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2-way communication for family-centred, individualised birth planning and informed decision-making

We want to revolutionise the way women & families interact with HCPs, to incorporate digital tools but maintain individualised discussions to enable empowerment in making informed and personalised birth choices.

Read comments 11
  • Proposal
  • 2022

Meet the team

Also:

  • Bryony Jones
  • Jasmine Tay
  • Maryam Allidina

What is the challenge your project is going to address and how does it connect to the theme?

Thousands of babies in England are being born preterm, smaller than expected, or stillborn because of socio-economic and racial inequalities across the country.  We need to improve antenatal planning for women with diverse and complex needs, to support them in making informed and timely decisions regarding their birth choices.

Challenges include:

– Inequity of information for women who have English as an additional language

– Women requesting caesarean birth without medical indication

– Women with obstetric risk factors requesting a midwife-led birth at home or in a birth centre

– Lack of continuity of care with women not seeing the MDT member at the right time

– Women tell us they feel frustrated, disempowered and anxious.

Facilitating maternal choice and informed decision-making is critical to women feeling empowered psychologically and physically to bond with and care for their newborn.  We need to modernise the way information moves between women and health care professionals (HCPs).

What does your project aim to achieve?

Co-production of a “Birth Options pathway” that utilises digital tools to facilitate family-centred, culturally-sensitive, informed decision-making in complex birth planning. We’ve already started testing improvement ideas and have learnt outcomes women want:

– individualised senior Obstetric and Midwifery (MDT) counselling, by HCPs interested in complex birth planning (takes experience, patience, motivational interviewing skills);

– access to information early in the antenatal period;

– choice of various formats (video, audio, text), including language options;

– A written birth plan confirmed in notes as soon as possible, to reduce anxieties

– video calling services – partner and patient can join in together, in comfort of home;

– Having a HCP who is a clear point of contact to ask further clarifying questions or to confirm a decision.

Measures:

– Time taken from referral to confirmed birth plan

– Qualitative measures regarding staff and women’s satisfaction with the process

How will the project be delivered?

Ideas we want to test:

– Dedicated Video calling clinic with a Consultant Obstetrician and Midwife working together for initial consultation

– Utilising a digital platform with a chat function between women and HCPs (has been shown to work in other MedTech applications) instead of relying on follow-up appointments, with messages saved seamlessly on electronic patient record (EPR)

– VIDEO (+ translated captions)/LEAFLET (+ translated language options)/AUDIO (patient choice as to which they want to engage with) that HCP can share

– birth plan co-produced by woman and HCP, visible on EPR. (+translated language options)

Ideally we would use 1 application to deliver all of the above, but recognise this may be challenging.  There is already some work being done in this space.  We would find ways to integrate and promote existing digital resources, many of which have patchy uptake at present (e.g Northwest London Mum and Baby app, Patient Knows Best, iDecide)

How is your project going to share learning?

This project will explore how HCPs interact with women outside of the traditional clinic model, a concept that is applicable to any and every healthcare encounter involving informed decision-making.  We will share learning from our evidence-based qualitative and quantitative data, openly and honestly with organisations.

Birth planning is an ever more important and time consuming part of routine obstetric care. Every maternity department in the UK is experiencing workforce challenges, in addition to integrating the new demands and expectations from women and national bodies.  Developing a robust, sustainable and safe system to enable two-way communication between HCP and women (including non-English speakers), will improve the experience for families and staff.  If targeted and executed well, this aspect of antenatal care and intrapartum preparation has the potential to improve outcomes for the most vulnerable women and babies.  Our learning will have infinite applications in enabling patient-centred decision-making.

How you can contribute

  • Critical Friend - has this been tried elsewhere? Where are our blind spots?
  • Collaborator - do you have a digital platform that we can work with to provide video calling, information sharing, and asynchronous text messaging securely between patients and HCPs? Any chance this will integrate with Cerner?
  • Strategist - are you aware of any national programmes with the same aim or addressing similar issues? What other measures can you suggest? Any additional resources required?
  • Investor - would you like to invest in our project? It has the potential to be huge!
  • Networker - any other Q projects or similar projects that you know of? This is such a huge issue we can't be the only ones wanting to work on this.
  • Expert - User Experience expertise or digital expertise welcome.

