IDENTIFICATION OF DOMAINS FOR THE DEVELOPMENT OF A DELIVERY-SPECIFIC UTILITY MEASURE IN OBSTETRICS

Purpose: In obstetrics, (cost)effectiveness studies often present several specific outcomes with possibly contradicting results. Generic classification systems are insensitive to the mostly process domains of delivery. A delivery-specific outcome measure that reflects the core domains of the labor and delivery and combines these into one utility score would solve this problem. Aim of this study is to investigate which domains are most relevant for the women’s overall experience of labor and delivery and should be included in such measure.

Methods: First, labor and delivery-specific domains were identified by a systematic literature search and three online focus groups with pregnant women, women who recently gave birth, and with their partners. Subsequently, in an online prioritizing task women who recently gave birth and professionals were asked to select their top-seven most important domains and rank these. The domains with the highest top-seven selection proportions and mean ranking scores formed the bases for a consensus discussion with experts, where the seven definitive domains were selected. This discussion was guided by three requirements; the definitive domains had to be clearly distinguishable and independent, measurable by the subjective experience of the mother, and applicable to all kinds of deliveries regardless of place and type.

Results: In the first step, 34 delivery-specific domains were identified, which cover domains regarding the caregivers, intrapersonal aspects of the mother, partner support, contextual and medical aspects of delivery. Based on the top-7 domain selection and ranking of samples of 96 women who recently gave birth and of 89 professionals (midwifes, gynaecologists, researchers) this list was reduced to 14 most relevant domains (Table 1). Between the two samples, six domains overlapped and eight varied. Professionals varied more in their selection than the women who gave birth. In a consensus discussion the final seven domains were selected by combining some of the 14 remaining domains, and giving priority to the domains indicated to be relevant by mothers.

Conclusion: The seven domains selected cover aspects of the caregivers’ competence, communication, and support, the mother’s feeling of safety, fulfilment of her needs, her worries about the health of the child and the experienced duration until the first contact with the baby. This selection of domains will form the basis for developing a delivery-specific utility measure in the near future.