Larkin Patricia, Begley Cecily M, Devane Declan
School of Health and Science, Scoil na Sláinte agus na hEolaíochta, Dundalk Institute of Technology, Dublin Road, Dundalk, Co. Louth, Ireland.
School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland.
BMC Pregnancy Childbirth. 2017 Jan 10;17(1):19. doi: 10.1186/s12884-016-1196-1.
How women experience childbirth is acknowledged as critical to the postnatal wellbeing of mother and baby. However there is a knowledge deficit in identifying the important elements of these experiences in order to enhance care. This study elicits women's preferences for the most important elements of their childbirth experiences.
A mixed methods design was used. An initial qualitative phase (reported previously) was followed by a second quantitative one using a discrete choice experiment (DCE), which is reported on here. Participants who had experienced labour, were over 18 and had a healthy baby were recruited from four randomly selected and one pilot hospital in the Republic of Ireland. Data were collected by means of a DCE survey instrument. Questions were piloted, refined, and then arranged in eight pair-wise scenarios. Women identified their preferences by choosing one scenario over another. Nine hundred and five women were sent the DCE three months after childbirth, with a response rate of 59.3% (N =531).
Women clearly identified priorities for their childbirth experiences as: the availability of pain relief, partnership with the midwife, and individualised care being the most important attributes. In the context of other choices, women rated decision-making, presence of a consultant, and interventions as less important elements. Comments from open questions provided contextual information about their choices.
Most women did not want to be typified as wanting the dichotomy of 'all natural' or 'all technology' births but wanted 'the best of both worlds'. The results suggest that availability of pain relief was the most important element of women's childbirth experiences, and superseded all other elements including partnership with the midwife which was the second most important attribute. The preferences identified might reflect the busy medicalised hospital environments, in which the vast majority of women had given birth, and may differ in settings such as midwifery led care or home births.
女性的分娩体验被认为对母婴产后的幸福至关重要。然而，在确定这些体验的重要因素以改善护理方面，存在知识缺口。本研究旨在了解女性对其分娩体验中最重要因素的偏好。
采用混合方法设计。最初是定性阶段（此前已报告），随后是使用离散选择实验（DCE）的定量阶段，本文报告的是该定量阶段。从爱尔兰共和国随机选择的四家医院和一家试点医院招募了有分娩经历、年龄超过18岁且婴儿健康的参与者。通过DCE调查问卷收集数据。问题经过试点、完善，然后安排在八个成对的情景中。女性通过选择一个情景而非另一个情景来确定自己的偏好。产后三个月向905名女性发送了DCE调查问卷，回复率为59.3%（N = 531）。
女性明确将其分娩体验的优先事项确定为：缓解疼痛的可用性、与助产士的合作关系以及个性化护理是最重要的属性。在其他选择的背景下，女性将决策、顾问的在场和干预评为不太重要的因素。开放性问题的评论提供了有关她们选择的背景信息。
大多数女性不想被归类为想要“全自然”或“全技术”分娩的二分法，而是想要“两全其美”。结果表明，缓解疼痛的可用性是女性分娩体验中最重要的因素，超过了所有其他因素，包括与助产士的合作关系，后者是第二重要的属性。所确定的偏好可能反映了大多数女性分娩所在的繁忙的医疗化医院环境，在助产士主导的护理或家庭分娩等环境中可能会有所不同。
