Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
PLoS One. 2019 Apr 11;14(4):e0215098. doi: 10.1371/journal.pone.0215098. eCollection 2019.
To explore pregnant women's preferences for birth setting in England.
Labelled discrete choice experiment (DCE).
Online survey.
Pregnant women recruited through social media and an online panel.
We developed a DCE to assess women's preferences for four hypothetical birth settings based on seven attributes: reputation, continuity of care, distance from home, time to see a doctor, partner able to stay overnight, chance of straightforward birth and safety for baby. We used a mixed logit model, with setting modelled as an alternative-specific constant, and conducted a scenario analysis to evaluate the impact of changes in attribute levels on uptake of birth settings.
Women's preferences for birth setting.
257 pregnant women completed the DCE. All birth setting attributes, except 'time to see doctor', were significant in women's choice (p<0.05). There was significant heterogeneity in preferences for some attributes. Changes to levels for 'safety for the baby' and 'partner able to stay overnight' were associated with larger changes from baseline uptake of birth setting. If the preferences identified were translated into the real-world context up to a third of those who reported planning birth in an obstetric unit might choose a midwifery unit assuming universal access to all settings, and knowledge of the differences between settings.
We found that 'safety for the baby', 'chance of a straightforward birth' and 'can the woman's partner stay overnight following birth' were particularly important in women's preferences for hypothetical birth setting. If all birth settings were available to women and they were aware of the differences between them, it is likely that more low risk women who currently plan birth in OUs might choose a midwifery unit.
探索英国孕妇对分娩环境的偏好。
标记离散选择实验（DCE）。
在线调查。
通过社交媒体和在线小组招募的孕妇。
我们开发了一个 DCE，根据七个属性评估女性对四个假设分娩环境的偏好：声誉、护理连续性、离家距离、看医生时间、伴侣能否过夜、顺产机会和婴儿安全。我们使用混合对数模型，将环境设置建模为特定替代项的常数，并进行了情景分析，以评估属性水平变化对分娩环境采用率的影响。
女性对分娩环境的偏好。
257 名孕妇完成了 DCE。除“看医生时间”外，所有分娩环境属性在女性选择中均具有重要意义（p<0.05）。一些属性的偏好存在显著异质性。“婴儿安全”和“伴侣能否过夜”水平的变化与分娩环境采用率从基线的较大变化相关。如果识别出的偏好转化为现实世界的情况，假设所有环境都可以普遍获得，并且了解环境之间的差异，那么多达三分之一报告计划在产科病房分娩的人可能会选择助产士单位。
我们发现“婴儿安全”、“顺产机会”和“分娩后女性伴侣能否过夜”在女性对假设分娩环境的偏好中尤为重要。如果所有分娩环境都对女性开放，并且她们了解它们之间的差异，那么目前计划在 OUs 分娩的低风险女性中，可能会有更多人选择助产士单位。
