What should be discussed when considering a caesarean birth? : A Delphi
Study to develop a Core Information Set for caesarean birth.
Abstract
Objective To develop a caesarean birth core information set.
Caesareans are the most common surgery performed in many countries.
Women need information for informed decision-making and consent. Core
information sets (CISs) provide baseline information, agreed upon by
parents and clinicians, for discussion before a procedure.
Design Two-phase consensus study using modified Delphi.
Setting United Kingdom, 2024 Sample People planning a
pregnancy/currently pregnant/new parents and maternity professionals
Methods Phase 1: Long-list of information points identified
from 273 systematic reviews, 50 patient leaflets, three pre-existing
qualitative studies, and a stakeholder survey (n=230); Operationalised
into a Delphi questionnaire comprising 11 information points with 108
items. Phase 2: Think-aloud interviews (n=9) informed questionnaire
restructure into information about planned caesarean birth, unplanned
caesarean birth (within 72 hours), and emergency caesarean birth (EMCB;
≤30 minutes), followed by two-round Delphi survey and consensus
meetings. Results N=360 participated in the Delphi survey Round
1. All items were carried forward, and three were added for Round 2
(n=188/56.4% attrition rate). From Round 2, one item was removed, 73
included, and 37 items no-consensus. Free-text responses identified an
unmet need for a postnatal EMCB-CIS. Over four meetings (n=36) consensus
was reached for an antenatal-caesarean-birth-CIS (14 points), EMCB-CIS
(5 points), and a postnatal EMCB-CIS (12 points). Conclusions
This study has established three caesarean birth CISs to support
informed decision-making discussions between women and clinicians: (1)
CIS for planned and unplanned caesareans when there is time for
discussion; (2) CIS for EMCB (within 30 minutes); (3) CIS post-EMCB
pre-hospital discharge.