Recipient organisationNIHR Midlands Patient Safety Research Collaboration
NIHR supportRecorded as supported by this research centre
PeriodApr 2025 — Jun 2027
In plain English
AI plain-English summary
Pregnant women told their baby is large for gestational age currently face a difficult choice between induction, caesarean section, or waiting for spontaneous labour—without a standard tool to help them weigh the risks. This project will build a decision aid that gives women clear, balanced information about the chances of birth trauma, stillbirth, and surgical complications, alongside prompts to discuss their personal values with clinicians. The researchers will co-design the tool with patients and doctors, test it using forum theatre where actors perform scripted clinical conversations, and then pilot it in real maternity units. If it works, the aid could reduce the anxiety and decisional conflict that many women report, and make care less variable across the NHS. It would not eliminate the hard trade-offs, but it would ensure those trade-offs are made with shared understanding rather than confusion or exclusion.
View original technical description
What is the problem Many pregnant women are told late in pregnancy that their baby is “large for gestational age” (LGA), often leading to difficult decisions about the timing and mode of birth. These decisions involve weighing the risks of shoulder dystocia, birth trauma, and stillbirth with vaginal birth against the risks of caesarean section and early induction, both of which carry their own complications. Women often report feeling overwhelmed, poorly informed, and excluded from the decision-making process. There is currently no standardised, evidence-based tool to support women and clinicians in making shared decisions in this scenario. As a result, care is variable, and anxiety and decisional conflict are common. What we will do This project aims to develop a patient-centred decision aid to support women and healthcare professionals in making informed, value-based choices about the mode and timing of birth when a baby is suspected to be large. 1. We will begin by reviewing the existing evidence and clinical guidelines, and conduct interviews with women, clinicians, and birth partners to understand their experiences, concerns, and information needs. 2. Using these insights, we will co-design a prototype decision aid. This will include plain language explanations, balanced risk information, visual aids, and prompts to support conversations around values and preferences. 3. We will test this prototype through simulated clinical scenarios using forum theatre. Actors will perform scripted conversations between clinicians and women. Feedback from audiences – including patients, obstetricians, and midwives – will inform revisions. 4. Finally, we will pilot the refined decision aid in real-world clinical settings to assess its impact on decision quality, patient satisfaction, anxiety levels, and the nature of shared decision-making. This project will support safer, more respectful maternity care by helping women make choices that align with their values and clinical needs.
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