Audio recordings of birth planning consultations for breech presentation - evaluation of acceptability, relevance, and feasibility of a person-centered intervention (PregAUDIO)

• Applicant: Dr. Anja Lindig
• Subject Area: Public Health, Healthcare Research, Social and Occupational Medicine
• Term: since 2023
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 533716636

Background: The cesarean section rate in Germany has been rising continuously for years and is currently around 30%. In nine out of ten cases, a primary cesarean section is not medically necessary. This usually includes breech presentation of the fetus in the last trimester of pregnancy. In this case, the decision for the mode of delivery (vaginal vs. sectio) is often preference-sensitive. To date, there have been no studies evaluating person-centered interventions to promote shared decision-making and reduce the rate of sectio for breech presentation. Providing audio recording of medical consultations is a simple intervention that has shown positive effects on diverse patient outcomes. It can be hypothesized that pregnant women with breech presentation in the last trimester of pregnancy may also benefit from this intervention based on the medical evidence of the birth modes and the preference sensitivity of the decision. Therefore, the aim of this study is to investigate the acceptability, relevance, and feasibility of providing audio recordings of a decision consultations for planning birth in breech presentation from the perspective of pregnant women and physicians. Methods: In this multicenter mixed-methods study, n=10 decision consultations will be recorded in each of three clinics. Implementation of shared decision-making is analyzed using Observer OPTION5 TM. Afterwards, pregnant women and physicians will listen to the audio recording of their own conversation in semi-structured interviews and will be asked about their attitudes towards acceptance, relevance and feasibility of the intervention. The interviews will be analyzed using qualitative content analysis. Before and after the consultations and before the interview, the pregnant women's decision conflict will be recorded using the Decisional Conflict Scale. Expected Results: This study will provide insights regarding the attitudes of pregnant women and physicians toward the provision of audio recordings of decision consultations for planning birth in breech presentation, as well as the decision-making processes within the conversations. In addition, relevant factors influencing the implementation of the intervention will be evaluated. Discussion: This is the first study in Germany to examine a person-centered intervention in the context of birth planning consultations for breech presentation. A strength of this study is the mixed-methods approach in which decision-making processes within the recorded consultations are evaluated quantitatively and considered in the interpretation of the qualitative data. Providing audio recordings of decision consultations is a simple intervention that, if evaluated positively, can be evaluated for its effects on person-centeredness as well as other patient outcomes.

• DFG Programme: Research Grants
• Co-Investigators: Dr. Pola Hahlweg; Dr. Jördis Zill