What role does the decision support tool "MyBirthplace" play in women’s information gathering and decision making about place of birth?

Abstract

Health professionals and women accessing health care are increasingly recognising the importance of shared decision making (SDM) within pregnancy. Despite recognition, implementing SDM and truly supporting an informed choice is suggested to still be lacking in clinical exchanges. Literature focuses on creating ways and tools to support SDM in health care. One possible way is to incorporate Decision Support Tools (DST) into practice. Evidence within the context of general health care shows they improve knowledge and satisfaction with information, however less is known about DST use in pregnancy. MyBirthplace was developed by a National Health Service (NHS) Trust in response to both a local and national call for information in accessible formats and to enable women to be more informed about their choice regarding place of birth; as hospital birth is still seen as the norm. The primary aim of this thesis was to assess how effective a new DST called MyBirthplace is in helping make this decision. The impact of the DST was assessed using the Stages of Decision Making Scale (SDMS) (O’Connor 2000). Secondary aims were to; identify when women make a decision about place of birth; explore women’s information gathering and decision making behaviours during pregnancy to understand women’s views and opinions about using the DST; and to determine the use of the DST by their midwives. A mixed method, multiphase, sequential exploratory design was conducted with 172 pregnant women within one large urban NHS Trust. The study involved three phases. Phase 1 utilised questionnaires given to the participants’ pre and post the first appointment with the midwife where they had access to the DST. Phase 2 followed up these women via a survey sent at 28 weeks of pregnancy. In phase 3, face to face interviews were conducted with 12 women purposively chosen from the initial two phases. Finally, data were retrieved from the hospital database to identify actual place of birth. This study provides new evidence that the use of MyBirthplace positively affects women’s decision making. The DST resulted in a positive increase in decision making (reduced conflict) and by the 28 week follow up there was a significant shift with greater decision-making. Women’s views showed a division in the level of information they found acceptable, but in general they valued MyBirthplace as a source of information to help make them aware of their choices. Women highlighted the role a midwife plays in supporting them to be proactive in accessing MyBirthplace and the way in which midwives frame information affects women’s choices. Unfortunately, for some women the midwives acted as a barrier, making them rethink their birth options or not providing women with information about MyBirthplace. These findings provide a unique view of both the effectiveness of MyBirthplace and women’s views regarding choice for place of birth. The findings fill the gap highlighted by the recent maternity review that asked for more information to be given to women and to be available in different formats. DSTs have been found to be valuable in aiding women in decision making about place of birth but only when the midwives are engaged, supportive and women are introduced to MyBirthplace at the first appointment.