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Table 3 New pathway for women who request Caesarean Section

From: Improving the care pathway for women who request Caesarean section: an experience-based co-design study

The new pathway is as follows;  
• At booking-leaflet titled ‘Information about the way your baby may be born’ given to woman with information that there will be a discussion about mode of birth around 16 week appointment
• At 16 weeks - Community Midwife discusses type of birth the woman is considering; If woman requests caesarean section:
 o Assess and consider individual to see whether an appointment with health care professionals for support and information would be useful (e.g., Consultant Midwife, counsellor) Examples include previous traumatic or difficult birth, de-brief, anxious/tocophobia, undecided. Following that consultation if Caesarean section requested refer to Consultant Obstetrician.
 o If woman has decided on Caesarean section, make referral for consultant obstetrician appointment at 20/40
• At 20 week appointment with consultant obstetrician-detailed discussion re mode of birth:
 o Risks and benefits explained
 o Detailed documentation of discussion and current preferences
 o Book appointment for 24–28
• At 24–28 weeks appointment with same obstetrician
 o Make decision / agreement / consent about type of birth and document clearly in hospital and hand held records the final decision for type of birth that is planned (possible use of sticker or proforma in casenotes)
 o Discuss plans for what happens if woman goes into spontaneous labour prior to date for elective Caesarean section, including differing risks and benefits depending on stage in labour and emergency vs elective Caesarean section
 o Give Elective Caesarean section leaflet
• At every subsequent antenatal appointment re-confirm (not challenge) decision (e.g., ‘Are you happy with the plan made?’) which provides opportunity for woman to change her mind but not to be repeated challenged about her decision. If booked for Caesarean section and changes her mind an appropriate plan for birth will be made dependent on individual circumstances
• If previously midwife led care, then woman will remain under shared care but all other appointments (except 36/40) can be in the community
• Sign consent form (if not already signed) at 36/40 and book Caesarean section for 39/40