Protecting human rights in childbirth

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IDECIDE – a new consent tool is on its way…

You may have heard talk of IDECIDE – a new tool to help healthcare professionals to support women to make informed decisions in labour. In this blog we explain what IDECIDE is, where it came from, and when you can expect to see it in action…

OK, so what is IDECIDE?

IDECIDE is a digital framework for use by healthcare professionals and women/individuals and their partners during childbirth that results in the woman making an informed decision about next steps during her labour. It will take users through the following process on a tablet or electronic device as a guide to discussion:

I – Identify urgency

D – Details of the current situation

E – Exchange objective and subjective information (history, organisational context, woman’s perspective, healthcare professionals’ experience)

C – Choices available (evidence based information will be on the tool – generic at first but in time individualised)

I – I (the woman) confirm my understanding and seek any further clarification needed

D – Decision is made (by woman) and recorded on the tool

E – Evaluation takes place a few days/weeks later using a recorded experience measure

Where did the idea come from?

In October 2017, Birthrights held a seminar in Oxford to look at the opportunities and challenges of implementing the Supreme Court judgement in the case of Montgomery vs Lanarkshire.

The idea of developing an intrapartum (in labour) consent tool, to help healthcare professionals feel confident they had obtained consent and women to feel confident they had made an informed decision, was one of the resulting actions from that seminar.

In April 2018, NHSE and Birthrights convened a wide range of stakeholders to develop this idea, and IDECIDE was born.

Tell me more about Montgomery vs Lanarkshire…

This case clarified that the patient (in all areas of healthcare) is the decision maker, and the role of healthcare professionals (HCPs) is to support any individual patient to make an informed decision. There will be things that the HCP might assume any “reasonable patient” might wish to know but also facts that are “material” to that individual patient that may not be material to others. Consent should follow a two way dialogue about all reasonable options. 

Why an “intrapartum” tool?

It was felt that a tool that could be used in the most urgent and stressful situations, could be used in any other maternity care scenario, therefore the starting point should be that the tool was suitable for use in labour.

But what do service users and healthcare professionals think?

The concept has been tested with two groups of services users and healthcare professionals and the feedback was very positive with some constructive ideas about how it could be developed further.

The tool is being co-produced with service users and healthcare professionals (represented by the Royal Colleges and the British Intrapartum Care Society), as well as with NHS England, Birthrights, NHS Resolution and others.

So when will it be ready for use?

A first digital prototype is in development that will work for a small handful of decision such as augmentation of labour, an instrumental delivery and caesarean. The plan is to have this ready to pilot by summer 2020 before being rolled out more widely. At the same time the project Steering group are looking at sourcing or developing evidence-based information to go on the tool relating to these decisions and planning how staff should be trained.

The tool will continue to be added to and refined over time.

Why should hard pressed maternity staff adopt this new tool?

The feedback from users is clear that the tool will need to be rolled out gradually so that all staff can be properly trained and feel confident using the tool with women. Our hope is that HCPs find this tool empowers them to have choice conversations with women throughout their maternity care, and more confident that they have obtained valid consent.

We have had strong feedback that women will need to become familiar with the tool before they go into labour, so this will need to be made available to women during pregnancy.

Isn’t it too long to use in labour?

The tool will be properly piloted and refined if necessary but it is designed to be a tool where a little or a lot of information can be discussed under each step depending on the urgency of the situation.

What is the recorded experience measure for?

This will give staff feedback on how women found the experience of the consent process, enabling them to develop their skills further. Staff receiving very positive feedback will be able to mentor others.

Is a tool really going to change the culture of consent?

One tool will never be a silver bullet but its introduction will prompt important conversations and reflection. We are confident it will make a significant contribution to changing culture.

What might the future hold?

The tool could be accessed by women who want to learn more about decisions they may need to make in labour, and could be used as a framework for decisions in the antenatal and postnatal periods too.

In the future the tool may contain a whole raft of decisions and give women statistics personalised to them to factor into their decisions.

Who do I contact if I want to know more?

The Maternity Transformation Programme Team at NHS England & NHS Improvement england.maternitytransformation@nhs.net.  Please note the tool is still in its very early stages of development and further updates will follow…

8 thoughts on “IDECIDE – a new consent tool is on its way…”

  1. This sounds like the WHO checklists for theatre. I totally agree with this. As a midwife for over 30 years I must ay I am not always confident the women completely understand interventions as some midwives and doctors panic, they need to discuss with the woman, but some seem to think that discussion outside the room is informed consent! However informed consent in the full throws of labour the woman hasn’t always got full mental capacity, so the tool will need to reflect this.

  2. Informed consent gives power back to the woman to decide what they will or wont allow to happen to their bodies… tools that support this are a wonderful step forward…

    However, the nuances surrounding the way statistics and evidence are presented needs much wider consideration, along with the use of language, tone, what is said and what is unsaid by health providers.

    Despite all the tools we may develop and technology that will in time hugely support practise….the most essential ingredient for satisfaction from women’s experiences remains and always will remain the existence of trusting relationships.

    I would argue that continuity of care and relationships are far more important than more tick boxes and tools.

    • Hi Janine you are right that tools are not a silver bullet – the wider context is extremely important. IDECIDE is raising awareness of the need to build these relationships and have these conversations, even before it has been used in a maternity setting which can only be a good thing!

    • Hi Deborah NHSE are in charge of the IDECIDE development and roll out project but it is on track to be feasibility tested very soon indeed!


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