The effect of a birth place decision support tool on women's decision making and information gathering behaviours during pregnancy: MyBirthplace Study Protocol

Daisy Wiggins



Background: The recent Maternity Review for England highlighted the need for more choice for women with more accessible information to support decisions. This study assesses the effect of an unique Decision Support Tool (DST) called MyBirthplace on decision making and information gathering behaviours of pregnant women regarding birth place choice. The study seeks to understand women’s views and opinions about using the DST and their feelings about how well the DST supports them to make a decision.


Methods: A mixed method sequential exploratory design will be utilised to meet the above aim. This three phase study will involve a proposed sample of 169 women from a large maternity hospital in the United Kingdom. Phase one will be a questionnaire survey with women pre and post access to the DST, which is given to them by their midwife at the initial appointment. The questionnaire will look at baseline data, knowledge level and decision making using the Stages of Decision making scale (SDMS). A follow up questionnaire at 28 weeks (phase 2) will review the SDMS to enable the usefulness of Mybirthplace to be evaluated and to seek women’s opinion on various aspects of MyBirthplace. The proposed sample size was determined by a power calculation based on changes attributed to the DST as measured by the SDMS. Phase three involves qualitative interviews with a minimum of 10 purposely chosen women at approximately 36 weeks gestation, and is followed by collating data on where the women actually give birth.



Discussion: This study is the first study to assess the effect of a DST in supporting women’s choice of place of birth. It will add to current DST literature. It is also one of very few studies to utilise the stages of decision making scale with DST in pregnancy and thus will build on the existing literature; whilst broaching key concepts highlighted in the National Maternity Review.



Decision support tool;Mybirthplace; decision making; choice; birthplace; mixed methods

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National Health Service England, Shared decision making, NHS England, 2006 pg 1 -34 [Date accessed 28/12/16]

National Institute of care excellence, Patient experience in adult NHS services,NICE.ORG, 2012 [Date accessed 28/12/16]

Department of Health, Equity and Excellence: Liberating the NHS, Department of Health,2010, [Date accessed 26/07/2016]

Nunes, V., Neilson, J., O’Flynn, N., Calvert, N., Kuntze, S., Smithson, H., Benson, J., Blair, J., Bowser, A., Clyne, W., Crome, P., Haddad, P., Meningway, S., Home, R., Johnson, S., Kelly, S., Packham, B., Patel, M., Steel, J., Clinical guidelines and evidence review for medicines adherence : involving patients in decisions about prescribed medicines and supporting adherence. London national collaborating centre for primary care and royal college of general practicitioners, 2009 [date accessed 14/9/16]

Tupara, H., Facilitating functional decision making in midwifery lessons from decision theory, New Zealand college of midwives journal, 2008, 38,2:7

Houghton, G., Lavender, T., 2008, Factors influencing choice in birth place, an exploration of the views of women, their partners and professionals , Royal college of midwives, 2008, 2:1: [Date accessed 11/12/16]

National Childbirth Trust , Location Location Location; making choice of place of birth a reality, National Childbirth Trust, NCT,2009, London

Gretton, C., Honeyman, M., The digital revolution: eight technologies that will change health and care, The kings fund, 2016, [Date accessed 11/12/16]

Rupert, D., Squiers, L., Renaud, J., Whitehead, N., Osborn, R., Furberg, R., Squire, C., Tzeng, J., 2013, Communicating risk of hereditary breast and ovarian cancer with an interactive decision support tool, Patient education and counselling,2013, 92. 2:188-196, [Date accessed 11/12/16]

Shorten, A., Shorten, B., Keogh, J., West,S., Morris, J., 2005 , Making choices for childbirth a randomised control trial of a decision aid for informed birth after caesarean, Birth 2005, 32:4 Available from:;jsessionid=F835404A3EFE5D2CAA9C149E9A08D196.f01t04?deniedAccessCustomisedMessage=&userIsAuthenticated=false [Date accessed 11/12/16]

Montgomery, A., Emmett, C., Fahey, T., Jones, C., Ricketts,I., Patel, R., Peters,T., Murphy,D.,Two decision aids for mode of delivery among women with a previous caesarean section, ;A randomised controlled trial BMJ,2007,23:334, Available from: [Date accessed 28/12/16]

Frost, J., Shaw, A., Montgomery, A., Murphy,D., Women’s views on the use of decision aids for decision making about the method of delivery following a previous caesarean section: qualitative interview study [online], BJOG,2009, 116, 7, Available from: [date accessed 17/04/16]

Schoorel, E., Vankan,E., Scheepers,H., Augustijn, B., Dirksen,C., Koning, M., Van Kuijk, Kwee,A., Melman,S., Nijhuis, J., Aardenburg,R., Boer, K., Hasaart,T., Mol,B., Nieuwenhuijze, M., Van Pampus,M., Roosmalen,J., Roumen,F., De Vries,R., Wouters, M., Van der Weijden,T., Hermens,R., involving women in personalised decision making on mode of delivery after caesarean section: the development and pilot testing of a patient decision aid, BJOG,2013, 121; 2., Available from: [Date accessed 11/5/16]

