Objectives: To understand differences between birth expectations and experiences, and to explore possible reasons for mismatches. Design: Online survey Setting: UK Population: Postnatal primiparous (PP) and multiparous (MP) women within 5 years of a birth Methods: Survey advertised on social media, Participants completed questions relating to birth expectations, experience and preparedness. Data were analysed descriptively and presented overall and by parity. Results: Of the 819 women, 40% expected birth to be straightforward [PP 29% vs MP 51%], 20% anticipated difficulty [PP 22% vs MP 19%], and 40% [PP 51% vs MP 30%] were unsure. Among the 737/819 whose birth was not exactly as expected, 44% [PP 30% vs MP 47%] found it better than expected, while 56% [PP 66% vs MP 38%] found it more difficult. Unplanned births were higher in those with difficult experiences, particularly for primiparous women [PP 58% vs MP 23%]. Women cited quicker births, fewer complications, and better coping as reasons for positive experiences, while complications, pain, and slower labour contributed to difficulties. Overall, 77% (633/819) [PP 64% vs MP 80%] of women felt very or somewhat prepared for birth. Among them, 76% (484/633) [PP 88% vs MP 69%] had attended antenatal education. However similarly, 75% (130/174) [PP 80% vs MP 66%] of those who felt less prepared had also attended antenatal education. Conclusions: Most women have an element of expectation-experience mismatch. Over half in the found birth more difficult than expected, this suggests current approaches to birth preparation may be inadequate. Further research into reducing the expectations-experience gap is needed.

Background: In 2023-24, 33% of labours were induced in England. The prostaglandin dinoprostone is commonly used, but evidence is increasing that misoprostol may be a better alternative. Objectives: Compare the efficacy and safety of vaginal dinoprostone with vaginal misoprostol for labour induction. Search Strategy: Electronic databases (Medline, Scopus, CINAHL, Cochrane Central Register) were searched in 2025. Selection Criteria: Randomised controlled trials comparing singleton, term inductions with vaginal dinoprostone or misoprostol published after 2000. Primary outcome was vaginal births within 24 hours. Secondary outcomes included birth mode, induction to birth interval, oxytocin augmentation, uterine hyperstimulation and adverse maternal or neonatal outcomes. Data Collection and Analysis: Data extraction used a standardised proforma including the Cochrane Risk of Bias. A random effects meta-analysis was performed using R. Main Results: From 8,529 records, 44 papers reported 7,040 participants induced with vaginal misoprostol and 6,604 with dinoprostone. Risk of bias was moderate. Participants given misoprostol were 48% (OR 1.48 95% CI 1.20, 1.84) more likely to achieve vaginal birth within 24 hours compared with those given dinoprostone, although heterogeneity was high. The rates of the above-mentioned secondary outcomes were comparable. In the misoprostol group, fewer patients required augmentation with oxytocin (OR 0.51 95% CI 0.40, 0.65). Conclusion: Induction of labour with vaginal misoprostol seems to improve the rate of vaginal birth within 24 hours when compared to dinoprostone without increasing the incidence of adverse events with fewer patients requiring oxytocin augmentation. We encourage consideration of vaginal misoprostol as a first-line agent for labour induction.

Objective: To design and validate an instrument to measure birth expectations (EXPECTBirth). Design: Mixed methods instrument development study Setting: Online maternity services users and in-person at a maternity unit Population: Pregnant women Methods: 1) systematic review of birth expectations to identify instrument content, 2) think aloud interviews to iteratively develop instrument, 3) online survey for exploratory analysis and item reduction, 4) Rasch analysis to select best functioning items and 5) responsiveness to change test was assessed using data from an antenatal education intervention development study 6) test-retest reliability using responses from 3, 7) external validity compared to existing gold standard. Main outcome measures: EXPECTBirth tool for assessment of expectations of birth which can be positive, negative or neutral. Results: An initial 45 item questionnaire was developed based on the systematic review and modified in 14 think aloud interviews. 255 women completed the online questionnaire (elements 3,6,7) and 110 participated in the antenatal education intervention (elements 4&5). The applied statistical procedures led to a 12-item tool for measuring birth expectations that presents satisfactory overall responsiveness to change (Cohen’s average effect size 0.35, showing moderate responsiveness), test-retest reliability (Spearman Co-efficient 0.83 p<0.001) and performs well against the existing gold standard Slade-Pais tool, all subscales being at least moderately correlated (rho 0.25 and 0.71). Conclusions: The EXPECTBirth tool can be used to assess expectations of birth quickly and in a neutral manner. It can be used to investigate whether antenatal interventions alter expectations of birth, or whether expectations vary within and between groups.

