Table 3 Processes and outcomes of co-design of clinical resources for detecting and responding to possible fetal deterioration during labour

Intrapartum clinical practice tool [38]

• Human factors engineering analysis and usability evaluations with healthcare professionals informed a draft prototype of the tool.

• ABC clinicians involved in the tool’s development presented the draft prototype to the ABC PPI group.

• The ABC PPI group discussed how use of the prototype might impact communication with those in labour and their partners, and made suggestions for improvements.

• The group identified there was no option for the woman’s concerns to be noted and actioned in this draft of the tool.

• The group suggested an additional prompt: “Is the woman concerned?”

• The prompt was incorporated into a subsequent draft prototype, tested with maternity professionals during pilot training evaluations, and incorporated into the final version of the tool.

Multi-professional training package

• Videos of simulations of the approach to detecting and responding to possible fetal deterioration – including use of the prototype tool by a clinical team with service user actors – were produced.

• The ABC PPI group pre-viewed recorded simulations and provided feedback, particularly on how clinical teams were communicating with those in labour and their partners.

• The ABC PPI group reviewed a draft of the training package (trainer’s handbook and set of presentations for training of healthcare professionals), including iteratively co-designing a presentation on communicating and making decisions with those in labour and their birth partners.

• The ABC PPI group also provided feedback on the overall structure and inclusivity of language of the training package.

• Feedback on the simulation videos emphasised the importance of introducing the tool and its potential use for inclusive communication with women and their partners.

• The PPI group suggested use of “conversation starters” to support professionals in their communication during labour. The conversation starters were subsequently developed jointly by the PPI group and facilitators, and incorporated in the training package.

• Review of the training package highlighted the need for further emphasis on shared decision-making, the impact of body language, tone of voice, other verbal aspects of communication, and involving birth partners when communicating during labour.

• Five communication principles developed in a prior consultation with women and birth partners (Supplemental material 2) were integrated in the training package through iterative discussions between the PPI group and ABC clinicians.

• Focused discussions about equity and inclusion suggested further improvements to the framing and language of the training package, with the aim to support staff in encouraging women and giving them space to ask questions and share concerns. This may be especially significant for those of minority ethnicity, who may be less trusting of the NHS [69]. Other PPI recommendations on culturally inclusive language were also integrated in the final prototype of the training package.