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Cited by 54Maternal and Perinatal Health InterventionsHealth Policy Implementation ScienceClinical practice guidelines implementation

Improving the care pathway for women who request Caesarean section: an experience-based co-design study

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Kenyon, Sara L., Johns, Nina, Duggal, Sandhya, Hewston, Ruth, Gale, Nicola·2016·BMC Pregnancy and Childbirth
DOI 10.1186/s12884-016-1134-2PMC PMC5103505
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Abstract

BACKGROUND: Maternal request for Caesarean section is controversial and yet the NICE Caesarean section Guideline recommends that that if this is requested, following discussion of the risks and benefits, women should be supported in their choice. There was a desire to improve the pathway at Birmingham Women's NHS Foundation Trust. METHODS: Experience-based co-design methodology uses service user and clinicians experiences collected using qualitative methods to jointly re-design services. Firstly semi-structured interviews were conducted to elicit the views and experiences of health care professionals and women who requested Caesarean section (with and without medical indication). Analysis identified key themes arising from the health care professionals' interviews and 'touch points' (key moments or events related to the experience of care) arising from the interviews with women.. Separate workshops were then held with each group to ensure these resonated and to identify key areas for service improvement. At the first joint workshop a pathway using 'audio clips' demonstrating women's agreed 'touch points' prompted discussion and joint working began to change the pathway. A final second workshop was held to agree changes to the pathway. RESULTS: Interviews were conducted with health care professionals (n = 22, 10 consultant obstetricians and 12 midwives) and women (n = 15). The women's 'touch points' included repetition of request, delay in the decision for Caesarean section to be made, feeling judged, and that information was poor with similar findings identified from the health care professionals. Joint working resulted in a revised pathway for women who request Caesarean section. Changes to the pathway for women as a result of the work include written information about 'The way your baby may be born' which is given to the woman followed by a discussion about mode of birth around the 16 week appointment. If the woman wishes to have a Caesarean section, referral is made to appropriate health care professionals (e.g., Consultant Midwife, counsellor) only if support and information would be useful. If Caesarean section is requested, woman is referred to a consultant obstetrician for an appointment at 20/40, with a decision by 28/40. Recording this in the notes minimises repeated challenge described by women. Final consent and timing of Caesarean section remain as recommended. CONCLUSION: This has resulted in changes to the pathway agreed by a co-design process and which are acceptable to both health care professionals and women. Use of such methodologies should be considered more frequently when implementing service change.

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  • A codesign workshop that involved healthcare providers and patients recommended initiating discussion about mode of delivery at the 16-week appointment and finalizing the birth plan by 28 weeks, while still providing opportunities for patients to request changes up to the time of delivery.

    “A codesign workshop that involved healthcare providers and patients recommended initiating this discussion at the 16-week appointment and finalizing the birth plan by 28 weeks (while still providing opportunities for patients to request changes up to the time of delivery).55”

    From Guidelines for antenatal and preoperative care in cesarean delivery: Enhanced Recovery After Surgery Society recommendations (part 1)—2025 update (2026) · cites this paper as [55]

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Research works printed but not linked: 2

  1. [16]National Institute for Health and Clinical Excellence. Caesarean section. (Clinical guideline 13). 2004. http://guidance.nice.org.uk/CG13 31886991
  2. [17]National Institute for Health and Clinical Excellence. Caesarean section (update). (Clinical guideline 132). 2011. http://guidance.nice.org.uk/CG132 31886991

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Authors
Kenyon, S. L., Johns, N., Duggal, S., Hewston, R., & Gale, N.
Affiliations
  • University of Birmingham (GB)
  • Birmingham Women's Hospital (GB)
Corresponding author
Kenyon, Sara L.
ORCID
Venue
BMC Pregnancy and Childbirth
Publisher
Springer Science and Business Media LLC
Published
2016-11-09
Volume
16
Issue
1
Pages
348-348
ISSN
1471-2393 (ISSN-L)
DOI
10.1186/s12884-016-1134-2
PMC
PMC5103505
OpenAlex
W2556051267
Cited by
54
References
21
Citations by year
2026: 3 · 2025: 6 · 2024: 13 · 2023: 5 · 2022: 5 · 2021: 7 · 2020: 6 · 2019: 7 · 2018: 2
FWCI
3.88
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • BMC Pregnancy and Childbirth (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
  • Worcester Research and Publications (University of Worcester) (submittedVersion)
Funders
Collaboration for Leadership in Applied Health Research and Care
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
Keywords
cesarean section, care pathway redesign, experience-based co-design, touchpoints, shared decision-making, patient information, obstetricians, midwives, service improvement
MeSH terms
Adult, Attitude of Health Personnel, Cesarean Section, Congresses as Topic, Female, Humans, Informed Consent, Interviews as Topic, Male, Middle Aged, Midwifery, Obstetrics, Patient Education as Topic, Pregnancy, Prenatal Care, Referral and Consultation, Critical Pathways, Patient Preference

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