The acceptability to women of techniques for managing an impacted fetal head at caesarean section and of randomised trials evaluating those techniques: a qualitative study

Abstract

Background This study aimed to explore women’s views on the acceptability of different techniques for managing an impacted fetal head at caesarean; and the feasibility and acceptability of conducting a trial in this area. Methods Qualitative semi-structured interviews with a systematic sample of women who experienced second stage emergency caesarean section at a tertiary National Health Service (NHS) hospital in England, UK. Thematic analysis was used to extract women’s views. Results Women varied in their perceptions of the acceptability of different techniques for managing impacted fetal head. Trust in medical expertise and prioritising the safety of the baby were important contextual factors. Greater consensus was found around informed choice in trials where subthemes considered the timing of invitation, reduced capacity to give consent in emergency situations, and the importance of birth outcomes and having good rapport with healthcare professionals who invite women into trials. Finally, women reflected on the importance of supportive antenatal and postpartum education for impacted fetal head. Conclusions This research provides information on the acceptability of techniques and any trial to evaluate these techniques. Findings illustrate the importance of context and quality of care to both acceptability and approaching women to take part in a future trial.

The acceptability and feasibility of a randomised trial exploring approaches to managing impacted fetal head during emergency caesarean section: a qualitative study

“…Women and obstetricians also raised the importance of the content and format of information being tailored to the circumstances under which it is given. These findings are consistent with previous literature [ 10 , 17 ]. The difficulty of obtaining informed consent in emergency situations has been widely debated.…”

“…Two trial designs were developed based on previous work in the MIDAS study. This work included a national survey of health professionals about current practice [ 9 ]; interviews with women about the acceptability of different techniques [ 10 ]; and a Delphi survey to get consensus on which techniques should be prioritised and tested in an RCT [ 11 ]. The proposed trial designs are summarised in the visual guide in Fig.…”

“…The MIDAS study (Managing an Impacted fetal heaD At emergency caesarean Section) (NIHR HTA 17/75/09) examined the acceptability and feasibility of different techniques of managing impacted fetal head. This programme included a national survey of health professionals about current practice [ 9 ]; interviews with women about the acceptability of different techniques [ 10 ]; a Delphi survey to get consensus on which techniques should be prioritised and tested in an RCT; and the design of two possible RCTs of different techniques for managing impacted fetal head during emergency CS [ 11 ]. Before proceeding to a definitive RCT it is important to explore whether this is feasible and acceptable and which of the two RCT designs is preferred.…”