Differences in the Valuation of Birth Outcomes Among Pregnant Women, Mothers, and Obstetricians

Authors

  • Frank P.H.A. Vandenbussche MD,

    1. Frank Vandenbussche is in the Department of Obstetrics and Gynecology; Lieke De Jong-Potjer is at the General Practice Research Institute; Anne Stiggelbout is in the Medical Decision Making Unit; Saskia Le Cessie is in the Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. Marc Keirse is in the Department of Obstetrics, Gynaecology and Reproductive Medicine, The Flinders University of South Australia, Flinders Medical Center, Adelaide, Australia.
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  • Lieke C. De Jong-Potjer MD,

    1. Frank Vandenbussche is in the Department of Obstetrics and Gynecology; Lieke De Jong-Potjer is at the General Practice Research Institute; Anne Stiggelbout is in the Medical Decision Making Unit; Saskia Le Cessie is in the Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. Marc Keirse is in the Department of Obstetrics, Gynaecology and Reproductive Medicine, The Flinders University of South Australia, Flinders Medical Center, Adelaide, Australia.
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  • Anne M. Stiggelbout PhD,

    1. Frank Vandenbussche is in the Department of Obstetrics and Gynecology; Lieke De Jong-Potjer is at the General Practice Research Institute; Anne Stiggelbout is in the Medical Decision Making Unit; Saskia Le Cessie is in the Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. Marc Keirse is in the Department of Obstetrics, Gynaecology and Reproductive Medicine, The Flinders University of South Australia, Flinders Medical Center, Adelaide, Australia.
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  • Saskia Le Cessie PhD,

    1. Frank Vandenbussche is in the Department of Obstetrics and Gynecology; Lieke De Jong-Potjer is at the General Practice Research Institute; Anne Stiggelbout is in the Medical Decision Making Unit; Saskia Le Cessie is in the Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. Marc Keirse is in the Department of Obstetrics, Gynaecology and Reproductive Medicine, The Flinders University of South Australia, Flinders Medical Center, Adelaide, Australia.
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  • Marc J.N.C. Keirse MD, DPhil, FRACOG,. FRCOG

    1. Frank Vandenbussche is in the Department of Obstetrics and Gynecology; Lieke De Jong-Potjer is at the General Practice Research Institute; Anne Stiggelbout is in the Medical Decision Making Unit; Saskia Le Cessie is in the Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands. Marc Keirse is in the Department of Obstetrics, Gynaecology and Reproductive Medicine, The Flinders University of South Australia, Flinders Medical Center, Adelaide, Australia.
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Address correspondence to Frank P.H.A. Vandenbussche, Department of Obstetrics, K6, Leiden University Medical Center, P.O, Box 9600, 2300 RC Leiden, The Netherlands.

Abstract

Background:Decisions are usually based on the perceived merits of alternative approaches. This process can be quantified by combining the probabilities of expected outcomes with their desirability. We studied differences in the valuation of birth outcomes among pregnant women, mothers, and obstetricians, and assessed how these would affect a particular obstetric decision.Methods:In a study conducted at Leiden Hospital, Leiden, The Netherlands, 12 obstetricians, 15 pregnant women, and 15 mothers participated in a standard reference gamble to determine the value of 12 different outcomes: 3 types of birth combined with 4 states of infant outcome. These were then applied to an obstetric decision tree based on the Dublin trial of intermittent auscultation versus electronic intrapartum fetal heart rate monitoring.Results:Contrary to obstetricians, women valued permanent neurologic handicap significantly higher than neonatal death ( p < 0.01). Women expressed no overriding preferences for the type of birth, whereas obstetricians were clearly antipathetic to cesarean section. Within-group consistency was significantly higher for pregnant women and mothers than for obstetricians ( p < 0.0001). However, application of the measured values to the obstetric decision tree merely led to marginal changes in overall expected value of the decision alternatives.Conclusions:Values attached to birth processes and outcomes differ significantly between (expectant) mothers and doctors. These differences should be recognized and respected in obstetric decision making.

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