Women
EVENTS, FAILED INSTRUMENTAL DELIVERY
Women who had a second stage CS in the prior 24 months were identified from hospital records by a research midwife. Both urgency of CS (emergency versus elective) and indication for CS (failed instrumental delivery) are mandatory reporting fields on the maternity dataset, enabling eligible women to be identified. To try to ensure a representative sample, all women who were eligible over a 24 month period were identified from medical records. Of these, 80 were invited to participate: 43 who lived in deprived areas (i.e. an Index of Multiple Deprivation Decile (IMD) of 1 or 2) and 37 in other areas (IMD of 3–10).Women who had a second stage CS were sent a letter of invitation and participant information sheet. Women were also invited via social network channels. Women who were interested in taking part returned a pre-paid postcard to the research team indicating their interest, providing contact details, and a signed consent form. Consent forms were signed and dated by the participant before they entered the study and checked by the research team who provided a countersignature upon receipt. The master files and documents were held by City, University of London in secure, locked facilities. At the end of the study documents were archived electronically and hard copies destroyed.Pregnant and primiparous women were invited to take part through letters of invitation from the NHS teaching hospital and via social media networks (e.g. Twitter, LinkedIn, Facebook). Letters of invitation were sent to 80 pregnant women under the care of the NHS teaching hospital. Social media invitations used a digital poster which provided brief information about the study and contact details of the research team. Women who were interested in taking part were asked to contact the research team. All participants were sent a participant information sheet and consent form which they then returned to the research team.For women in both groups telephone or online interviews were arranged for a suitable time and conducted by a research psychologist experienced in conducting qualitative research. Interviews were conducted between October 2020 and February 2021. At the beginning of the interview, participants were asked to provide basic sociodemographic information such as age, ethnicity and relationship status. A semi-structured interview was then conducted which lasted approximately 45 min. The interview covered: (i) verbal descriptions of the push technique and fetal pillow; (ii) acceptability of different techniques; (iii) willingness to be involved in a trial of this type and (iv) a description of the two proposed trial designs using Fig. Proposed RCT designsThe interview was conducted by a researcher who was unaware of the participants’ childbirth details. If women wanted more information about their birth events and/or a referral to an obstetrician to find out more they were encouraged to contact their GP. The number of interviews conducted was dependent on women’s availability and data saturation. All interviews were audio recorded and transcribed.