The Which? Birth Choice tool has been developed to help women and their partners make confident and informed decisions when planning where to give birth.
As per quality statement 1 of NICE QS105 on intrapartum care the Which? Birth Choice tool highlights the birth settings available. The tool encourages women to consider out-of-hospital settings where appropriate, in-line with the recommendation that for women planning to give birth at home or in a midwife-led unit there is a higher likelihood of a ‘normal’ (vaginal) birth with less intervention.
Expectant parents are the intended users of the tool. Supported by the Royal College of Midwives we also promote the tool as a resource that midwives can use when talking to women about their options.
Shared Learning examples contain complementary information from sources outside of NICE. This website has been developed by Which? and is not maintained by NICE. NICE has not made any judgement about the quality and usability of the resource. In the event of any issues or errors, please contact Which?.
- Intrapartum care (QS105)
Aims and objectives
The Birth Choice tool aims to provide expectant parents with the information they need to make the best decision for them when deciding where to give birth. Statement 1 of Quality Standard 105 (2015) supports women being offered choice of planning birth at home, in a freestanding midwife-led unit, an alongside midwife-led unit or an obstetric unit and the objective of the Birth Choice tool is to provide an easy, free and accessible way for women to engage with this choice and have informed conversations with health care professionals.
By asking women about their preferences for giving birth (e.g. do they see birth as a natural or clinical event), personal circumstances (e.g. their age) and their postcode location, the Birth Choice tool presents personalised results. Local birth options are displayed in order of suitability for women in their circumstances as well as their individual preferences, with tags signifying what options are a “Best fit” or “Good fit” for them as well as what their “Other options” might be depending on an individual’s situation and location.
Users of the tool can view their results by suitability (“fit”) or distance and also select units to compare side by side to help them decide which is right for them.
Personalised messages that accompany the results alert women to statistics that are relevant to them to inform their choice. For example, first time mums having an uncomplicated pregnancy are told that “planning to give birth in a birth centre (freestanding or alongside) is particularly suitable for you because you're less likely to have medical interventions and it's as safe for the baby as a labour ward”. If a woman has said that she would like to have a water birth as well as an epidural they are told that “if you want an epidural you'll have to get out of the birth pool”.
By encouraging women to consider what’s important to them and by presenting their local options in the order most appropriate for them according to both NICE guidelines and their preferences, the tool aims to support women in making an evidence based decision.
Reasons for implementing your project
The Birthplace Study (BMJ, 2011) indicates that place of birth has implications for the sort of birth experienced by women. Intervention rates are lower for out-of-hospital births, and with the exception of first time mums it is no less safe for second or subsequent time mums to have their baby out of hospital. Therefore choosing where to give birth is an important choice that women and their partners make when expecting a baby.
Which? began to develop the Which? Birth Choice site in 2013. At this time Which? research found that many clinicians were keen to share information with patients and carers, but that 7 in 10 GPs felt that they didn’t have enough time to talk women through their options of where to give birth in detail and 6 in 10 said that they didn’t have enough information to do this.
Our research also found that at the beginning of their pregnancy a third (34%) of mothers said they knew nothing or not much about the amount of choice they had about where to give birth and half (49%) said the same about the different types of maternity units available to them.
The market for information about pregnancy and birth was and remains crowded, but yet nothing existed to help women piece together the Birthplace Study findings with the availability of services in their local area.
As Which? seeks to use data and available evidence to create tools that empower consumers of public services to engage in decisions about their health and social care, we saw a clear need for an accessible and easy-to-use online tool to help women plan where to give birth and ultimately help them make informed choices.
As the tool and website were developed we conducted user testing to co-design the site with expectant parents to ensure it met their needs. In addition to the tool, Which? Birth Choice offers advice content aimed at first time mothers, acting as an entry point to encourage them to use the tool and find out more about the impact their decisions can have on their birth experience.
