Knowing the Likelihood of Delivery Mode
Research type
Research Study
Full title
Does knowing in advance the likelihood of mode of delivery affect experiences of labour and birth for parents and healthcare professionals?
IRAS ID
296778
Contact name
Christoph Lees
Contact email
Sponsor organisation
Research Governance and Integrity Team (RGIT) - Imperial College London
Duration of Study in the UK
1 years, 7 months, 31 days
Research summary
Research Summary:
Giving birth involves many unknowns, most importantly delivery mode. This project aims to explore whether reducing the uncertainty around delivery mode has an impact on the birth and postpartum experiences of pregnant women, particularly those with high fear of childbirth (FOC). An intrapartum app has been developed which can predict, with reasonable accuracy, the likelihood of having a vaginal delivery versus a Caesarean birth for pregnant women during the early stages of labour. Little is known about how women and their partners view having this prediction information and whether it has any psychological effects on pregnant women’s experiences.
This research project is divided into two separate studies:
• An online survey of parents and healthcare professionals’ views on knowing the birth delivery mode
• A cohort study looking at the psychological effects of understanding the likelihood of the birth delivery modeOnline Survey
The aim of the online survey is to explore the perspectives of women, partners and healthcare professionals, on the potential impact of having the prediction information regarding the delivery mode using a one-off online mixed-methods survey.Cohort Study
This is a prospective longitudinal quasi-experiment cohort study following nulliparous women prior to labour (35+ weeks’ pregnant) to eight +/- 2 weeks following delivery. A proportion of the women will be offered the predictive ultrasound and therefore the predictive risk of delivery mode. This will depend on the availability of the research team and whether it is appropriate to offer them the ultrasound as judged by the clinical team responsible for their care.Outcome Measures
• Fear of Childbirth/Experiences of Childbirth - Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ) and the Fear of Birth Scale (FOBS);
• Anxiety/Depression - Depression, Anxiety and Stress Scale (DASS)Eligibility
Inclusion
• >18 years old
• Nulliparous population
• 35 + completed pregnancy weeks
Exclusion
• Elective caesarean
• Not a singleton pregnancyDuration
The project will take place over a period of 18 months.Summary of results:
Labour is an anxiety-provoking event with many unknowns. The concept of unpredictable events may be particularly difficult for women, during and prior to the start of labour. These unknowns have been linked to the development of a fear of childbirth (FOC). Recently, intrapartum ultrasound has been used, together with clinical examination, to inform a prediction model for the likelihood of having a vaginal birth. This model has been transcribed into the form of a research-based intrapartum app that allows a traffic signal style understanding of chance of vaginal delivery – grouped into categories for likelihood of vaginal delivery. We sought to analyse views of current parents, pregnant women, and their partners, midwives and obstetricians on receiving information on prediction of delivery mode from intrapartum ultrasound through an online survey. We then sought to investigate the psychological impact of receiving prediction information while in labour on women in a more comprehensive cohort study. This is the first study to investigate the psychological impact of receiving birth prediction information in labour.
Participants were recruited through social media and in-person at a hospital to fill in the online survey about their views regarding the prediction of delivery mode on scales from 0-10. 50 parents, pregnant women and partners, and 35 healthcare professionals (8 midwives, 27 obstetricians) participated. The online survey indicated that women were keen to know their likelihood of vaginal or Caesarean delivery. Three quarters of healthcare professionals surveyed agreed that women would want the prediction and rated it to be helpful for the woman and their own work. Obstetricians were more confident in disclosing the prediction information to women than midwives.
A cohort of women on their first pregnancy (≥35 weeks) was identified to complete measures of fear of childbirth, depression, stress and anxiety using validated psychometric questionnaires before labour. Where possible, intrapartum ultrasound assessment was undertaken in early stages of labour and the participant received information on the likelihood of vaginal delivery. At 8+/-2 weeks post-delivery, participants filled in postnatal questionnaires with the same psychometric measures. The depression, stress and anxiety scores from before and after labour were compared for each woman. We found that merely giving birth prediction information, regardless of prediction accuracy, was associated with lower depression, stress and anxiety scores postnatally compared to before delivery. On the other hand, there was a worsening in postnatal scores when compared to prenatal scores on all dimensions in those who were not given a prediction. These results provide a signal that delivery prediction information could be helpful for the postpartum mental health of women, especially in preventing depression and stress. It may be that reducing the unpredictability of childbirth could ameliorate the impact on postpartum mood, even if the prediction is not accurate.
REC name
London - Harrow Research Ethics Committee
REC reference
21/LO/0432
Date of REC Opinion
23 Jul 2021
REC opinion
Further Information Favourable Opinion