A new care pathway helps pregnant women make decisions about birth There are risks and benefits to having a vaginal birth after a caesarean section (VBAC). An initial pilot study Farnworth et al (2007) found that women who previously had a caesarean section were more confident about making decisions on their next birth, when supported with an informational DVD at 12 weeks, plus counselling from a trained midwife at 34 weeks. The women felt better informed, were able to access information and ask questions. They were able to justify their choices and felt their decision had been informed and effective. Most women felt midwife-led counselling was better than the DVD. What happened? In Newcastle, while an obstetrics team wanted to apply the learning from this pilot study, they felt that a midwife home visit at 34 weeks was unfeasible. Instead, they decided to change the care pathway for women who had one previous caesarean section and no other risk factors. These women were given more information and attended midwife-led appointments to help them make their decision. They were also sent an adapted Ottawa Personal Decision Guide (OPDG) to read and bring to their appointment to facilitate shared decision making discussions. The OPDG is designed for any health-related and/or social decisions and can help people assess their decision making needs, plan the next steps, and track their progress in decision making. What was the impact? Of 75 women who had made a decision at 20 weeks, six changed their choice at