A scoping review of decision aids for pregnant women around childbirth: Do they improve decision quality, processes, and outcomes?

Abstract

Background

Meaningful engagement of women in childbirth decisions is a growing priority in maternity care. Decision aids are tools designed to improve decision quality, decision-making processes quality, care behaviours, and health outcomes (quadruple aim).

Objective

To map quantitative studies evaluating the effects of decision aids for women making decisions around childbirth.

Methods

We searched MEDLINE, Cochrane DSR and CENTRAL, CINAHL, and EMBASE (January 1975–April 2025) for reviews, randomized controlled trials and controlled before-and-after studies that assessed the effect of decision aids for childbirth decisions.

Results

28 studies (11 reviews, 17 primary studies) met selection criteria. Most involved high-risk pregnant women and showed that decision aid improved the quality of decision and decision-making process. Positive impacts on care behaviour and health outcomes were more evident when decision aids were combined with other components and required discussions with healthcare providers.

Discussion

Although limited, evidence suggests decision aids are more effective when women are prepared to use the tool and healthcare providers are actively involved. The review identified gaps in research targeting low-risk women in low- and middle-income countries and assessing women’s value and preferences for shared decision-making.

Conclusions

Decision aids around childbirth have the potential to meet women’s needs in decision-making, appropriate use of care and perinatal health outcomes especially when they are prepared to use the tool and supported by healthcare providers. Future research should evaluate all four aim objectives to strengthen the evidence on the benefits of decision aids, especially for low-risk population and in low- and middle-income countries.