Models of intrapartum care and women's trade-offs in remote and rural Scotland: a mixed-methods study.
OBJECTIVE
To explore women's preferences for, and trade-offs between, key attributes of intrapartum care models.


METHODS
Mixed-methods study using discrete choice experiments (DCEs) and focus groups.


METHODS
The North of Scotland.


METHODS
Women from the catchment areas of eight rural maternity units in the North of Scotland.


METHODS
Based on current policy, 'model of care' and 'time travelled' were selected as key attributes of intrapartum care in remote and rural settings. A DCE questionnaire explored women's preferences for and trade-offs between these attributes. Focus groups validated the DCE attributes and provided valuable information about the drivers of women's preferences for place of delivery.


METHODS
Preferences for attributes of intrapartum care.


RESULTS
Eight focus groups were conducted, and 877 eligible women completed the questionnaire. Overall, the DCE results found women preferred delivery in a unit to home birth and consultant-led care (CLC) to midwife-managed care (MMC). Women preferring CLC associated it with covering every eventuality and increased safety. Although women preferred shorter travel times, trade-offs indicated a willingness to travel for approximately 2 hours to get one's preferred choice. Focus group findings and subgroup DCE analysis showed heterogeneity of preferences related to experience, risk status, geographic location, perception of care and family circumstances.


CONCLUSIONS
In contrast to service redesign offering local midwife-managed intrapartum care, most rural women in our study expressed a preference to give birth in hospital and have CLC because they felt safer. Women were willing to travel for this but within limits. Qualitative results showed that women's preferences were influenced by their home and family context, beliefs and previous pregnancy experiences. Challenges for service redesign are to provide comprehensive obstetric services within acceptable travel time, while responding to the heterogeneity of women's preferences.
Pitchforth
E
E
Social Science Group, Department of Health Sciences, University of Leicester, Leicester, UK. elp17@le.ac.uk
Watson
V
V
Tucker
J
J
Ryan
M
M
van Teijlingen
E
E
Farmer
J
J
Ireland
J
J
Thomson
E
E
Kiger
A
A
Bryers
H
H
D000293:Adolescent; D000328:Adult; D005190:Family; D005260:Female; D006700:Home Childbirth / Q000523:psychology; D006760:Hospitalization; D006801:Humans; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000517:prevention & control / Q000523:psychology*; D010146:Pain / Q000517:prevention & control / Q000523:psychology; D017060:Patient Satisfaction; D011247:Pregnancy; D037841:Pregnant People / Q000523:psychology*; D011295:Prenatal Care / Q000592:standards*; D011446:Prospective Studies; D012423:Rural Health; D012606:Scotland; D013997:Time Factors; D014195:Travel