Background Maternal request for Caesarean Section (CS) is controversial¹ and yet the NICE CS Guideline² recommends that that if this is requested, following discussion of the risks and benefits, women should be supported in their choice. There was a desire to improve the pathway at Birmingham Women’s Hospital.

Methods Experience-based co-design³ utilises service user and clinical experiences to re-design services. Semi-structured interviewed were conducted to elicit the views and experiences of healthcare professionals (n = 22, 10 consultant obstetricians and 12 midwives) and women (n = 15) who had requested CS (with and without medical indication). Analysis identified ‘touch points’ (key moments or events related to the experience of care), which were compared to themes arising from the HCP interviews. Workshops were then held, initially separately and then jointly to identify areas for improvement and then to re-design services. Ethical approval was obtained.

Results The women’s ‘touch points’ included: repetition of request, feeling judged and poor information. A pathway using ‘audio clips’ demonstrated women’s agreed ‘touch points’ and prompted discussion at the joint workshop. Joint working has resulted in earlier referral for consultant discussion and a decision by 28/40. Recording this in the notes minimises repeated challenge described by women. Final consent and timing of CS remain as recommended. Additional information is now provided at booking to explore mode of birth and additions to the leaflet for women having Elective CS have been made.

Conclusion This methodology provides an opportunity for the views of both service users and clinicians to improve care.