Women’s Preferences for Aspects of Labor Management: Results from a Discrete Choice Experiment

Authors

  • Graham S. Scotland MSc,

    1. Graham Scotland is a Research Fellow and Paul McNamee is a Reader at the Health Economics Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen; Helen Cheyne is a Research Programme Leader and Vanora Hundley is an Honorary Senior Lecturer at the Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling; and Carol Barnett is a Senior Midwife at the Directorate of Public Health, National Health Service Tayside, Dundee, United Kingdom.
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  • Paul McNamee PhD,

    1. Graham Scotland is a Research Fellow and Paul McNamee is a Reader at the Health Economics Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen; Helen Cheyne is a Research Programme Leader and Vanora Hundley is an Honorary Senior Lecturer at the Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling; and Carol Barnett is a Senior Midwife at the Directorate of Public Health, National Health Service Tayside, Dundee, United Kingdom.
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  • Helen Cheyne PhD,

    1. Graham Scotland is a Research Fellow and Paul McNamee is a Reader at the Health Economics Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen; Helen Cheyne is a Research Programme Leader and Vanora Hundley is an Honorary Senior Lecturer at the Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling; and Carol Barnett is a Senior Midwife at the Directorate of Public Health, National Health Service Tayside, Dundee, United Kingdom.
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  • Vanora Hundley PhD,

    1. Graham Scotland is a Research Fellow and Paul McNamee is a Reader at the Health Economics Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen; Helen Cheyne is a Research Programme Leader and Vanora Hundley is an Honorary Senior Lecturer at the Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling; and Carol Barnett is a Senior Midwife at the Directorate of Public Health, National Health Service Tayside, Dundee, United Kingdom.
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  • Carol Barnett MPH

    1. Graham Scotland is a Research Fellow and Paul McNamee is a Reader at the Health Economics Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen; Helen Cheyne is a Research Programme Leader and Vanora Hundley is an Honorary Senior Lecturer at the Nursing Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling; and Carol Barnett is a Senior Midwife at the Directorate of Public Health, National Health Service Tayside, Dundee, United Kingdom.
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  • This study was funded by a research grant from the Chief Scientist Office of the Scottish Government Health Directorates (CZH/4/2450), Edinburgh, Scotland. The views expressed here are those of the authors and not necessarily those of the Scottish Government Health Directorates.

Address correspondence to Graham S. Scotland, MSc, Health Economics Research Unit, Division of Applied Health Sciences, University of Aberdeen, Aberdeen AB25 2ZD, UK.

Abstract

Abstract:  Background:  The latent phase of labor can vary greatly in duration, and many women are uncertain about when to contact the maternity unit. The aim of this study was to elicit and value women’s preferences for some aspects of labor management.

Methods:  A questionnaire was sent to 1,251 women who had recently given birth to their first child at one of 14 maternity units in Scotland. Discrete choice questions were used to measure women’s preferences for five attributes of care: number of visits (assessments) before admission to the labor ward, time spent on the labor ward before delivery, mobility during labor, pain relief required, and mode of delivery. Responses were analyzed for the sample as a whole and for subgroups defined by recent experiences of labor.

Results:  A total of 730 (58.4%) questionnaires were returned and analyzed. Women expressed a preference for fewer visits before admission, shorter times on the labor ward before delivery, mobility during labor, normal vaginal deliveries, and moderate forms of pain relief (Entonox and opiates). Subgroup analysis suggests that women’s preferences for pain relief are influenced by their recent labor experience. The elicited preference values provide a means for estimating the tradeoffs women are willing to make between attributes of labor management.

Conclusions:  Women appear to dislike being turned away from the labor ward before admission for delivery. Extra visits before admission only appear to be a price worth paying if they result in reductions in the duration of time spent on the labor ward, reductions in the chance of being immobilized in hospital during labor, or a lower chance of requiring an instrumental or operative delivery. (BIRTH 38:1 March 2011)

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