Exploring women's preferences for birth settings in England: A discrete choice experiment

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...

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Bibliographic Details
Published in:	PloS one Vol. 14; no. 4; p. e0215098
Main Authors:	Fletcher, Benjamin Rupert, Rowe, Rachel, Hollowell, Jennifer, Scanlon, Miranda, Hinton, Lisa, Rivero-Arias, Oliver
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 11-04-2019 Public Library of Science (PLoS)
Subjects:	Adult Analysis Biology and Life Sciences Birth Birth Setting - statistics & numerical data Childbirth & labor Choice Behavior Computer and Information Sciences Decision Making Delivery (Childbirth) Digital media England Epidemiology Experiments Female Health aspects Health Knowledge, Attitudes, Practice Health sciences Health Services Accessibility Heterogeneity Home births Humans Internet Logit models Maternal & child health Medicine and Health Sciences Methods Midwifery Midwifery - organization & administration Nursing Obstetrics Patient care Patient Preference People and places Physicians Population Practice guidelines (Medicine) Pregnancy Pregnant women Pregnant Women - psychology Prenatal Care Primary care Research and Analysis Methods Risk analysis Safety Social media Social Sciences Studies Surveys and Questionnaires Systematic review Women Womens health Young Adult England United Kingdom United Kingdom > UK Scotland
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Summary:	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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 Competing Interests: Miranda Scanlon is a volunteer with BirthChoiceUK, a voluntary non-commercial organisation, which has in the past provided information to help women chose where to have their baby. Miranda has also been a consultant to the consumer association ‘Which?’ in the development of their Which? Birth Choice website. She did not receive any payment from BirthChoiceUK or Which? to participate in this study. All other authors declare no conflicts of interest.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0215098