Plan timeline

31 May 2022 Concurrent Communications drive for CIE uptake (or Mum & Baby app)
31 May 2022 Concurrent production/collation of patient information (some already exist)
31 May 2022 PLAN - various digital platforms we can test (start with CIE?)
31 May 2022 Start seeing women in MDT Birth Counselling Video clinics
1 Jun 2022 Q Funding bid successful!
30 Jun 2022 Concurrent engagement with translation apps/tools for video/leaflets
30 Jun 2022 Engagement of stakeholders, recruit Project Manager
31 Jul 2022 Tested various digital platforms, confirm which we will adopt + scale
31 Aug 2022 Ongoing data collection qualitative + time taken to agree birth plan
31 Dec 2022 6 month review of learning and reflection on data/human resource

Comments

  1. Please let me know if you need any help creating diagrams or Service and process maps. I can produce visualisations in many formats including for publication on the internet or intranet.

  2. Hi Sabrina and team - this sounds like a great idea.

    I was wondering if there was any learning from previous Q Exchange projects that could be worth exploring, to help you strengthen the idea or anticipate potential challenges. You may be familiar with some of them already.

    • This project was about developing an app for breastfeeding support....so a different side of the journey but I think they have some useful learning on developing a digital platform that may be of use: https://q.health.org.uk/idea/2020/helping-mums-access-top-quality-breastfeeding-support/
    • If you are looking to co-design with women from typically under-represented groups, you may find learning from this project helpful? https://q.health.org.uk/idea/2020/making-primary-care-accessible-to-women-with-experience-of-trauma/
    • This project was about developing a remote maternity assessment and advice service https://q.health.org.uk/idea/2020/maternity-assessment-and-advice-service-linking-hospital-and-community/
    • This project was about improving communication between parents and health professionals in a specialist neonatal service. I think they had useful learning on the co-design process, and how they perhaps did this too late in the idea-generation stage https://q.health.org.uk/idea/2020/talk-to-us-together-enhancing-parent-experience-of-neonatal-encephalopathy/
    • If video calling is going to be a part of this intervention, there may be relevant learning from this project https://q.health.org.uk/idea/2020/embedding-video-consultation-services-inclusive-of-non-english-speaking-communities/

    best of luck!

    Jo

    1. What a great list of projects you have compiled for us!  Thank you.  Will certainly be able to refine and learn from others who have done similar work.  What we are grappling with at the moment is just getting the funding to get started.  I am hoping that once we kickstart, and can demonstrate the value of investment, we can make the case for ongoing funding of a "Birth Options" team who specifically care for women with complex birth planning needs.  I think that if done well it is massively scalable! Completely agree co-design should happen at the outset!

  3. Sounds like a great project ! I was interested to read todays news article "NHS England drops limit on offering Caesarean births - BBC News" which touches on the idea of birth choice, and getting away from the use of % C-Section rate as a KPI/quality indicator

    1. When we first started work on Birth Options, we noticed a real disconnect between what our reporting structures were asking us to do (reduce Caesarean rates) and what our women wanted (autonomy and support in decision-making).  Hence our outcome measure isn't focussed on Caesarean rates, but rather experience based measures that women told us were important to them (with process measures like how long between women expressing a concern and being seen in Birth Options clinic).  We also introduced a routine question "What Matters to You for Your Birth" in the 16 +28 week visits, so we could identify concerns early in a way that wouldn't cause worry for women.

  4. Guest

    Alison Perry 4 months ago

    This all sounds great.  I like the interest to ".... explore how HCPs interact with women outside of the traditional clinic model, a concept that is applicable to any and every healthcare encounter involving informed decision-making". I think small shifts in dynamics can open whole possibilities.

    1. Totally agree!  The traditional model takes the power away from women - they cannot have any access to contact the HCP outside of the limited clinic setting.  We want to test if messaging following the clinic visit can be safe and sustainable - we think it will be if designed well.

  5. Guest

    Shawn Walker 4 months ago

    This is a great idea. It will also be relevant to OptiBreech work. Our Public Involvement and Engagement group is very keen to collaborate on non-biased informational tools. Excellent initiative.

    1. Yes Shawn - discussing birth options and supporting informed decision making is huge!  And with something so complex as birth... There is so much scope to expand the model and to use our tests of digital tools to inform us on what good looks like for women and HCPs in the future. And what the resource ask is.

  6. Guest

    Josie O’Heney 4 months ago

    This is such an important area to address. iDecide has been in production for some time and it is hoped that this will help with informing women, but we need to work with women and families to produce birth plans that work for them in a seamless way

    1. Would welcome iDecide as a tool! And would certainly incorporate existing resources in this.  What I find lack is that interface that combines purely digital information resources with something that allows for interaction between HCP (key to informed decision making).  Patient information and tools like iDecide would work as the complementary tools and could be added and updated as we go on.

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