Are women's expectations and preferences for intrapartum care affected by the model of care on offer?

Abstract

Objective To investigate the effect of service provision on consumer preferences, in particular, whether women who have access to systems of care which offer particular attributes (such as continuity of carer) value these attributes more highly than women for whom the attributes are not a realistic option. Design Simple rating scales and a discrete choice experiment were used to assess the importance to women of different aspects of intrapartum care. Sample and setting The sample consisted of 301 women at low obstetric risk, identified from three geographical areas, each with a different system of maternity care provision. Methods Midwives gave an anonymous, self-completed questionnaire to the women at the booking visit.Categorical data from the rating scales were analysed using the m 2 test. Analysis of the discrete choice experiment was conducted using random effect probit regression. Main outcome measures Women's preference for different attributes of intrapartum care.Results From the rating scales, it appeared that women in the area with least continuity rated this aspect of care significantly lower than women in other areas (P ¼ 0.007). Although the discrete choice experiment appeared to confirm this, the difference was not statistically significant. Conclusions The findings from this study suggest that the systems of care on offer do influence women's preferences for aspects of intrapartum care. Women in areas where continuity of carer was a realistic option appeared to value this aspect of care more highly. The tendency for preferences to be influenced not only by previous experience of a service but also by knowledge of its availability has important implications for the inclusion of consumers' values in deciding whether to introduce innovations in care. It has been suggested that greater consumer involvement may be a useful means of challenging the accepted view of what is important in health services and of facilitating change. However, the findings from this study suggest that consumer views may have the opposite effect. If consumers do prefer what they know, then a policy of tailoring health services to local preferences will simply reinforce current provision of services, reinforcing existing inequalities in the provision of care.

Patient preferences and National Health Service costs: a cost-consequences analysis of cancer genetic services

“…Clarke et al [46] recommend elicitation of patient views on completion of the care process or once they are sufficiently informed to make a judgement. However, Hundley and Ryan [47] and Ryan et al [13] have found that experience and knowledge of the availability of certain aspects of care influence patient preferences and patients report preferences for current service provision. Finally, this study has the limitation of a small sample of patients from which choices were elicited.…”

An ethnographic organisational study of alongside midwifery units: a follow-on study from the Birthplace in England programme

“…1 Research into how women and their families make decisions about where to give birth has tended to focus on home and OUs, with the following factors being consistently important to women: finding a balance between safety and a satisfactory birth experience, the influence of friends, family and doctors, social class and cultural values, 54,55 and the model of care on offer. 56 More recent work has found that women value birth centre care, particularly the environment, personal attention, calm ambience and close to obstetric support if needed, 51,[57][58][59] in essence what is often perceived as 'the best of both worlds'. 58 Longworth et al 60 found that women who chose a home birth valued continuity of care, a homely environment and the ability to make their own decisions regarding interventions.…”

Who decides the position for birth? A follow-up study of a randomised controlled trial

“…4 It has been suggested that the care options available to women influence their preferences for intrapartum care, indicating that the choice of birthing positions in the second stage of labour may be determined more by midwives' advice than by women's personal preferences. 5,6,7 In a recent Cochrane review it was suggested that the influence of midwives on the positions adopted by women during labour and birth, can be regarded as inconsiderate of women's comfort and disempowering. 2 It is well documented that women who have choices and are involved in decision making during labour and birth have an increased sense of control, which optimizes their birth experiences.…”

“…Hundley et al 6 concluded that for 40 % of the women the most important attribute was involvement in decision-making. Very little scientific investigation has considered women's decision-making and preferences for birth positions in the second stage of labour.…”