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

Area of Science:

• Obstetrics and Gynecology
• Patient-Centered Care
• Healthcare Service Improvement

Background:

• Maternal request for Caesarean section (C-section) is a complex issue.
• NICE guidelines recommend supporting women's choices for C-section after discussing risks and benefits.
• There was a need to enhance the C-section pathway at Birmingham Women's NHS Foundation Trust.

Purpose of the Study:

• To improve the pathway for women requesting Caesarean section (C-section) using an experience-based co-design methodology.
• To integrate the perspectives of both women and healthcare professionals in redesigning the C-section service.
• To address key themes and 'touch points' identified in the C-section request process.

Main Methods:

• Experience-based co-design methodology was employed.
• Qualitative methods, including semi-structured interviews with healthcare professionals (n=22) and women (n=15) who requested C-section, were used.
• Separate and joint workshops were conducted to analyze experiences, identify key themes and 'touch points,' and collaboratively redesign the service pathway.

Main Results:

• Key themes from healthcare professionals and women's 'touch points' included repetitive requests, decision delays, feeling judged, and poor information.
• A revised C-section pathway was developed through joint working.
• Pathway changes include providing written information early in pregnancy, timely referrals for support, and standardized appointment scheduling to minimize repeated challenges.

Conclusions:

• The co-design process resulted in an improved C-section pathway acceptable to both women and healthcare professionals.
• This collaborative approach effectively addressed identified issues in the C-section request process.
• Experience-based co-design is a valuable methodology for implementing service changes in healthcare.