'Birthplace - Your Choice' A Smartphone Application Designed to Aid Informed Decision Making on Birthplaces for Primigravida Women in New Zealand
Birthplace choices influence maternal and neonatal outcomes. Despite popular belief, International, New Zealand and local research confirms that birthing in an obstetric hospital does not improve maternal or neonatal outcomes for healthy, low-risk women and their babies. Research evidence agrees that it instead, increases the likelihood of unnecessary medical interventions leading to maternal and neonatal morbidities. Health outcomes for birth planned at home or in midwife-led birthing units is safer for mothers and as safe as an obstetric hospital for babies, yet in New Zealand the majority of women choose to birth in an obstetric hospital. Knowledge on birthplace options and outcomes is hindered by a lack of easily accessible, user-friendly, evidence-based information. Worldwide ehealth technologies are increasing in use with Smartphone healthcare applications (Apps) being increasingly integrated into mainstream healthcare as monitoring and information tools. The main aim of this research was to develop an ehealth Smartphone App called 'Birthplace - Your Choice' This App would provide evidence based, accessible information that focused on: birthplace choices; outcomes for mothers and babies giving birth in hospital, midwife-led birthing units and at home; obstetric interventions; and the benefits of physiological birth.
This prototype App was developed as a Patient Decision Aid Tool in collaboration with Centre for Learning and Teaching, Auckland University of Technology. International Patient Decision Aid Standards criteria, decisional-conflict measurements, information processing, ehealth frameworks and communication theories informed App development. An extensive literature search was conducted to provide evidence-based content. ‘Birthplace – Your Choice’ includes New Zealand specific statistical data which makes this project unique to the birthing population information needs. The statistical likelihood of vaginal birth, caesarean, water-birth, bleeding after birth, perineal trauma, Apgar score and admission to neonatal intensive care unit is presented. Information on transfer from home or midwife-led birthing units to hospital is also provided. Written text, drop-down information options, interactive quizzes and interactive infographics are provided to engage the user with the content.
Prototype testing involved a small sample of four primigravida women who each answered a questionnaire before using the ‘Birthplace – Your Choice’ App and another a week after use. Observational notes were also recorded on navigation and usability while the App was being used.
Results: Use of a New Zealand specific Smartphone App has potential in aiding low-risk primigravida women in making informed decisions on their birthplace and understanding childbirth choices. The four women desired information on Birthplace options and deemed this important to make informed decisions yet none was available that was easily accessible. The women expressed their frustration at having to rely on their midwife, family and friends for information which they recognised as potentially biased. The provision of credible information via a Smartphone was appreciated and validated as a suitable platform to deliver such information. The fact that this information could be shared and discussed with others and freely accessed, improved its acceptability. Three of the women stated that the content of the App increased their confidence that they had made the right choice to birth at a midwife-led birthing unit. One of these women who tested the App at 38 weeks’ gestation stated that had she had this information earlier she would have likely chosen a homebirth. The last woman had chosen to birth at a hospital but changed to a midwife-led birthing unit after using the App. This demonstrates that women prefer and may benefit from being able to access evidence-based information on birthplace options in New Zealand. New Zealand women make their birthplace decision early in, if not before, pregnancy. This demonstrates the need for high quality information on birthplace options and outcomes to be easily accessible if any improvements in informed decision making is to occur. By explaining the benefits of physiological birthing for mother and babies, along with information on birthplace options and outcomes, the ‘Birthplace – Your Choice’ App fills a gap not being met by any current Public Health initiatives in this country. Further App development and a larger sample size is needed for meaningful statistical analysis that can measure any effect of the App on choice of birthplace. ‘Birthplace – Your Choice’ offers potential as an ehealth tool to improve education on Birthplace options, obstetric interventions, maternal and neonatal outcomes and the benefits of physiological birth. Potential benefits for maternity Stakeholders include a reduction in costs and staffing demands if exposure to accurate birthplace information results in a shift away from birth in hospitals.