Differences in the valuation of birth outcomes among pregnant women, mothers, and obstetricians.
BACKGROUND
Decisions are usually based on the perceived merits of alternative approaches. This process can be quantified by combining the probabilities of expected outcomes with their desirability. We studied differences in the valuation of birth outcomes among pregnant women, mothers, and obstetricians, and assessed how these would affect a particular obstetric decision.


METHODS
In a study conducted at Leiden Hospital, Leiden, The Netherlands, 12 obstetricians, 15 pregnant women, and 15 mothers participated in a standard reference gamble to determine the value of 12 different outcomes: 3 types of birth combined with 4 states of infant outcome. These were then applied to an obstetric decision tree based on the Dublin trial of intermittent auscultation versus electronic intrapartum fetal heart rate monitoring.


RESULTS
Contrary to obstetricians, women valued permanent neurologic handicap significantly higher than neonatal death (p < 0.01). Women expressed no overriding preferences for the type of birth, whereas obstetricians were clearly antipathetic to cesarean section. Within-group consistency was significantly higher for pregnant women and mothers than for obstetricians (p < 0.0001). However, application of the measured values to the obstetric decision tree merely led to marginal changes in overall expected value of the decision alternatives.


CONCLUSIONS
Values attached to birth processes and outcomes differ significantly between (expectant) mothers and doctors. These differences should be recognized and respected in obstetric decision making.
Vandenbussche
F P
FP
Department of Obstetrics and Gynecology, Leiden University Medical Center, The Netherlands.
De Jong-Potjer
L C
LC
Stiggelbout
A M
AM
Le Cessie
S
S
Keirse
M J
MJ
D001291:Attitude of Health Personnel; D001294:Attitude to Health; D001314:Auscultation; D003663:Decision Trees; D005260:Female; D005323:Fetal Monitoring; D006801:Humans; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology*; D009035:Mothers / Q000523:psychology*; D009774:Obstetrics; D011247:Pregnancy / Q000523:psychology*; D011256:Pregnancy Outcome / Q000523:psychology*