Abstract: PREFERENCE METRICS: AN EVALUATION OF MATERNAL PREFERENCES TOWARD MODE OF DELIVERY

Monday, October 19, 2009

Grand Ballroom, Salons 1 & 2 (Renaissance Hollywood Hotel)

Teresa N. Sparks, MD¹, Marina Stasenko, BS², Jillian Main, MD³, Anjali Kaimal, MD, MAS⁴, Vargas Juan, MD⁵, Kier Van Remoortere, MD⁵ and Aaron B. Caughey, MD, MPP, MPH, PhD⁵, (1)Brigham & Women's Hospital, San Francisco, CA, (2)Cornell Medical College, New York, NY, (3)Kaiser San Francisco, San Francisco, CA, (4)Massachusetts General Hospital, Harvard Medical School, Boston, MA, (5)University of California, San Francisco, San Francisco, CA

Preference Metrics: An Evaluation of Maternal Preferences Toward Mode of Delivery Sparks TN, Stasenko M, Main J, Kaimal A, Vargas J, Van Remoortere K, Caughey AB Department of Obstetrics, Gynecology, & Reproductive Sciences, University of California, San Francisco

Purpose: To characterize maternal preferences toward mode of delivery using preference metrics.

Methods: A cross-sectional survey of 342 women from inpatient and outpatient settings at our institution during their third trimester of pregnancy. Women were surveyed for demographics, obstetric history, beliefs about modes of delivery, preference toward vaginal delivery (VD) vs. cesarean delivery (CD), and reasons for these preferences. Preferences toward MOD were assessed using willingness to pay (WTP) and time trade off (TTO) metrics. Chi-square tests were completed to analyze differences in preferences toward MOD among subgroups, and adjusted odds ratios (aOR) were calculated with multivariable logistic regression.

Results: Of the 342 women surveyed, 57% of those preferring VD and 67% desiring CD were willing to pay any money in order to achieve their preferred MOD, with a median of $1000 in both groups. Thirty-six percent of patients desiring VD and 28% desiring CD were willing to trade any time at the end of life to attain their preferred MOD, with a median of 6 months in the VD group and 18 months in the CD group. After adjusting for factors such as age, ethnicity, and parity, nulliparous women showed an aOR of 2.22 (95% CI 1.23-4.04) for willingness to trade any time at the end of life for preferred VD. Preference metrics results by subgroups are shown in the table below. Table 1. WTP and TTO to attain preferred MOD by subgroup.

WTP any money for VD

Median amount of money

TTO of any time for VD

Median time in months

Nulliparous
62.2%

$1000

42.7% *

6

Multiparous
50.0%

$1000

26.5% *

2.5

Age <30
40.7% *

$500

25.6% *

2.5

Age >30
65.8% *

$1000

42.1% *

6

* p<0.05

Conclusion: A higher proportion of nulliparous women and women over 30 years of age were willing to trade any time or money for desired vaginal delivery. Understanding women's preferences toward delivery outcomes enables providers to better care for patients and to understand the reasons for changing trends in obstetric practice.

	WTP any money for VD	Median amount of money	TTO of any time for VD	Median time in months
Nulliparous	62.2%	$1000	42.7% *	6
Multiparous	50.0%	$1000	26.5% *	2.5
Age <30	40.7% *	$500	25.6% *	2.5
Age >30	65.8% *	$1000	42.1% *	6

35JDM PREFERENCE METRICS: AN EVALUATION OF MATERNAL PREFERENCES TOWARD MODE OF DELIVERY