor after cesarean. J Midwifery Womens Health. 2014; 59:(3)246-253

Serçekus P, Baskale H. Effects of antenatal education on fear of childbirth, maternal self-efficacy and parental attachment. Midwifery. 2016; 34:166-172

Shorten A, Fagerlin A, Illuzzi J Developing an internet-based decision aid for women choosing between vaginal birth after caesarean and planned repeat caesarean. J Midwifery Womens Health. 2015; 60

Sinclair M, Stockdale J, Holman MR A systematic literature review of computer-based behavioural change interventions to inform the design of an online VBAC intervention for the OptiBIRTH European randomised trial (project HEALTH – F3 – 2012-305208). Evid Based Midwifery. 2017; 15:(1)5-13

Stacey D, Légaré F, Col NF Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2014; 10:(1)

Stockdale J, Sinclair M, Kernohan WG, Keller JM. Motivation, Midwives and Breastfeeding: Theory in Action, Second edn. In: Bryar R, Sinclair M. Basingstoke: Palgrave Macmillan; 2011

Tolman EC. Purposive behaviour in animals and men.New York (NY): Appleton-Century; 1932

Western S. Coaching and Mentoring: A Critical Text.London: Sage Publications Ltd; 2012

World Health Statistics 2015.Geneva: WHO; 2015a

World Health Organization. WHO statement on caesarean section rates. 2015b. (accessed 20 June 2019)

Sharing the decision about VBAC: introducing the ARCS-V motivational learning model

02 August 2019
Volume 27 · Issue 8


Shared decision-making is considered key to influencing women's motivation to choose vaginal birth after caesarean section (VBAC), as when women's self-determination is respected, they are more likely to avoid intervention. However, the shared decision-making conversation can be challenging.

This article introduces the ARCS-V (attention, relevance, confidence, satisfaction, volition), an model for understanding and responding to women's motivation to share the decision about VBAC vs repeat caesarean section. Each of the model's components are introduced, including the psychological basis for managing a shared conversation; capturing and holding women's attention on what they need to learn; matching the learning goals with women's personal goals; building their confidence to achieve their optimal birth; and ensuring they are satisfied with decision-making experience. When these educational conditions are met, women are more likely to use shared decision-making conversations to choose optimally.

The World Health Organization (WHO) (2015a) estimates that in the UK, 24.9−29.1% of births are by caesarean section, despite evidence illustrating that caesarean section rates greater than 10% fail to achieve a reduction in maternal and newborn mortality rates (WHO, 2015b). Additionally, vaginal birth is associated with lower staffing and financial demands; potentially due to reduced need for pharmacological analgesia and longer hospital stays (Royal College of Obstetricians and Gynaecologists (RCOG), 2015; National Institute for Health and Care Excellence (NICE); 2019). Although there has been a focus for more than a decade on reducing unnecessary caesarean section by increasing vaginal birth after caesarean (VBAC) (Emmett et al, 2006), evidence suggests that this public health goal has not yet been realised (Macdonald and Loder, 2015; Miller et al, 2016). In an effort to engage women in the decision-making process, women who are clinically eligible for VBAC are routinely informed that successful VBAC after a single previous caesarean section is estimated at 72–75%, rising to 85–90% for those with a history of a previous vaginal birth, either before or after their caesarean section (RCOG, 2015). Yet despite this statistical evidence, some women's motivation and preference is still focused on a repeat caesarean section. This article introduces practitioners to a motivational systems-and-learning model to guide women through the shared decision-making process. It is proposed that, by providing practitioners with a practical guide to optimising the VBAC vs repeat caesarean section conversation, knowledge of how to promote VBAC through shared decision-making can be improved.

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