Maternal choice to give birth by caesarean section is now a recognised phenomenon globally, is approved by UK authoritative bodies and is supported by UK law on informed consent in healthcare. Caesarean birth is also increasingly offered in the presence of relative, rather than absolute, indications eg. when estimated birthweight of the baby is high.
Thousands of studies have compared maternal and offspring outcomes of caesarean section and vaginal birth but few provide meaningful findings to inform birth mode choice in advance of labour starting. Only a comparison of a plan for vaginal birth with a plan for caesarean section reflects the risks a woman can weigh up in advance of labour, as the actual mode of birth eg. emergency caesarean section may not be in a woman’s control as events unfold in labour. Women should therefore have access to relevant information during pregnancy to ensure an informed choice is made.
As the number of studies comparing a plan for vaginal birth and a plan for caesarean section is slowly growing, there is a need to identify what outcomes should be reported from these to ensure that results meet the needs of women, clinicians and healthcare providers and are comparable between studies. By developing a core outcome set for such studies, future research in this area will benefit from both reporting of relevant clinical outcomes and being able to assess rare events by combining results from similar studies.
Aim: To develop a core set of outcomes to be reported in future observational and experimental studies which compare a plan for vaginal birth with a plan for caesarean section
Methods: Core outcome set development will follow a recognised set of steps as described in the Core Outcome Measures in Effectiveness Trials (COMET) handbook. These include registering with the COMET database, developing and registering a core outcome set protocol, identifying existing knowledge via systematic review and qualitative work followed by a Delphi process.
A 2-round electronic Delphi survey will be employed to ensure broad inclusion across the UK, reaching stakeholders including women who plan a first pregnancy in future, women currently pregnant, women who have had their first baby in the past 5 years, postmenopausal women who have previously given birth, midwives, general practitioners, obstetricians, neonatologists and anaesthetists. The first round would identify an exhaustive list of outcomes of interest. The second round would prioritise those outcomes to identify those in which there is clear agreement regarding their importance or lack of it. A final face-to-face round with a representative from each stakeholder group would enable nuanced discussion of the outcomes to be considered for inclusion and a final decision to be made. Using this established methodology, consensus will be reached on which outcomes are of interest within studies comparing outcomes of a plan for vaginal birth with a plan for caesarean section in a first pregnancy.
Alignment with university themes: This project will support the quality and impact of research into effectiveness of common interventions.
Dissemination: Findings will be widely disseminated via published manuscripts in peer-reviewed journals, presentation at professional conferences, engagement with the research community via social media and dissemination via the CoRe Outcomes in Women’s and Newborn health (CROWN) and COMET initiatives.
Impact: The findings of this work will be registered in the COMET database and be accessible for use by all future researchers in this area worldwide. The subject is of enormous National and International interest such that the findings of the research are expected to have lasting impact within the research community and on the quality of evidence available for sharing with pregnant women.
Training opportunities: Health services research training will be provided in project management, protocol development, systematic review, focus group facilitation, qualitative data management software, qualitative data analysis, Delphi processes, presentation of research at professional conferences and public engagement activities.
This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: https://www.abdn.ac.uk/pgap/login.php
. You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.
NOTE CLEARLY THE NAME OF THE SUPERVISOR AND EXACT PROJECT TITLE ON THE APPLICATION FORM.
Candidates should contact the lead supervisor to discuss the project in advance of submitting an application, as supervisors will be expected to provide a letter of support for suitable applicants.