What matters to you? Improving the adoption of shared decision-making for birth planning in women with chronic hypertension: a multicentre multiple methods study

PMCID: PMC12182189

PMID: 40527566

DOI: 10.1136/bmjopen-2024-094607

Journal: BMJ open

Publication Date: 2025

Authors: Whybrow R, Chappell L, Webster L, Girling J, Brown H, et al.

Key Points

• Women with chronic hypertension experienced limited involvement in birth planning, with only 34.6% of case notes documenting patient participation
• Caesarean section rates were high (52.7%), significantly higher than the general population's 30%, indicating potential over-medicalization
• Implementing SDM strategies, including professional training and personalized information provision, could improve patient trust and care experiences

Summary

This multimethod study explored shared decision-making (SDM) in antenatal care for women with chronic hypertension across three NHS hospital trusts. Researchers used case-note review (n=55), structured observations (n=18), and qualitative interviews with healthcare professionals and patients to assess the implementation of evidence-based practice in birth planning for high-risk pregnancies.

The findings revealed significant gaps in patient-centered care: despite aligned communication practices, only one-third of case notes documented women's involvement in birth planning. Structured observations showed that only one-fifth of women received personalized information, half were encouraged to share preferences, and one-third were offered choices about birth timing or mode. The study highlighted that uncertainty about optimal birth timing and a tendency toward paternalistic decision-making were primary barriers to effective SDM, with healthcare professionals often making decisions without comprehensive patient engagement.