Table 3 Statements on quality criteria and competencies that reached consensus

I

Interaction around decisions during PREGNANCY

Decisions with more or less equal (treatment) options or decisions with inconclusive evidence that one option is better than the others.

Choice talk

The care provider creates an open dialogue to discuss the choices and decisions based on respect, empathy, trust and comfort.

The care provider explores which role the woman is willing to play in the decision-making process.

The care provider encourages all women to play an active role in the decision-making process and supports her throughout.

Option talk

The care provider is aware of the available evidence, guidelines and decision aids, is capable of assessing their quality, and can apply them to the woman’s individual situation.

The care provider explores what the woman already knows and provides additional or corrective information if necessary.

The care provider provides objective and accurate information on the available options.

The care provider informs the woman using accessible language tailored to her social and cultural background.

The care provider explores available options, also those the woman is not immediately interested in.

The care provider explores the values and preferences of the woman.

The care provider explores the underlying motives for the woman’s preferences.

The care provider gives the woman ample time and space to process this information.

Complex decisions are discussed over the course of several consultations.

With the woman's consent, the care provider will involve the partner in the decision-making process.

The care provider involves the partner in the conversation around information.

The care provider involves the partner in the deliberation of the options.

The care provider respects the woman’s choice to involve a third party in the decision-making process.

The woman should always feel autonomy in the decision-making process.

Decision talk

Once a decision is taken, it is clearly stated.

The care provider verifies whether the decision was understood.

The care provider stresses that the woman can change her mind about her decision at any time.

During the pregnancy, the care provider revisits the decisions that were made.

The care provider will inform other care providers involved in the care for the woman about the woman's decisions and underlying motivations with.

The care provider makes sure that the autonomy of the woman is respected

The care provider makes sure that her/his preference is not forced upon the woman.

The care provider puts forward her/his viewpoint based on evidence about the benefits and harms.

II.

Interaction around decisions during PREGNANCY

Decisions with an option that is clearly better - based on research or experience.

If there is an option that is clearly better, the care provider will explain this to the woman.

The care provider encourages the woman to express her thoughts and opinions.

The care provider listens to and respects the woman's input.

The care provider ensures that the woman has understood the information provided.

If the woman is responsive, the care provider will always ask for informed consent.

III.

Interaction around decisions during BIRTH

Decisions with more or less equal (treatment) options or decisions with inconclusive evidence that one (treatment) option is better than the others.

During the pregnancy, the care provider discusses the possibility of unforeseen decision moments during birth.

During the pregnancy, the care provider explores with the woman possible dilemmas surrounding decisions during birth.

During the pregnancy, the care provider discusses the woman's needs, preferences and expectations concerning labour and birth, and puts the preferences on paper (e.g. in a birth plan).

The care provider makes it clear that the woman can change her mind about any decisions and choices regarding her birth plan.

Preferably, a woman in labour should not be confronted with choices or decisions for the first time.

The care provider exudes calm and takes the time to explain and discuss the situation.

The care provider briefly describes the essence of the situation and the available options.

The care provider always checks whether the woman has heard and understood her/him.

The woman will always be asked for her consent.

IV.

Interaction around decisions during BIRTH

Urgent decisions with an option that is clearly better - based on research or experience.

During the pregnancy, the care provider explains that acute situations may arise during birth that require quick decisions.

The care provider takes a moment to explain the situation to the woman and her partner.

The care provider strives to eliminate a rushed feeling.

During an acute situation, the care provider explains that s/he will take the lead.

If possible, the care provider obtains the explicit consent of the woman before taking any measures.

The care provider will discuss the situation again after the birth.

V.

Competencies

Establish a relationship and open dialogue with the woman (and her partner) based on respect and recognition of cultural diversity.

Evaluate available evidence and experience, and provide the woman with accurate, honest information in the context of her individual situation.

Enable and activate the woman to participate in the decision-making process, support her to deliberate about the options and express her preferences and views.

Reduces tension and guides the process to reach a shared decision.