Readable info on vaginal birth after cesarean is scarce online

By Kathryn Doyle (Reuters Health) - Giving birth by C-section doesn’t mean a woman can’t give birth vaginally the next time, but people who want to learn more might not find helpful information on the internet, according to a new study. Many of the most common search results for information on vaginal birth after cesarean (VBAC) are written at too high a reading level, the researchers found. Giving birth vaginally after a cesarean section is a reasonable option for most women, according to the 2010 National Institutes of Health consensus development conference, but some mothers who would be eligible for VBAC still choose a repeat cesarean. “The purpose of our study was to determine what kind of information is available online when women look for VBAC,” said Dr. Haim Arie Abenhaim of the Department of Obstetrics and Gynecology at Jewish General Hospital in Montreal, Canada. While much of the information on the internet was accurate, the readability was for a higher level of education than the general population, Abenhaim told Reuters Health by email. The new study evaluated 20 common search results after entering the term “VBAC” or “vaginal birth after cesarean.” Half of the sites that showed up in their search were run by medical organizations, like the Mayo Clinic, the American College of Obstetricians and Gynecologists and the National Institutes of Health, while the other half included Wikipedia and blogs or communication boards. Most appeared to be neutral on the topic of VBAC. Thirty percent seemed pro-VBAC, the authors write. Abenhaim and his colleague Nadia Bantan evaluated the sites based on accountability, i.e. listing an author and citing sources, aesthetic presentation, and readability. More than half of the sites met criteria for accountability, and 11 qualified as “aesthetically agreeable.” Most presented their information in a well-organized way, with clear headings and sub-sections. But on all the sites, the material was written for college-level readers, and much of it would have been difficult for a non-medical audience to comprehend, according to results in the journal Women and Birth. None of the sites met every criterion the researchers were looking for, Abenhaim said. “Some women are excellent candidates (for VBAC) while others are not and should strongly consider an elective caesarian delivery,” he said. “Our overall recommendation is thus that women should have a discussion with their health care providers and obtain the best information that is applicable to their specific situation.” Better educated women will be more likely to find useful information online, since experts who compose the sites naturally write for people similar to themselves, said Dell Horey, senior lecturer in epidemiology and research fellow at La Trobe University in Melbourne, Australia. “The study found that most of the information on the websites was written at a level suitable for college graduates, but women who haven’t been to college want the same type of information,” Horey told Reuters Health by email. She was not part of the new study. Guidelines about VBAC vary by country in part because people interpret the evidence differently, and because the availability of resources differs and what people value, or think important, differs too, she said. “A caesarian delivery is considered major abdominal surgery and few people take it lightly,” Horey said. “Good information for those receiving health care is fundamental to good care,” she said. “This is particularly true for topics like VBAC where decision-making can be complex as choices rely on a mix of factors that includes limited evidence and where there is no one ‘right’ answer.” SOURCE: Women and Birth, online October 28, 2014.