Since launch in January 2014, further user testing has enhanced the advice and information as well as the layout of the tool to ensure the site provides the information expectant parents want. When QS105 (2015) was published the algorithm behind the tool and the personalised alerts were updated to reflect the new statement and underpinning recommendations.
How did you implement the project
The Birthplace Study (BMJ, 2011) and NICE guidelines 55 (as the tool was originally developed before CG190 and QS105 were published) were the key sources of guidance on what birth environments the tool would suggest for women in different scenarios. In collaboration with the maternity data experts BirthChoiceUK Which? built the tool based on these key sources.
Which? also gathered a project review board made up of a number of relevant experts including a consultant obstetrician, consultant midwives and midwifery researchers. This board reviewed and tested the Birth Choice tool to ensure that the results were clinically appropriate. This process has been repeated since to re-align the tool with the changes made to QS105 in 2015.
The users of the tool have also been central to its development, with considered design and user testing to ensure that it’s easy to use, with help text embedded throughout to explain the questions that it asks.
A key challenge for the project was sourcing detailed and useful information about each individual birth centre, labour ward and home birth service in the UK to help women and their partners understand what is available in their area. This has been overcome by designing and delivering an annual audit that goes out to NHS Trusts across the UK. We contact heads of midwifery directly for annual updates on the facilities and services offered by the units in their trust as well as asking for up-to-date birth statistics.
Further information that we display about each unit comes from a variety of sources:
- CQC: We display the CQC scores for trusts as a whole from the 2015 Maternity Services Survey on each unit page, providing an indication of whether this trust is “better”, “about the same” or “worse” compared with other trusts.
- Patient opinion reviews: We display the three most recent reviews that have been left on the independent Patient Opinion site. We do not show reviews that are older than 2 years old.
- Government sources of statistics: BirthChoiceUK supply Which? with maternity statistics that have been supplied to them by the following sources; HSCIC for England, StatWales for Wales, ISD for Scotland and DHSSPSNI for Northern Ireland.
The site is supported by the Royal College of Midwives (RCM) as a source of information and advice to encourage women and their partners to have informed discussions with their midwives. In this video, Chief Executive of the RCM Cathy Warwick explains why she recommends that expectant parents use Which? Birth Choice: https://youtu.be/UdeTa7DuH1s.
Since launch in January 2014 the number of visitors to the site has increased steadily, seeing a total of around 480,000 visitors in 2015. With a significant proportion of our traffic coming directly through natural search we know that there's a real appetite for the information and advice that we provide for expectant parents.
Use of the Birth Choice tool has also been impressive, with most people who use the tool using it more than once, demonstrating real engagement with how their preferences and circumstances can influence what might be right for them.
Unprompted feedback via press and social media channels has seen mothers describe the tool as a “fantastic online resource” and “a fabulous website to help women consider their birth choices”. User testing has also provided us with encouraging insight into how women have felt after using the tool and reading the advice we provide:
- “I feel less scared, more empowered. I have noticed many times that when you go to the Doctor and you know what you are talking about they won’t just fob you off and you get directed better”
- “Your information is not based on opinion, it is more objective and I like that”.
We provide the tool in a widget format which is shared with third party sites so that they too can provide the tool for their visitors. Both the NCT and Babycentre now host the tool and we see hundreds of people each month using the tool on their sites.
Key learning points
The project took information and evidence based research that was already available and sought to present it in a user-friendly way. By doing this, women and their partners are more likely to benefit from what is known about place of birth than if they have to explore all of the individual information sources themselves.
Being a purely digital tool that is free to access, it is easily shared by women themselves which supports our efforts to promote the tool to expectant parents and encourages more people to consider their options.
The majority of our visitors are on their mobile. This is crucial to understanding how to present the information, as large tables of statistics don’t look great on a small screen! Thinking about who the audience are and on what devices they are looking for information has been key to creating a tool that is useable, helpful and recommended.