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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| Published in: | PloS one Vol. 14; no. 4; p. e0215098 |
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| Format: | Journal Article |
| Language: | English |
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11-04-2019
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| Abstract | 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. |
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| AbstractList | 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. Objective To explore pregnant women’s preferences for birth setting in England. Design Labelled discrete choice experiment (DCE). Setting Online survey. Sample Pregnant women recruited through social media and an online panel. Methods 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. Main outcome measures Women’s preferences for birth setting. Results 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. Conclusions 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. To explore pregnant women's preferences for birth setting in England.OBJECTIVETo explore pregnant women's preferences for birth setting in England.Labelled discrete choice experiment (DCE).DESIGNLabelled discrete choice experiment (DCE).Online survey.SETTINGOnline survey.Pregnant women recruited through social media and an online panel.SAMPLEPregnant 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.METHODSWe 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.MAIN OUTCOME MEASURESWomen'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.RESULTS257 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.CONCLUSIONSWe 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. ObjectiveTo explore pregnant women's preferences for birth setting in England.DesignLabelled discrete choice experiment (DCE).SettingOnline survey.SamplePregnant women recruited through social media and an online panel.MethodsWe 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.Main outcome measuresWomen's preferences for birth setting.Results257 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.ConclusionsWe 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. 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. Objective To explore pregnant women’s preferences for birth setting in England. Design Labelled discrete choice experiment (DCE). Setting Online survey. Sample Pregnant women recruited through social media and an online panel. Methods 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. Main outcome measures Women’s preferences for birth setting. Results 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. Conclusions 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. |
| Audience | Academic |
| Author | Scanlon, Miranda Rowe, Rachel Hinton, Lisa Fletcher, Benjamin Rupert Hollowell, Jennifer Rivero-Arias, Oliver |
| AuthorAffiliation | 3 BirthChoiceUK, London, United Kingdom University of Brighton, UNITED KINGDOM 1 Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom |
| AuthorAffiliation_xml | – name: University of Brighton, UNITED KINGDOM – name: 3 BirthChoiceUK, London, United Kingdom – name: 1 Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom – name: 2 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom |
| Author_xml | – sequence: 1 givenname: Benjamin Rupert orcidid: 0000-0003-3633-7716 surname: Fletcher fullname: Fletcher, Benjamin Rupert organization: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom – sequence: 2 givenname: Rachel orcidid: 0000-0003-2994-3240 surname: Rowe fullname: Rowe, Rachel organization: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom – sequence: 3 givenname: Jennifer surname: Hollowell fullname: Hollowell, Jennifer organization: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom – sequence: 4 givenname: Miranda surname: Scanlon fullname: Scanlon, Miranda organization: BirthChoiceUK, London, United Kingdom – sequence: 5 givenname: Lisa surname: Hinton fullname: Hinton, Lisa organization: Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom – sequence: 6 givenname: Oliver surname: Rivero-Arias fullname: Rivero-Arias, Oliver organization: Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30973919$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1136_bmjopen_2021_051747 crossref_primary_10_1371_journal_pone_0239311 crossref_primary_10_1016_j_wombi_2024_101616 crossref_primary_10_1016_j_sciaf_2022_e01499 crossref_primary_10_1136_bmjpo_2021_001183 crossref_primary_10_2196_18208 crossref_primary_10_1016_j_midw_2024_103999 crossref_primary_10_1016_j_midw_2022_103564 crossref_primary_10_53424_balikesirsbd_970863 crossref_primary_10_1371_journal_pone_0280441 crossref_primary_10_1007_s40271_024_00695_6 crossref_primary_10_1007_s40271_022_00608_5 crossref_primary_10_1016_j_midw_2022_103386 |
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| ContentType | Journal Article |
| Copyright | COPYRIGHT 2019 Public Library of Science 2019 Fletcher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License. 2019 Fletcher et al 2019 Fletcher et al |
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| DOI | 10.1371/journal.pone.0215098 |
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| DocumentTitleAlternate | Exploring women’s preferences for birth settings in England |
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| Notes | 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. |
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| References | M Pavlova (ref10) 2009; 93 J Coast (ref29) 2012; 21 C Henshall (ref37) 2016; 16 DW Eccles (ref23) 2017; 9 GS Scotland (ref31) 2011; 38 C Henshall (ref38) 2018; 59 (ref7) 2017 M. Ryan (ref19) 2004; 328 M Clark (ref20) 2014 C Grigg (ref14) 2014; 14 K Coxon (ref17) 2017; 17 J Hollowell (ref16) 2016; 16 (ref1) 2014 EW de Bekker-Grob (ref24) 2015; 8 (ref9) 2018 L Longworth (ref33) 2001; 9 C Donaldson (ref32) 1998; 25 VL Scarf (ref36) 2018; 62 ref26 ref25 E Lancsar (ref27) 2017; 35 S Downe (ref28) 2018; 13 M Dodwell (ref3) 2009 ref21 N Tayyari Dehbarez (ref12) 2018; 11 (ref6) 2013 E Pitchforth (ref30) 2008; 115 P Larkin (ref34) 2017; 17 T van Haaren-Ten Haken (ref11) 2012; 28 L Hinton (ref18) 2018; 18 M Redshaw (ref8) 2015 M Quaife (ref22) 2018; 19 B Murray-Davis (ref15) 2014; 30 U. Waldenstrom (ref39) 1999; 17 H Hoang (ref13) 2012; 20 (ref2) 2011; 343 G Houghton (ref35) 2008; 6 M Dodwell (ref5) 2013 L Ellberg (ref40) 2010; 26 D Walsh (ref4) 2018; 56 |
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| Snippet | To explore pregnant women's preferences for birth setting in England.
Labelled discrete choice experiment (DCE).
Online survey.
Pregnant women recruited... Objective To explore pregnant women's preferences for birth setting in England. Design Labelled discrete choice experiment (DCE). Setting Online survey. Sample... To explore pregnant women's preferences for birth setting in England. Labelled discrete choice experiment (DCE). Online survey. Pregnant women recruited... Objective To explore pregnant women’s preferences for birth setting in England. Design Labelled discrete choice experiment (DCE). Setting Online survey. Sample... To explore pregnant women's preferences for birth setting in England.OBJECTIVETo explore pregnant women's preferences for birth setting in England.Labelled... ObjectiveTo explore pregnant women's preferences for birth setting in England.DesignLabelled discrete choice experiment (DCE).SettingOnline... Objective To explore pregnant women’s preferences for birth setting in England. Design Labelled discrete choice experiment (DCE). Setting Online survey. Sample... |
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| SubjectTerms | 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 |
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| Title | Exploring women's preferences for birth settings in England: A discrete choice experiment |
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