Objective
Spontaneous vaginal births are often the presumed choice, representing 45% of UK births. However, information about benefits and risks is inconsistently given, impacting decision-making and experience. A Core Information Set (CIS) is an agreed set of information points discussed prior to a decision. We aimed to develop a CIS for vaginal birth.
Design
A Delphi study was used to create the CIS. Information points were identified from a literature search, patient leaflets, interviews, and a survey. These informed a two-round Delphi survey, where stakeholders rated item importance. Items rated critically important by =?80% of parents or professionals, and of limited importance by
Setting
The study took place in the UK, with participants recruited online.
Population
Pregnant and postnatal women, birth partners, healthcare professionals, medicolegal professionals, and representatives from relevant organizations.
Main Outcome
A CIS for vaginal birth.
Results
77 information items were identified. In round 1 (631 participants) of the Delphi Survey, 84.5% were from the patient group and 15.5% from the professional group; in round 2 (228 participants), 74.3% were from the patient group and 25.7% from the professional group. 29 items met the criteria for consensus discussion. The final CIS includes 19 information points addressing: labour process, pain relief, labour complications, procedures or interventions during labour, experiences after birth, outcomes for the baby and labour environment.
Conclusions
This CIS can facilitate discussions and support informed decision-making about vaginal birth.
Principal investigator- Dr Andrew Demetri
Principal investigator- Dr Abi Merriel
Partner- Dr Anna Davies
Partner- Dr Danya Bakhbakhi
Partner- Ms Sarah Dawson
Partner- Dr Sharea Ijaz
Partner- Professor Sheelagh McGuinness
Disease Category: Pregnancy & childbirth
Disease Name: Childbirth
Age Range: 18 - 120
Sex: Female
Nature of Intervention: Other
- Charities
- Clinical experts
- Families
- Patient/ support group representatives
- Core information set
- Consensus meeting
- Delphi process
- Interview
- Literature review
- Survey
To develop the core information set we will first identify the information women require about vaginal birth and we will then undertake a Delphi process. Once the Delphi process has been completed, we will have a core information set for vaginal birth.
Objective 1: What information do women need
1.1: Systematic review to identify information items of interest to women
A pragmatic systematic search will be developed alongside an information specialist(SD) to identify outcomes reported in studies and key issues women identify about vaginal birth. Records will be uploaded to systematic reviewing software (Covidence) papers will be screened, the full texts retrieved and the key information items extracted by ADe/SD/SI/ ADa/DB/KB/CB/SM/AM.
1.2: Interviews with antenatal and postnatal women
We will carry out semi-structured interviews with up to 20 women to explore what information they want to receive about vaginal birth. We will recruit antenatal and postnatal women from online forums and community groups. These interviews will be recorded and transcribed. A rapid template analysis will enhance the existing long list of items from 1.1.
1.3 Online survey to collect information items
We will carry out a piece of public involvement work inviting stakeholders (women, partners, maternity staff and organisations) to tell us what information should be discussed with women about vaginal birth. Information items will be extracted and added to those from 1.1/2.
Objective 2: Delphi Process
2.1: Developing the Delphi
The items identified in 1.1/2 will be taken and a draft Delphi designed by the research team in conjunction with a patient contributor. This will be taken to a public involvement meeting to discuss and refine before carrying out 5-10 think-aloud interviews with women to ensure that the language is understandable and the survey functions appropriately.
2.2: Delphi Process
This will take place online using REDCap software. We will recruit via social media and existing networks to achieve a diverse sample of Women, partners, maternity staff, medico-legal experts, and representatives of interested groups. We will aim to engage at least 100 participants in the Delphi process with 50 women, and 50 from across the other areas.
We will undertake two 2-week Delphi rounds. Using a likert scale, participants will score the importance of each survey item, for inclusion in the core information set. A-priori consensus criteria will be applied, where items rated as critical or with no consensus being carried through to the next rounds.
2.3 Consensus process.
Following the second Delphi round, an online consensus meeting will take place with participants from the online survey invited (up to 30 estimated). During this meeting, items that have survived the prior two rounds will be discussed and the core information set finalised.