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My Birthplace: a computerised decision making tool to support women, their partners and midwives to make a decision about place of birth

Women have the right to choose where they plan to give birth, but there is evidence that many women are not getting the information that they need to enable them to make an informed choice.

Background

Women have the right to choose where they plan to give birth, but there is evidence that many women are not getting the information that they need to enable them to make an informed choice. Decision support tools (DST) have been a mechanism to encourage the practice of shared decision‐making.

Objective

To assess the effectiveness of MyBirthplace, a DST that facilitates shared decision making regarding place of birth.

Design

A quasi-experimental pre-test post-test study. 

Setting

A large urban NHS trust in the south of England.

Population

All pregnant women who accessed maternity care between April and December 2016.

Methods

Women’s stage of decision making was assessed prior to the midwife using the DST (MyBirthplace) at their booking appointment. Their stage of decision making was assessed again after their booking appointment and at 28 weeks gestation. SPSS statistical testing was used to explore decisional conflict scores before and after having accessed the DST.

Main outcome measure

Effectiveness of the decision support tool as measured by the Stage of Decision Making Scale (SDMS).

Results

A total of 172 women were recruited with a mean age of 30.0 (SD 5.1). Exposure to MyBirthplace resulted in a significant increase in SDMS score suggesting that women had greater certainty in their decision (P< 0.0001 [SD 1.077]. Women who accessed the DST had more improved scores (35.5% compared with 22.0%) indicating less decisional conflict after the booking than those that did not access the DST.

Conclusion

If introduced as a standard part of practice DSTs have the potential to remove bias and streamline discussions, ensuring women are informed of their options and have shared decision making about place of birth. Our study suggests that overall women were more confident with their decision following the booking appointment and by 28 weeks, and this confidence was greater where they had access to the DST as part of the booking appointment with the midwife.

Outputs

Wiggins D, Hundley VA, Wilkins C, Bond C, Walton G. (2018) The effect of a birthplace decision support tool on women’s decision-making and information gathering behaviours during pregnancy: mybirthplace study protocol. J Innov Health Inform. 8; 25(1):001–006

Wiggins D, Hundley VA, Bond C, Wilkins C, Walton G. (2020) Could a decision support tool be the key to supporting informed choice for women regarding place of birth? In review.

https://mybirthplace.org/wessex/