What Should Be Discussed When Considering a Vaginal Birth? A Delphi Consensus Study

Abstract

Objective: Spontaneous vaginal births are often the presumed choice, representing 45% of UK births. However, information about benefits and risks is inconsistently given, impacting decision-making and experience. A Core Information Set (CIS) is an agreed set of information points discussed prior to a decision. We aimed to develop a CIS for vaginal birth. Design: A Delphi study was used to create the CIS. Information points were identified from a literature search, patient leaflets, interviews, and a survey. These informed a two-round Delphi survey, where stakeholders rated item importance. Items rated critically important by ≥ 80% of parents or professionals, and of limited importance by < 15%, progressed to consensus meetings, where 20 parents and professionals discussed retained items. The final CIS was populated with an engagement group ensuring accessibility. Setting: The study took place in the UK, with participants recruited online. Population: Pregnant and postnatal women, birth partners, healthcare professionals, medicolegal professionals, and representatives from relevant organizations. Main Outcome: A CIS for vaginal birth. Results: 77 information items were identified. In round 1 (631 participants) of the Delphi Survey, 84.5% were from the patient group and 15.5% from the professional group; in round 2 (228 participants), 74.3% were from the patient group and 25.7% from the professional group. 29 items met the criteria for consensus discussion. The final CIS includes 19 information points addressing: labour process, pain relief, labour complications, procedures or interventions during labour, experiences after birth, outcomes for the baby and labour environment. Conclusions: This CIS can facilitate discussions and support informed decision-making about vaginal birth.