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What outcome information do women need to support an informed choice between planning a vaginal or caesarean birth? – a consensus study
Ekong A, Nicoll A, Locock L, Fairley T, Devane D et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This document is a consensus study on what outcome information should be included in decision aids to help pregnant women choose between vaginal or caesarean birth. It used a three-phase process including systematic review, Delphi surveys, and stakeholder meetings to identify and prioritise 62 outcomes across maternal and child health. While the study identifies outcomes related to birth complications, recovery, pelvic floor function, and child health, it does not evaluate an intervention or measure child well-being outcomes.
Key points
- Seventy-one outcomes were initially identified from systematic reviews, guidance, and stakeholder interviews
- Through two Delphi rounds, 54 outcomes reached consensus as critically important
- Final list included 44 maternal outcomes and 18 child outcomes
- Maternal outcomes covered assistance with birth, complications, recovery, pelvic floor, psychological issues, sexual function, and future pregnancy
- Child outcomes related to morbidity, mortality, disease, obesity, and developmental issues
Limitations
This is a consensus-building exercise on what information should be included in a decision aid tool, not an evaluation of whether such a tool improves maternal or child health outcomes. The document does not measure actual impacts on women's decision-making, health outcomes, or child well-being.
Abstract
Background A mode of birth decision aid (DA) can provide information and support discussions about the potential risks and benefits (outcomes) associated with planning a vaginal or caesarean birth. Evidence shows that DAs can enhance patient knowledge, reduce decisional conflict, minimise inconsistencies in decision-making support, especially in maternity settings, and promote informed decision making. Despite these benefits, DAs specific to mode of birth are currently lacking in routine antenatal care. This paper outlines the process we followed to reach consensus on which outcomes of planned mode of birth should be included in a mode of birth DA. Methods Outcome identification and selection occurred in three phases. Phase 1 involved compiling a long list of outcomes from systematic reviews, the NICE Caesarean Birth Guidance and qualitative interviews with stakeholders. In Phase 2, this list was refined via a 2 round Delphi survey to prioritise outcomes considered important. An outcome reached consensus if ≥70% of all participants, or 70% of women/partners rated it as “critically important” (7–9), and <15% rated it as “not important” (1–3). Phase 3 involved two stakeholder consensus meetings to finalise the outcome list. Results Seventy-one outcomes were identified. Following two Delphi rounds and consensus meetings, 54 outcomes were rated as critically important. Seventeen outcomes were consistently rated as not critical across both the survey and consensus phases, meaning that ≥70% of participants in each phase did not consider them essential for informing women during pregnancy. Of these, 8 were retained due to NICE recommendations and ultimately, 9 outcomes were excluded. The final list included 44 maternal and 18 child outcomes. Maternal outcomes related to assistance with birth, complications at the time of birth, issues during recovery, pelvic floor, psychological issues, sexual function, and future pregnancy. Child outcomes related to morbidity and death, disease, obesity, issues with cognitive development and physical development. Conclusions Sixty-two priority outcomes were identified for inclusion in a planned mode of birth DA.