A comprehensive representation of the birth-experience: identification and prioritization of birth-specific domains based on a mixed-method design

Abstract

BackgroundIn obstetrics, effectiveness and cost-effectiveness studies often present several specific outcomes with likely contradicting results and may not reflect what is important for women. A birth-specific outcome measure that combines the core domains into one utility score would solve this problem. The aim of this study was to investigate which domains are most relevant for women’s overall experience of labor and birth and should be included in such a measure.MethodsA sequential mixed-method design with three steps was applied. First, the domains were identified by literature review and online focus groups consisting of pregnant women, women who recently gave birth, and their partners. Second, in a prioritizing task, women who recently gave birth and professionals (midwives, gynecologists, and researchers) selected and ranked their top seven domains. Third, the domains that were most frequently selected and had the highest ranking scores determined the basis for a consensus discussion with experts, whereby the definitive list of domains was formed.ResultsIn the first step, 34 birth-specific domains were identified, which cover domains regarding the caregivers, intrapersonal aspects of the mother, partner support, and contextual and medical aspects of birth. Based on the prioritizing task results (step 2) of 96 women and 89 professionals, this list was reduced to 14 most relevant domains. In a consensus discussion, the final seven domains were selected by combining several of the 14 remaining domains and giving priority to the domains indicated to be relevant by mothers. The seven definite domains were: 1) availability of competent health professionals; 2) health professionals’ support; 3) provision of information; 4) health professionals’ response to needs and requests; 5) feelings of safety; 6) worries about the child’s health; and 7) experienced duration until the first contact with the child.ConclusionsThe experienced availability and quality of received care, concerns about safety and the baby’s health, and first contact with the baby are regarded as key aspects for a mother’s overall birth experience. Therefore, these domains are considered to be the most crucial for inclusion in a birth-specific outcome measure.

The Development of a Conceptual Framework and Preliminary Item Bank for Childbirth‐Specific Patient‐Reported Outcome Measures

“…Furthermore, Gartner et al. () developed core domains for women's birth‐specific priorities that were largely consistent with our work. Our work narrows this long‐standing evidence gap and offers a tool for assessment of women's values and preferences for childbirth.…”

Good reliability and validity for a new utility instrument measuring the birth experience, the Labor and Delivery Index

“…A birthspecific utility measure reflecting the course of labor and birth would be more informative, as Petrou and Henderson [5] pled for in 2003. To fulfill this need, we have developed a new birthspecific utility questionnaire, called the Labor and Delivery Index (LADY-X). In a mixed-method study, the view of women who recently gave birth and the view of professionals in the field of obstetrics were investigated and led to the selection of a set of seven birth-specific domains to include in this new measure [14]. Based on the seven selected domains, we formulated items and response categories that construct the LADY-X.…”

“…Development and pilot testing of the LADY-X. A process of domain identification and selection preceded this study, which included a scoping review, focus groups and quantitative methods for domain prioritization of women and professionals and resulted in seven domains: (1) availability of competent professionals, (2) information provided, (3) professionals' responses to woman's needs, (4) professionals' emotional support of woman, (5) feelings of safety, (6) concerns about child's condition, and (7) duration until first contact with child [14]. For each domain, one item with three response categories was formulated and subsequently pilot tested in verbal-probe interviews with eight women who have given birth in the past year.…”

“…Based on the seven selected domains, we formulated items and response categories that construct the LADY-X. Subsequently, in a discrete choice experiment, preference weights were estimated for each birth situation as classified by the LADY-X, to calculate the LADY-X utility score [14].…”

Respect to Women’s Autonomy in Childbirth: A Qualitative Study

“…Enabling women to make aware decisions is an important factor to have a positive childbirth experience (3).…”