Ten year follow-up of a randomised controlled trial of care in a stroke rehabilitation unit.

Our quantitative findings indicate that a minority of professionals would recruit to a trial comparing planned caesarean section with planned vaginal birth. However, the qualitative finding—that midwives who favoured a trial did so because of their confidence in the benefits of vaginal birth—adds complexity because it negates the necessary individual professional equipoise. We explored the opinions of senior obstetricians and midwives simultaneously and nationally, and we identified views about a possible randomised trial. To gain unbiased views, we deliberately did not present participants with a protocol, rather than give the impression that a trial was planned. We also believe that evidence about benefits and risks is insufficient to develop a protocol. If caesarean birth were shown to be as safe as normal birth in a non-inferiority trial, the NHS would have to consider whether it would be willing to offer such a choice, given the huge resource implications. If the cost makes offering choice to all women unfeasible then carrying out a trial would be unethical. The ethical, moral, and practical challenges to a trial are considerable and would require involvement of women and society at large.