Improving the quality and content of midwives’ discussions with low-risk women about their options for place of birth: co-production and evaluation of an intervention package

Objective: Women’s planned place of birth is gaining increasing importance in the UK, however evidence suggests that there is variation in the content of community midwives’ discussions with low risk women about their place of birth options. The objective of this study was to develop an intervention to improve the quality and content of place of birth discussions between midwives and low-risk women and to evaluate this intervention in practice.


Design: The study design comprised of three stages: (1) The first stage included focus groups with midwives to explore the barriers to carrying out place of birth discussions with women. (2) In the second stage, COM-B theory provided a structure for co-produced intervention development with midwives and
women representatives; priority areas for change were agreed and the components of an intervention package to standardise the quality of these discussions were decided. (3) The third stage of the study adopted a mixed methods approach including questionnaires, focus groups and
interviews with midwives to evaluate the implementation of the co-produced package in practice.


Setting: A maternity NHS Trust in the West Midlands, UK.


Participants: A total of 38 midwives took part in the first stage of the study. Intervention design (stage 2) included 58 midwives, and the evaluation (stage 3) involved 66 midwives. Four women were involved in the intervention design stage of the study in a Patient and Public Involvement role (not formally consented as participants).


Findings: In the first study stage participants agreed that pragmatic, standardised information on the safety, intervention and transfer rates for each birth setting (obstetric unit, midwifery-led unit, home) was required. In the second stage of the study, co-production between researchers, women and midwives resulted in an intervention package designed to support the implementation of these changes and included an update session for midwives, a script, a leaflet, and ongoing support through a named lead midwife and regular team meetings. Evaluation of this package in practice revealed that midwives’ knowledge and confidence regarding place of birth substantially improved after the initial update session and was sustained three months post-implementation. Midwives viewed the resources as useful in prompting discussions and aiding communication about place of birth options.


Key conclusions and implications for practice: Co-production enabled development of a pragmatic intervention to improve the quality of midwives’ place of birth discussions with low-risk women, supported by COM-B theory. These findings highlight the importance of co-production in intervention development and suggest that the place of birth package could be used to improve place of birth discussions to facilitate informed choice at other
Trusts across the UK.

List of abbreviations
Capability, Opportunity, Motivation – Behaviour (COM-B); Midwifery-Led Unit (MLU); Obstetric unit
(OU); Place of Birth Lead (PoBL)
Keywords:
Place of birth discussions, midwifery, behaviour change, co-production
Introduction

Women’s planned place of birth is gaining increasing importance in the UK, with recent guidance from the National Institute for Health and Care Excellence (NICE) recommending that all low risk women are given information about the safety, intervention and transfer rates of giving birth in different settings, to promote informed choice (NICE, 2014). Their recommendations state that for low risk