Authentic Consumer–Clinician Co-Design of a Labour and Childbirth Intervention to Optimise Maternal Hydration in Labour: Reaching Consensus to Enhance Rigour

Abstract

Introduction

Medical interventions during labour and childbirth have rarely been designed with end-users, including frontline clinicians and consumers of maternity care. This has resulted in difficulties in evidence uptake, translation and acceptability by those who it is designed to help. Diverse views of ‘what is best’ in research interventions and approaches exist, yet arguably, if consensus can be reached, more rigorous and acceptable interventions will ensue. One such area of uncertainty is hydration management in induced labour, with an increasing reliance on intravenous therapy, without high-quality evidence pervasive across maternity settings. Therefore, we aimed to co-design a labour and childbirth intervention to optimise maternal physiology during labour, through evidence synthesis, consumer survey and a consensus-generating activity.

Methods

A multi-modal, intervention co-design study was undertaken. This involved three key stages: evidence-synthesis, consumer-survey and then a modified nominal group technique workshop to reach consensus on the intervention design. The whole process took place between April and November, 2023 in South-East Queensland, Australia.

Results

In total, 96 completed responses were returned in the consumer survey, detailing women's preferences for hydration management during induced labour. This informed a Nominal Group Technique Workshop, inclusive of consumers, midwives, obstetricians, lactation consultants, dietitians, clinical trialists, neonatologists and nurses. Following robust discussion and various viewpoints presented, the expert reference group decided to support an approach whereby women would self-determine their own intake during induced labour and that the routine administration of intravenous fluids as a ‘side-line’ (current ‘standard practice’) to the synthetic oxytocin (labour hormone) infusion for induction of labour would not be routinely administered. In order to provide information/education to women on how best to optimise their hydration, a co-designed information brochure was developed.

Conclusion

What clinicians and researchers may assume is important as interventions and outcomes in a clinical trial may not always align with the opinions and lived experience of consumers. Incorporating co-design into trial protocol development has the potential to improve the relevance of research to the target population. This in turn may improve trial feasibility through enhanced recruitment, intervention and treatment adherence, and fidelity.

Patient or Public Contribution

People with lived experience (inclusive of both first-time mothers who had recently experienced a labour induction; and two maternity consumers involved in advocacy and research work to optimise labour and birth care) were involved in several parts of this study. This included study conceptualisation, data collection and analysis, interpretation and authorship of manuscript.