II: Feasibility and acceptability.
W014)If
SAID
The second area for consideration identified a number of issues raised by obstetricians and women about the acceptability and feasibility of conducting a trial into ways of managing impacted fetal head. A key theme raised by obstetricians was about being randomised to a technique that might cause conflict between the trial and individual/site practice for managing impacted fetal head, which might be a barrier to taking part in a trial. At an individual level, obstetricians pointed out that different individuals preferred or were familiar with different management techniques.We're all … even though the procedure is similar but we're all completely different because we are influenced by previous outcomes, bad outcomes, by how many you have done. (HCP06).I would need to be demonstrated how to use the fetal pillow because I haven’t done that. (HCP08)I actually haven't had much training to be honest with you because we are so used to using the push technique here and I'm so used to using it. (HCP06)Similarly, obstetricians mentioned that techniques required by the trial might conflict with existing site practices.Getting us to revert to doing the push technique will require some bit of groundwork done just to convince our clinicians to also give it a bit of a trial so yeah … already we … we use the fetal pillow anyway. (HCP09).So, I think for me, in my unit, I wouldn’t want to take part in the study… because my trainees are trained to anticipate an impacted head when they have done an unsuccessful forceps delivery. And to then ask them not to do those things. (HCP05).However, obstetricians were aware that a trial is needed to reduce this variation in practice between obstetricians and sites in order to provide safer care.I know that there is no recommended ideal and I also know that the way we improve quality in our service is to minimise variation and, therefore, having a trial proven best approach would potentially make for a safer obstetric care. (HCP08).Given the variation between individuals and sites, obstetricians emphasised the importance of training in the different techniques prior to the trial so health professionals taking part were clear and confident in using them.I would want to know what appropriate training consists of for fetal pillow, given the lack of any validated training, and if, if it’s within an actual research context, then yes. (HCP04).Training will be, you said that, you know, maybe training developed, delivered by your team that will be great….Because that would have more credibility and give people confidence. (HCP03).I mean I would suppose that the training would have to be done through a simulator to begin with, it's probably much easier. (HCP06)Women were less explicitly aware of variation between individuals and sites but were concerned that obstetricians may be more experienced in, or favour, a particular technique. Women felt this would affect the obstetrician’s confidence and therefore influence women’s willingness to be a part of the trial.I just want the tried and tested technique and it might be that this particular doctor's better at one than the other, or more experienced in one than the other (ECS W014)If they're not confident then that's gonna be a major issue. Um, that's it, I think. (ECS W011)Women also highlighted that it may not be acceptable to ask obstetricians to perform a technique they are not comfortable with.I think the other, in terms of acceptability for me would be more is it, is it, is it acceptable to make an obstetrician do something that they don’t feel as comfortable with. (ECS W002).Overall, women said they would trust health professionals’ judgement if impacted fetal head arose and would expect the team to do the most appropriate technique regardless of the trial. Women had confidence that the obstetrician would use their expertise to deliver the baby safely and would be happy to trust in their judgement.any interventions during birth, I know that I’d actually be quite happy to, I would be pretty oblivious and would just go with whatever the doctor wanted to do… there’s not enough of a difference between the two that would strike me as wanting a preference but I don’t know if that’s down to my nature of I’ve always sort of said to myself I am quite happy to trust the team, the medical team’s judgement. (Primiparous W015).Obviously the, the discretion of the Midwife or the Obstetrician who is, thinks it’s the best care for the child. But then ultimately if the OB says well this is the best thing for it then you have to listen to a professional opinion (Primiparous W018).Several women discussed it being important to them to be made aware of what plans would be in place if the technique they were randomised to did not work to manage impacted fetal head. Specifically, their opinion of acceptability dependent on confidence that the obstetrician could move onto a different technique if needed.I suppose I’d be comfortable if you said okay, we’ll try it for X period of time and then there’s plan B which we can move to quickly… then that would give me some confidence. (ECS W003).Most women also considered the idea of a trial acceptable and valued it’s importance in improving care.I think they’re an important part to you know, research and study and the only way we can improve is by trying things out.(ECS W010)There’s no evidence one way or another that either technique is better, so you, we need that evidence. So, I think it’s, I feel like it’s acceptable, because we don’t know the right one, so you know, … we should find out (Primiparous W001).