Educational Video, Anxiety, and Mode of Delivery After Previous Cesarean

Trial of labor after cesarean (TOLAC) is a complex clinical decision that may be associated with significant maternal anxiety. Adequate counseling is essential to support informed decision-making; however, the optimal method for delivering information remains unclear.

This randomized interventional study aims to assess whether video-based patient education can reduce anxiety levels compared with standard verbal counseling. Eligible pregnant women planning delivery after a previous cesarean section will be randomly assigned to one of two study arms: video-based educational counseling or standard verbal counseling.

Anxiety will be measured using the validated State-Trait Anxiety Inventory (STAI) questionnaire after counseling. The results of this study may inform future strategies for patient counseling and shared decision-making in women considering TOLAC.

• Video-Based Educational Intervention (Behavioral): A structured educational video providing information on benefits, risks, and expectations of trial of labor after cesarean.
• Standard Verbal Counseling (Other): Routine verbal counseling provided by the treating clinician regarding trial of labor after cesarean.

Primary outcomes

• Maternal Anxiety Level [Immediately after completion of counseling.]: Assessment of maternal anxiety using the State-Trait Anxiety Inventory (STAI) questionnaire.

Secondary outcomes

• Patient Knowledge Regarding Trial of Labor After Cesarean [Immediately after completion of counseling.]: Assessment of patient knowledge regarding trial of labor after cesarean, based on a structured questionnaire developed for the study.
• Rate of Successful Trial of Labor After Cesarean (TOLAC) [From delivery.]: Proportion of participants who achieved a successful vaginal birth following a trial of labor after cesarean.
• Patient Satisfaction With Counseling Method [Immediately after completion of counseling.]: Patient-reported satisfaction with the counseling method received (video-based education or standard verbal counseling), assessed using a Likert-scale questionnaire.
• Maternal Preference for Trial of Labor After Cesarean Versus Elective Repeat Cesarean Delivery [Immediately after completion of counseling.]: Participant-reported preference for mode of delivery (trial of labor after cesarean versus elective repeat cesarean delivery) following counseling.

Sex: Female, ages: 18 Years to any

Inclusion Criteria:

* Pregnant women with a singleton pregnancy.
* History of one previous cesarean delivery with a low transverse uterine incision.
* Eligible for a trial of labor after cesarean (TOLAC) according to clinical assessment and Israeli national clinical guidelines.
* Age 18 years or older.
* Hebrew-speaking.
* Ability and willingness to provide written informed consent.

Exclusion Criteria:

* Medical or obstetric conditions contraindicating vaginal delivery, including but not limited to placenta previa or marginal placenta previa.
* History of uterine surgery other than one prior low transverse cesarean section that precludes vaginal delivery.
* History of two or more prior cesarean deliveries.
* Non-vertex fetal presentation or any presentation unsuitable for a trial of labor.
* Multiple gestation.
* Diagnosed severe anxiety disorder or other significant psychiatric disorder that may interfere with participation in the study or completion of questionnaires.

• Shir Lev, MD, Principal investigator, Wolfson Medical Center