Birth outcomes: utility values that postnatal women, midwives and medical staff express

Abstract

Objective: To determine if and to what extent postnatal women's preferences for birth outcomes differ from those of midwives and medical staff, and whether any variations in utility scores are associated with demographic variables. Design: Cross sectional cohort study. Setting: The Women's and Children's Hospital, Adelaide. Population: A total of 180 participants which included 90 postnatal women, 59 midwives and 31 medical staff. Methods: Preferences (utility scores) for eight birth outcomes were measured by direct interviews using two utility techniques: the visual analogue scale and the standard gamble. Main outcome measures: Preferences (utility scores) for eight birth outcomes. Results: Women assigned higher utility scores for the five birth outcomes of jaundice requiring phototherapy, admission to neonatal nursery, shoulder dystocia, nerve palsy and transient neurological symptoms than midwives, which suggested that women regarded these outcomes as less severe (P < 0.01). Utility scores for the women and medical staff were similar. The majority of postnatal women, midwives and medical staff preferred permanent neurological sequelae to perinatal death. Eighty-nine percent of postnatal women preferred permanent neurological sequelae to perinatal death compared with 71% of midwives (P < 0.01), and 68% of medical staff (P < 0.01). Conclusion: Utility values for important birth outcomes varied between women who had recently given birth and health professionals. Clinical practice should recognise and respect the preferences of women, with appropriate balance between their preferences, those of health professionals and the known benefits of care.