What is patient’s experience of assisted vaginal deliveries?

Dr Faiza Cheema, Dr Hamdi Dahir, Mr Alex Steshenko

Princess Royal University Hospital, King’s College NHS Trust

Objective: Assisted vaginal birth is common since 10-15% of babies are born with the assistance of a vacuum or forceps. This study aims to evaluate women's experience having assisted deliveries in the room and the operating theatre and what support could improve the service provided.

Design: A prospective survey was performed between November 2022 and January 2023 using a semi-structured questionnaire asking women that had instrumental deliveries to share their experiences.

Method: Patients were randomly selected for the face-to-face or over the phone survey, which asked to grade the care provided by clinicians concerning informed consent, analgesia, assisted vaginal delivery procedure, debriefing and overall experience using a 1 to 10 scale. Also, participants could provide additional information via verbal feedback to the survey doctor. The data was evaluated as sufficient for analysis after collecting 50 cases. The survey was a data collection tool and the data analysis was by descriptive statistics. Common themes were also extracted from patient comments.

Results: Many women found it difficult to rate the quality of discussions of the procedure with clinicians due to the patient's physical and psychological state during labour. Around 27% of patients did not feel their consent was fully informed, and 6% even stated regretting the decision. Only 46% of clients could recall having a debrief with an obstetrician after delivery. Overall, 86% reported not being offered written information leaflets; of these women, 63% said they would not want a brochure due to the intense environment. However, 30% felt having had information in advance would have helped with the experience. One patient experienced an instrumental delivery in the past and had read about the procedure, which enabled her to be more confident in the decision-making process.

Conclusion: Although the experience was satisfactory in most cases, the fact that patients had limited information in advance and felt pressured to decide seemed to impact the quality of care negatively. Providing pregnant women with information about delivery modes in advance may improve informed choices and experience during labour. There was a combination of factors responsible for patients' better experience of assisted vaginal delivery, such as having access to verbal or written information in advance, adequate analgesia, immediate and delayed debriefing after the procedure, and the opportunity for the patient to ask questions. Conducting a prospective survey post-assisted vaginal delivery shows an effective tool for monitoring and improving patients' care and experience.