Which? Birth Choice

AIMS Journal 2014, Vol 26, No 1

Miranda Dodwell introduces a new website providing information on local maternity services

The website (www.which.co.uk/l/pregnancy-and-birth) is the result of a year-long project working with Which?, and a longer history of providing information to women about choosing where to have their baby.

The original birthChoiceUK website, launched back in 2001, was created as a result of my experience facilitating antenatal classes. I realised that women were not receiving all the information they needed from health professionals to decide where to give birth. They were unaware of the benefits of continuity of care, and of how to avoid getting fragmented care by choosing particular birth options. The birthChoiceUK website was designed to help them understand the implications of different choices and provide information, including statistics for maternity units around the UK, so that they could make a more informed decision.

My colleague, Rod Gibson, and I developed and maintained the website on a voluntary basis. Over time, however, the website became outdated and needed fresh investment. It was therefore very exciting to be contacted by Which? asking us to collaborate on a new website helping women explore their birth options.

For us, Which? was a perfect partner - an independent consumer organisation with charitable objectives and a trusted brand which was keen to do more to help the consumers of public services. birthChoiceUK's reputation for maternity data, experience of running a website and knowledge of maternity services made us the ideal partner from Which?'s point of view.

Choosing where to give birth is a hugely important and personal decision. Pregnant women need specific information to help them understand the different choices available to them so they can make the right decision. The heart of the Which? birth Choice website is the interactive 'Find and Compare' tool where pregnant women answer questions about where they live, their own preferences for birth and their circumstances (such as age and previous birth history) to find out which options are their 'best fit'.

For a woman at low risk of complications, this tool combines her preferences with evidence from the birthplace Study to show her the birth settings (such as home, birth centre or labour ward) most suited to her, as well as their location in relation to where she lives. Women who are actively trying to avoid interventions are recommended to plan birth at a distance from a labour ward. For all low-risk women, the default option will be a birth centre or at home, as the birthplace evidence shows that these are the safest places to give birth (with additional information given to first-time mothers about increased transfer rates and about the slight differences in safety for the baby at home). Recommendations will be affected, however, by a woman's strong preference for giving birth in a clinical environment, with doctors nearby, or for an epidural.

Women who self-report that they are at increased risk of complications and show a preference for birth in a clinical setting or for an epidural will have a labour ward suggested as their best fit, in accordance with guidelines. However, other options will be flagged where women indicate by their preferences that this is not the type of birth they want. For these women, information is given to help them negotiate appropriate care either in a labour ward, in a midwife-led setting or at home, with details of individuals or organisations (including AIMS) that can support them in their choices.

To ensure that it is an effective tool, we consulted carefully with the wide range of maternity exper ts on our Review Board and tested it out thoroughly with a variety of pregnant women.

Another area of the website - Understand Your Choices - helps women explore the differences between different birth environments and to compare them side by side. Each maternity unit in the UK also has its own profile page giving information about their facilities and policies in place. This includes details on how to arrange a home birth, how reliable the home birth service is, and home birth rates for that hospital. This information has been collected from Heads of midwifery themselves, with the help of the Royal College of Midwives, and we have had a great response rate. However, if data on your local maternity unit are missing, then please do urge the Head of midwifery to complete our questionnaire.

An innovative feature of the site is the presentation of personalised maternity statistics, based on whether a woman has given birth before and whether she is at low risk of complications. In the same way, women who have had a previous caesarean can see the rates of repeat caesareans and of vaginal birth after caesarean (VBAC) at different maternity units. The website also offers the opportunity to 'Learn More', with a variety of articles on topics such as the importance of continuity of care and coping with pain in different birth settings.

You can find the Which? birth Choice website at www.which.co.uk/birth-choice. Use the menu buttons to access the 'Find and Compare' interactive tool.

We are very grateful to the members of the AIMS committee who have reviewed the website for us and made suggestions for amendments. If you have any feedback on the site, you can contact us via birthchoice@which.co.uk.

Miranda Dodwell, Founder of BirthChoiceUK

References

1. National Perinatal Epidemiology Unit (NPEU) (2011) birthplace in England Study. Available at www.npeu.ox.ac.uk/birthplace