2. Background
Portsmouth Hospitals has a large maternity service with over 6000 births per annum
There are 3 free standing midwifery led units (FMU), an alongside midwifery led unit (AMU), home birth service and a consultant led labour ward
The ‘Nurture’ programme implemented an integrated model to provide one to one midwifery care in labour
BUT In 2011/12 only 10.9% of births were out of hospital

3. Giving birth is generally very safe in all environments
Birth in MLUs offers considerable benefits for mothers
High normal birth rate
Lower intervention
Less costly

4. Too many questions!
How do we increase the number of women expressing their preference for place of birth?
How do we give information to mothers about their choices?
How do we help mothers and midwives understand the Birthplace research?
How do we design something that is what women want and will use?
How do we influence the people who influence the mothers?
How do we encourage an informed shared decision for place of birth?

5. Health Foundation Shine Award £80K Objectives
• Develop a web application accessible on computers,
smartphones or tablets
• Provide a decision tool for prospective parents and
midwives by providing clear, evidence based, unbiased
information
• Incorporate data to show national and local statistics
• Enable parents to consider their thoughts and feelings
around place of birth
• Provide summaries of key information about their
preferred place of birth as a prompt at the discussion
at 36 weeks

6. Learning 1 Don't underestimate the scale of the project
Set up a steering group
Appointed a project manager
Appointed a technical designer
Worked with women to develop the tool
Appointed Midwife leads
Designed the audit tool
Identified pilot cohort of women
Trained the midwives
Evaluation
Enhanced the graphics
Spread-local, regional, national, world!!!
Marketing

7. Learning 2 Getting the right people involved
Project lead-in a position of influence
A dedicated project manager
Women's participation lead
Midwifery clinical experts, clinicians and consultant midwife
A researcher
A technical expert
Finance
Midwife training leads

8. Learning 3-have a clear structure
Service Governance framework
MY BIRTHPLACE STEERING GROUP
System
Specification
Sub Group
Comms
sub Group
Data collection and analysis
Implementation and training
Final Report Group
SPREAD AND MARKETING

9. Conception to birth with a long labour!

10. Developing the app. Learning 4-ask the end user early!!
First design and ideas very basic
Focus groups of women reshaped information and design-simple representation of data
Linked to other information (eg original research, hospital tours)
Graphics are important
Involve IT early
Understand the differences in the applications (eg web based, app available in an app store and specific to devices)

12. Pilot
The 30 midwives received training in July 236 mothers (target 250) were given access to the app via a leaflet with a QR code after 20 weeks 167 women went on to have their babies in October or November 2013

13. Outcomes Data analysis
Personal feedback from mothers-interviews Personal feedback from midwives-focus groups
App survey

14. Preference for place of birth recorded at 12 and 36 weeks for women in the pilot group who gave birth in October or November 2013.

15. Personal Feedback
“I am incredibly excited about this app as I think there was a total lapse in women's knowledge in their choices of place of birth and this app will ensure that all women have the information to make an informed and educated choice of where they would like to have their baby. It’s ground-breaking and I’m so proud to have been a part of it.” (Midwife)

16. Good Practice we would share with others include:
• Make sure you always work with the end user
to develop the app
• Get key personnel in place early – Project
Manager, clinical leads etc
• Cost in the expert time that is required
• Give time to training of any staff that may be
involved in the project
Think about regular revisions and re-launch

17. Our trademark

18. What are we doing now?
PhD studentship with Bournemouth University -evaluation
Local roll out to all areas started June 2014
Funding for regional roll out awarded all Trusts in Wessex
Individual Trusts interested - process and contract developed
Intention to develop more apps for shared decisions
Marketing-conferences, papers (RCM), awards
Sited as best practice in NICE guideline for intrapartum care

19. However
The numbers of births in freestanding MLUs have still not increased
The number of births off the labour ward is now 25%
The normal birthrate is higher than the national average-Nov %!!!
A new project has started to fully implement a full shared decision making programme based on The Health Foundation MAGIC

20. Gill.walton@porthosp.nhs.uk http://mybirthplace.org/portsmouth/
Questions?