Objective Spontaneous vaginal births are often the presumed choice and represent 45% of UK births. However, information is inconsistently given about benefits and risks. This impacts decision-making and experience. A Core Information Set (CIS) is an agreed set of information points discussed prior to a decision. We aimed to develop a CIS for vaginal birth. Design Information points were identified from a literature search, patient information leaflets, interviews, and a survey. These informed a two-round Delphi survey, where stakeholders voted on the importance of items for inclusion. Items supported by >80% of participants were discussed by 28 parents and professionals at consensus meetings. The final CIS was populated with an engagement group ensuring accessibility. Setting The study took place in the UK, with participants recruited online. Population Pregnant and postnatal women, birth partners, healthcare professionals, medico-legal professionals and people working for interested/relevant organisations. Main outcome A CIS for vaginal birth. Results 77 information items were identified. In round 1 (631 participants) of the Delphi Survey, 84.5% were from the patient group and 15.5% from the professional group; in round 2 (228 participants), 74.3% were from the patient group and 25.7% from the professional group. 28 items met the criteria for consensus discussion. The final CIS includes 19 information points addressing: labour process, pain relief, labour complications, procedures or interventions during labour, experiences after birth, outcomes for the baby and environment during labour. Conclusions This CIS can be used to facilitate discussions and support informed decision-making about vaginal birth.

Objective: This study aims to develop a core information set (CIS) for induction of labour. A CIS is an agreed set of information points for discussion prior to an intervention. Design: First a long list of information points was identified through a systematic review of reviews, reviewing patient leaflets, analysis of pre-existing qualitative interviews and an initial stakeholder survey. A long list of items was collated before combining and refining alongside an involvement group. Cognitive interviews were undertaken to refine the Delphi Survey before a two-round modified Delphi process where participants voted on the importance of the information items. Pre-specified criteria were used to select the items taken forward to a consensus meeting. Participants were recruited via UK hospital sites, online and social media platforms and included parents and professionals. Setting and population: Participants were recruited via UK hospital sites, online and social media platforms and included parents and professionals. Main outcome: A core information set for induction of labour. Results: 199 information points were identified through systematic review (110), patient information leaflets (162), qualitative interviews (58) and a survey (93). 46 unique information items entered the first Delphi round after 4 cognitive interviews, 2 items were added following round 2. 368 people (310 parents/ 58 professionals) participated in round 1 and 177 people (154 parents/23 professionals) in round 2. 44 items met inclusion criteria; 1 item excluded, and 3 items were carried forward for consensus meeting discussion where 12 overarching information points were agreed upon. Conclusion: This CIS can help to inform and support discussions about induction to enable parents to make informed decisions about birth.

Objective: To identify which risk communication graphics are easiest to understand when communicating risks surrounding birth; and investigate the effect of numeracy and health literacy on understanding. Design: Online survey with randomised content Setting: UK Population: Women and their partners, healthcare professionals and stakeholders in the UK. Methods: Seven candidate graphics (’10-person’, ‘100-person’, ’10-circle’, ‘100-circle’ icon arrays, ‘bar charts’, ‘pie charts’ and ‘words’) were co-produced with a patient and public involvement group. These were used to develop seven online surveys. Participants were recruited using social media and adverts in participating hospitals. Each participant was randomised to see one of seven surveys, the survey questions remained the same, the graphics varied. Data were collected on risk perception, perceived ease of understanding and preference, alongside demographic factors, numeracy skills and health literacy. Main outcome measures: Objective comprehension and subjective preference for graphics. Results: There were 858 participants, 771 women/partners/parents and 87 healthcare professionals and stakeholders. 70% of participants answered all four numeracy questions correctly, and respondents reported high health literacy (76.5% can understand health material, 72.8% were comfortable completing medical forms). All graphics were understood; however, the ‘100-person’ icon array elicited the best score when comparing two risks (mean score 97.5% compared to next best performing graphic 95.8%), 41% believed it was the easiest to understand and 36% selected it as the preferred graphic. Conclusions: All graphics are well understood. The ‘100-person’ icon array scored best in terms of risk comparison and participant preference. Using this graphic may support high-quality communication of risk in maternity care.

Objective To develop a caesarean birth core information set. Caesareans are the most common surgery performed in many countries. Women need information for informed decision-making and consent. Core information sets (CISs) provide baseline information, agreed upon by parents and clinicians, for discussion before a procedure. Design Two-phase consensus study using modified Delphi. Setting United Kingdom, 2024 Sample People planning a pregnancy/currently pregnant/new parents and maternity professionals Methods Phase 1: Long-list of information points identified from 273 systematic reviews, 50 patient leaflets, three pre-existing qualitative studies, and a stakeholder survey (n=230); Operationalised into a Delphi questionnaire comprising 11 information points with 108 items. Phase 2: Think-aloud interviews (n=9) informed questionnaire restructure into information about planned caesarean birth, unplanned caesarean birth (within 72 hours), and emergency caesarean birth (EMCB; ≤30 minutes), followed by two-round Delphi survey and consensus meetings. Results N=360 participated in the Delphi survey Round 1. All items were carried forward, and three were added for Round 2 (n=188/56.4% attrition rate). From Round 2, one item was removed, 73 included, and 37 items no-consensus. Free-text responses identified an unmet need for a postnatal EMCB-CIS. Over four meetings (n=36) consensus was reached for an antenatal-caesarean-birth-CIS (14 points), EMCB-CIS (5 points), and a postnatal EMCB-CIS (12 points). Conclusions This study has established three caesarean birth CISs to support informed decision-making discussions between women and clinicians: (1) CIS for planned and unplanned caesareans when there is time for discussion; (2) CIS for EMCB (within 30 minutes); (3) CIS post-EMCB pre-hospital discharge.