Eden, K., Perrin, N., Vesco, K., Guise, J., A randomised comparative trial of two decision tools for pregnant women with prior caesarean [online], Journal of Obstetrics Gyneacology and neonatal nursing, 2014,43, 5, Available from: [Date accessed 11/5/16]

Bjorklund, U., Marsk, A., Levin, C., Ohman, S., 2012, Audiovisual information affects informed choice and experience of information in antenatal down syndrome screening- a randomised controlled trial, Patient education and counselling, 2012,86: 390-395 Available from: [Date accessed 11/12/16]

Nassar, N., Roberts, C., Raynes-Greenlow, C., Barratt, A., Peat, B., Evaluation of a decision aid for women with breech presentation at term; a randomised control trial, The international journal of obstetrics and gynaecology, 2016,10,(2):326

Dugas, M., Shorten, A., Dube, E., Wassef, M., Bujold, E., Chaillet, N., Decision aid tools to support women’s decision making in pregnancy and birth: a systematic review and meta analysis , Social science and medicine, 2012,7 (2): [Date accessed 11/12/16]

Which, WhichBirthChoice,2016 [Date accessed 11/12/16]

Gaskell,E., Walton, G., Forrester, M., Grosvnor, M., Phillips, D., Rees, J., Barton, S., 2014, MyBirthplace – An app to support shared decision making, International Journal of integrated care, 2014,14, [date accessed 11/12/16]

Birthplace in England Collaborative Group, Perinatal and maternal outcomes by the planned place of birth for healthy women and low risk pregnancies: the birthplace in England national prospective cohort study, BMJ,2011,2, 343 Available from: [date accessed 11/12/14]

O’Connor, Am., Stage of decision making [online], Ottawa hospital research unit, 2000, 4: [Date accessed 11/07/14]

Walton, G., 2011, Nurturing maternity service development, Portsmouth Hospital NHS trust 2011, [Date accessed 17/02/17]

Hampshire County Council, Social and Deprivation Analysis, 2015,1, [date accessed 17/2/17]

UKPopulation, population of Portsmouth in 2016, 1,2016: [date accessed 17/2/17]

Sullivan, L., (unknown) Nonparametric tests, Boston university available form: [date accessed 17/2/17]

Murray-Davis, B., Macdonald, H., Reitsma, A., Coubrough, M., Deciding on home or hospital birth; result of the Ontario choice of birthplace survey, Midwifery,2014, 30:(7) [date accessed 17/2/17]

Griggs, C., Tracy, S., Daellenbach, R., Kensington, M., Schmied,V., An exploration of influences on women’s birthplace decision making in new Zealand; a mixed methods prospective cohort within the evaluating maternity units study, BMC,2014, 14;2:10 Available from: [date accessed 17/2/16]

Raynes- Greenlow, C., Nassar, N., Torvaldsen, S., Trevena, L., Roberts, C., 2010, Assisting informed decision making for labour analgesia: A randomised controlled trial of a decision aid for labour analgesia versus pamphlet [online], BMC pregnancy and childbirth, 10, (15) page 6 Available from [date accessed 11/5/14)

Grant, FC., Laupacis, O’Connor, A., Ruben, F., Robblee, J., 2001,Evaluation of decision aid for patients considering autologous donation of blood before open heart surgery, CMAJ,2001, 164 (8) Available from: [date accessed 10/10/16]

Palinkas, L, Horwitz, S., Green, C., Wisdom, J., Duan, C., Hoagwood, K.,Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research, Adm Policy Ment Health,2013, 42, 5: 533-44: DOI 10.1007/s10488-013-0528-y [Date accessed 10/101/16]

O’ Connor, 1995, Validation of a decisional conflict scale [Online], Med decision making, 15, (1), 23-30: [Date accessed 10/10/16]

Anderson T, Kanuka H., On-line forums: New platforms for professional development and group collaboration. Journal of Computer Mediated Communication; 1988, 3(3). [Date accessed 4/4/14]

Pearson, M and Marshall, J Exploring father's influence on their partner's choice regarding place of birth. MIDIRS Midwifery Digest,2014, 24(2), pp. 171-178. ISSN (print) 0961-5555

Greasley, P., Quantitative data analysis using SPSS an introduction for health and social science,2008, 2nd ed ,Maidenhead, open university press

Boyatzis, R. E. 1998. Transforming qualitative information: Thematic analysis and codedevelopment. Thousand Oaks, CA: Sage.

Cheyney, MJ., Homebirth as a systems-challenging praxis, knowledge, power and intimacy in the birthplace, Qualitative health research. 2008,18:(2)

Coxon K., Sandal, J., Fulop, N., To what extent are women free to give birth? How discourses of risk, blame and responsibility influence birth place decisions , Health risk and society,2012,16, (1) page 11[Date accessed 17/2/17]

Madi, B., Crow, R., 2003, A qualitative study of information about available options for childbirth venue and pregnant women’s preference for a place of delivery, Midwifery, 19, 4 328-36

Cochrane Review by Sandall, J., Soltani, H., Gates, S., Shennan, A., Devane, D., 2016, Midwife-led continuity models of care compared with other models of care for women during pregnancy birth and early parenting, Cochrane

O’Cathain, A., Murphy, E., Nicholl, J., 2002, Why and How mixed methods research is undertaken in health services research in England: a mixed methods study, BMC health services research, 7, 85 Available from :



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