Project Details
Description / Abstract
"Aim: This work will develop a decision aid to support pregnant women to choose between planning vaginal or caesarean birth during antenatal discussions with health professionals.
Background: Childbirth is a safe and positive experience for most women in the UK, but it often involves input from doctors, e.g. to do an unplanned caesarean section. This can be difficult for women who were not expecting help to give birth or unaware of the possible risks. Equally, some women may feel that they should have had help when they did not. These issues can lead to disappointment, and physical or mental health problems, particularly in women from minority and under-served groups. Aiming for a vaginal birth or having a planned caesarean birth each have potential benefits and harms. Both are reasonable options, and for 10 years national guidance has stated that the risks and benefits of each should be discussed with women during pregnancy to help plan their birth. Legal changes in 2015 made this essential. However, with no guidance or resources to support these discussions between maternity staff and pregnant women, they do not happen consistently, if at all. Highlighting the importance of this, maternity services reported a £2 billion compensation bill in 2018/19, with lack of informed consent and failure to offer a caesarean birth listed as key reasons.
Decision aids are tools that can help maternity staff have balanced conversations with women about their birth plan options. They provide a framework for discussions and can increase knowledge, support choice, and reduce regret. Currently, no decision aid exists for planning how to give birth in routine maternity care. We will address this.
Methods: Following expert guidance on developing a decision aid, we will 1) review published scientific evidence and 2) interview doctors, midwives, pregnant women and parents. This will allow us to understand how decisions about birth plans are made, influences on these decisions, what a decision aid should look like (e.g. how best to access, what it should contain) and when to use it in pregnancy. We will survey pregnant women, parents and healthcare staff to identify which outcomes of planned vaginal or caesarean birth are important to know about in advance. We will use these findings to develop a decision aid that will be tested and revised during workshops with women, doctors and midwives. It will then be tested in real-life in five UK maternity units. The testing will assess how women, midwives and doctors value it and will help us understand how best to embed it in the NHS. We will write a plan for how the NHS should adapt to support all women to use the decision aid. We will also consider the financial costs and benefits of using the decision aid.
Our research team includes women, midwives, maternity doctors, and researchers.
Patient and public involvement: We spoke to eight women about our ideas in 2018 and with four representatives of women's birth-related support groups in a workshop in 2019. Their input drove the study plans. Four women with different pregnancy and birth experiences, and representation of other women's views, are part of the research team. Four more women will join them to form a panel to help develop the decision aid and share the findings.
Dissemination: We will share the decision aid and our plan for embedding it in the NHS with maternity units, policymakers and the public via professional and public networks."
Background: Childbirth is a safe and positive experience for most women in the UK, but it often involves input from doctors, e.g. to do an unplanned caesarean section. This can be difficult for women who were not expecting help to give birth or unaware of the possible risks. Equally, some women may feel that they should have had help when they did not. These issues can lead to disappointment, and physical or mental health problems, particularly in women from minority and under-served groups. Aiming for a vaginal birth or having a planned caesarean birth each have potential benefits and harms. Both are reasonable options, and for 10 years national guidance has stated that the risks and benefits of each should be discussed with women during pregnancy to help plan their birth. Legal changes in 2015 made this essential. However, with no guidance or resources to support these discussions between maternity staff and pregnant women, they do not happen consistently, if at all. Highlighting the importance of this, maternity services reported a £2 billion compensation bill in 2018/19, with lack of informed consent and failure to offer a caesarean birth listed as key reasons.
Decision aids are tools that can help maternity staff have balanced conversations with women about their birth plan options. They provide a framework for discussions and can increase knowledge, support choice, and reduce regret. Currently, no decision aid exists for planning how to give birth in routine maternity care. We will address this.
Methods: Following expert guidance on developing a decision aid, we will 1) review published scientific evidence and 2) interview doctors, midwives, pregnant women and parents. This will allow us to understand how decisions about birth plans are made, influences on these decisions, what a decision aid should look like (e.g. how best to access, what it should contain) and when to use it in pregnancy. We will survey pregnant women, parents and healthcare staff to identify which outcomes of planned vaginal or caesarean birth are important to know about in advance. We will use these findings to develop a decision aid that will be tested and revised during workshops with women, doctors and midwives. It will then be tested in real-life in five UK maternity units. The testing will assess how women, midwives and doctors value it and will help us understand how best to embed it in the NHS. We will write a plan for how the NHS should adapt to support all women to use the decision aid. We will also consider the financial costs and benefits of using the decision aid.
Our research team includes women, midwives, maternity doctors, and researchers.
Patient and public involvement: We spoke to eight women about our ideas in 2018 and with four representatives of women's birth-related support groups in a workshop in 2019. Their input drove the study plans. Four women with different pregnancy and birth experiences, and representation of other women's views, are part of the research team. Four more women will join them to form a panel to help develop the decision aid and share the findings.
Dissemination: We will share the decision aid and our plan for embedding it in the NHS with maternity units, policymakers and the public via professional and public networks."
| Status | Active |
|---|---|
| Effective start/end date | 1/10/22 → 31/12/25 |
| Links | https://www.fundingawards.nihr.ac.uk/award/NIHR150979 |