Audioaufnahmen von Entscheidungsgesprächen in der Geburtsplanung bei Beckenendlage – Evaluation von Akzeptanz, Relevanz und Umsetzbarkeit einer perso-nenzentrierten Intervention

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In around five percent of pregnancies, the baby is in breech presentation at term, meaning that the buttocks or feet are positioned downward instead of the head. In Germany, a cesare-an section is performed in 87% of these cases. Many of these procedures are planned, alt-hough there is not always a clear medical indication. At the same time, many pregnant wom-en wish to receive comprehensive and understandable counseling in order to make an in-formed decision together with their healthcare professionals about whether to attempt an ex-ternal cephalic version before birth or about the mode of birth itself (vaginal birth or cesarean section). These decisions are considered “preference-sensitive” because personal wishes, fears, experiences, and life circumstances play an important role. The PregAUDIO pilot project, led by Dr. Anja Lindig, examined the attitudes of 23 pregnant women and 5 gynecologists toward a person-centered intervention – namely, audio record-ings of birth planning consultations at BEL. Only 7 participants listened to the audio recording at home. In interviews, pregnant women and gynecologists expressed support for audio re-cordings as part of birth planning. However, the pregnant women found the recording to be of little relevance to their own decision, as they remembered the content of the conversation well, their partner was present during the conversation, or the decision had already been made during the conversation. When the recording was listened to, it mostly served to con-firm a decision that had already been made. Gynecologists expressed concern regarding possible legal consequences of recorded counseling sessions. The Decisional Conflict Scale used showed that the pregnant women’s decision conflict de-creased significantly between t0 and t1 and continued to decrease slightly to t2. Pregnant women rated PEF as very high during the counseling session. However, the objectively measured extent of PEF (measured using the Observer OPTION 5 TM observation instrument) indicated low implementation of PEF, particularly regarding “supporting a collaborative coun-seling process.” The interviews with pregnant women revealed that consultations at the clinic and the experiences shared by others were particularly influential in their decision-making. Participants expressed a desire for better access to evidence-based information, particularly from private practice gynecologists, as well as for their ambivalent feelings to be addressed during counseling sessions.The findings from PregAUDIO can help develop interventions for pregnant women and gyne-cologists, and, through structural changes, empower pregnant women, improve the quality of care, and thereby facilitate more patient-centered obstetric care.

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