Informing Decision-Making About Caesarean Birth: A Delphi Study to Develop a Core Information Set

Carol Kingdon; Ben Greenfield; Mahmoud Aljubeh; Eve Bunni; Alexandra Hunt; Vicky Bradley; Caroline Cunningham; Siobhan Holt; Andrew Demetri; Christy Burden; Joanna Ficquet; Elena Otero-Romero; William Parry Smith; Mairead Black; Fiona Bradley; Amy Elsmore; Jenna Frizelle; Tabitha Jones; Abi Merriel; Options Collaborative Group

doi:10.1111/1471-0528.18269

Informing Decision-Making About Caesarean Birth: A Delphi Study to Develop a Core Information Set

BJOG. 2025 Jul 8. doi: 10.1111/1471-0528.18269. Online ahead of print.

Authors

Carol Kingdon¹, Ben Greenfield^{1

2}, Mahmoud Aljubeh^{1

2}, Eve Bunni^{1

2}, Alexandra Hunt³, Vicky Bradley¹, Caroline Cunningham², Siobhan Holt², Andrew Demetri⁴, Christy Burden⁴, Joanna Ficquet⁵, Elena Otero-Romero⁶, William Parry Smith⁷, Mairead Black⁸, Fiona Bradley⁹, Amy Elsmore⁷, Jenna Frizelle², Tabitha Jones¹, Abi Merriel^{1

2}; Options Collaborative Group

Collaborators

Affiliations

¹ Department of Women's and Children's Health, Institute of Life Course and Medical Sciences, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK.
² Liverpool Women's Hospital, Liverpool, UK.
³ Health Data Science, University of Liverpool, Liverpool, UK.
⁴ University of Bristol, Bristol, UK.
⁵ United Hospitals Bath, Bath, UK.
⁶ Cambridge University Hospitals NHS Foundation Trust UCLH, Cambridge, UK.
⁷ University of Keele, Keele, UK.
⁸ University of Aberdeen, Aberdeen, UK.
⁹ University Hospitals of Liverpool Group, Liverpool, UK.

PMID: 40626370
DOI: 10.1111/1471-0528.18269

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 h) and emergency caesarean birth (EMCB; ≤ 30 min), 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) an antenatal CIS for planned and unplanned caesareans when there is time for discussion in clinic; (2) a one-page CIS for emergency caesarean birth (within 30 min) when there is little time for discussion; (3) and a postnatal CIS for use after an unplanned caesarean birth before hospital discharge.

Trial registration: COMET Initiative | Development of a core information set for caesarean birth (comet-initiative.org).

Keywords: Delphi; birth; caesarean; choice; consent; core information set.

Grants and funding

National Institute for Health and Care Research