Objective To develop a core outcome set for stillbirth care. Design Consensus development study. Setting International. Population 542 participants from 29 countries, including 381 parents or family members who have experienced stillbirth, 192 care professionals and researchers (31 of which identified as both parent and professional). Methods Modified Delphi method and Modified Nominal Group Technique. Results A long list of 108 potential outcomes was developed by combining outcomes reported in 240 stillbirth care studies with those derived from interviews of 40 parents and family members with lived experience of stillbirth. Following a two-round Delphi process with consensus meetings, stakeholders agreed upon 8 core outcomes to measure in all stillbirth care studies; an additional 11 outcomes for specific interventions or care were also decided. Core outcomes for all stillbirth care studies were life-threatening complications and maternal death, parents’ experience of respectful and supportive care, grief, mental health and emotional wellbeing, isolation, stigma, impact on work, impact on relationship with immediate family. Outcomes for studies assessing interventions to understand the cause of stillbirth (investigations): cause of death identified and parents’ understanding of cause of death. Outcomes in studies assessing subsequent pregnancy after stillbirth: antenatal complications for mother, antenatal complications for baby, survival of baby, neonatal outcomes and attachment to baby. Outcomes for when a stillbirth occurs in a multiple pregnancy: Survival of other baby/ies, preterm birth, pregnancy complications for baby/ies and neonatal outcomes. Conclusion This core outcome set for stillbirth care should now be used in future trials and systematic reviews to ensure that outcomes considered important by a range of stakeholders are addressed, and to minimise outcome reporting bias.

SARS-CoV-2 has had a significant impact on pregnancy outcomes due to the effects of the virus and the altered healthcare environment. Stillbirth has been relatively hidden during the COVID-19 pandemic, but a clear link between SARS-CoV-2 and poor fetal outcome emerged in the Alpha and Delta waves. A small minority of women/birthing people who contracted COVID-19 developed SARS-CoV-2 placentitis. In many reported cases this was linked to intrauterine fetal death, although there are cases of delivery just before imminent fetal demise and we shall discuss how some cases are sub-clinical. What is surprising, is that SARS-CoV-2 placentitis is often not associated with severe maternal COVID-19 infection, and this makes it difficult to predict. The worst outcomes seem to be with diffuse placental disease and occurs within 21 days of COVID-19 diagnosis. Poor outcomes are often pre-dated by reduced fetal movements, but are not associated with ultrasound changes. In some cases, there has also been maternal thrombocytopenia, or coagulation abnormalities, which may provide a clue as to which pregnancies are at risk of fetal demise if a further variant of concern is to emerge. In future, multidisciplinary collaboration and cross-boundary working must be prioritised, to quickly identify such a phenomenon and provide clinicians with clear guidance for reducing fetal death and associated poor outcomes. Whilst we wait to see if COVID-19 brings a future variant of concern, we must focus on appropriate future management of women who have had SARS-CoV-2 placentitis. The histopathology reports with pathologies of chronic histiocytic villositis and/or massive perivillous fibrin deposition fill clinicians with concern about future pregnancy outcomes. However, we must remember, that in the context of a cause (SARS-CoV-2) and no other history of concern, it is not likely that SARS-CoV-placentitis will recur, and thus a measured approach to subsequent pregnancy management is needed.

Objective To explore and characterise maternity healthcare professionals’ (MHCPs) experience and practice of informed decision-making (IDM), to inform policy, research and practice development. Design Qualitative focus group study. Setting Online with MHCPs from a single maternity unit in the Southwest of England. Population MHCPs who give information relating to clinical procedures and pregnancy care and are directly involved in decision-making conversations purposively sampled from a single National Health Service (NHS) Trust. Data collection: A semi-structured topic guide was used. Data Analysis: Reflexive thematic analysis . Results Twenty-four participants attended seven focus groups. Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time, and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve IDM. There were communication challenges with women/birthing people who do not speak English. Three controversies were explored in the controversies theme: the role of prior clinical experience, the validity of informed consent when women/birthing people were in pain and during emergencies, and instances where women/birthing people declined medical advice. Conclusions We found that MHCPs are committed to IDM but need better support to deliver it consistently. Structured processes including core information sets, communication skills training and the decision support aids may help to standardise the information and better support IDM.