Open Access Research article

Women’s preferences for inpatient and outpatient priming for labour induction: a discrete choice experiment

Kirsten Howard1*, Karen Gerard2, Pamela Adelson3, Robert Bryce4, Chris Wilkinson5 and Deborah Turnbull3

Author Affiliations

1 Sydney School of Public Health, University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006, Australia

2 Faculty of Health Sciences, University of Southampton, Southampton, UK

3 School of Psychology, University of Adelaide, Adelaide, SA 5005, Australia

4 Obstetrics & Gynecology, Flinders Medical Centre, Adelaide, SA, Australia

5 Maternal Fetal Medicine, Women’s and Children’s Hospital, Adelaide, SA, Australia

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BMC Health Services Research 2014, 14:330  doi:10.1186/1472-6963-14-330

Published: 30 July 2014

Abstract

Background

In many countries a high proportion of births begin as induced labours. Induction can be lengthy if cervical priming is required prior to induction. This usually occurs as an inpatient, however, an alternative is to allow women to go home after satisfactory fetal monitoring. The aim of this study was to assess the preferences of women for cervical priming for induction of labour in an outpatient or inpatient setting.

Method

A discrete choice experiment (DCE) was conducted alongside a randomised trial of inpatient and outpatient cervical priming (the OPRA trial) in two maternity hospitals in South Australia. 362 participants were included, and women’s preferences for cervical priming for induction of labour were assessed.

Results

Women were willing to accept an extra 1.4 trips to hospital (2.4 trips total) and a total travel time of 73.3 minutes to be able to return to their own home while waiting for the priming to work. For enhanced inpatient services, women were willing to accept a total travel time of 54.7 minutes to have a private room with private bathroom while waiting for the priming to work. The overall benefit score for outpatient priming was 3.63, 3.59 for enhanced inpatient care and 2.89 for basic inpatient care, suggesting slightly greater preferences for outpatient priming. Preferences for outpatient priming increased when women could return to their own home (compared to other offsite accommodation), and decreased with more trips to hospital and longer travel time.

Conclusions

Our results suggest that outpatient priming was slightly more preferred than either enhanced inpatient priming or basic care; these results should be confirmed in different clinical settings. There may be merit in providing women information about both options in the future, as preferences varied according to the characteristics of the services on offer and the sociodemographic background of the woman.

Keywords:
Induction; Priming; Preferences