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Table 2 Maternity service attributes used to assess preferences in the included studies

From: Women’s birth place preferences in the United Kingdom: a systematic review and narrative synthesis of the quantitative literature

Study & method Preferences evaluated
Donaldson (1998) [19]
Willingness to pay
Labour ward vs. midwives unit
Labour ward characterised as:
 - Doctors more likely to be involved in decision-making; midwives involved but women will not see the same midwife all the time; Electronic fetal monitoring; because of monitoring/other reasons 1 in 2 women have limitations on movement during labour; 1 in 12 women try alternative positions for delivery; 1 in 5 have an epidural; 1 in 3 have episiotomy
Midwives unit characterised as:
 - Decisions made by women and midwives; most care from one midwife; traditional fetal monitoring, transfer to labour ward needed if continuous monitoring required; 1 in 4 women transferred to labour ward for electronic monitoring; because of monitoring/other reasons 1 in 3 have limitations on movement during labour; 1 in 8 try alternative positions for delivery; all types of pain relief available but transfer to labour ward required for epidural; 1 in 7 have an epidural; 1 in 4 have episiotomy
Emslie (1999) [21]
Questionnaire survey - longitudinal follow-up
Features of place of birth rated by women at 14 and 36 weeks (selected list – not all reported)
 - Quiet atmosphere
 - Baby with you at all times
 - Availability of specialist facilities
 - Convenience for visitors
 - Choices in pain relief
 - Choices in delivery
Aspects of labour management rated by women (at 36 weeks):
 - Partner being there
 - Availability of specialist staff/equipment
 - Being kept informed
 - Being involved in decisions
 - Time alone with partner
 - Choice of pain relief
 - Freedom to choose different positions
 - Handed baby immediately
 - Cared for by known staff
 - Not being left alone
 - Homely atmosphere
 - Cared for by named midwife
 - Being introduced to people
 - Provision of music/TV
Hundley (2004) [15], Hundley (2001) [16]
Discrete choice experiment
Continuity (midwife):
 - Meet midwife antenatally, same midwife present throughout labour/birth vs. meet team of midwives antenatally, one present throughout labour/birth vs. previously unknown midwife but present throughout labour/birth vs. midwives working shifts may change during labour/birth
Pain relief:
 - All methods except epidural vs. all methods available but epidural requires transfer vs. all methods available.
Fetal monitoring:
 - Continuous, movement may be restricted during labour vs. intermittent unless complications develop, then continuous if required
Appearance of room:
 - Homely vs. clinical appearance
Medical staff:
 - Involved in care vs. only involved if complications develop
 - Staff make decisions vs. staff make decisions but keep woman informed vs. staff discuss things with women before deciding vs. staff give woman assessment, woman in control of decisions
Lavender (2005) [22]
Questionnaire survey
Women were asked to state their level of agreement/disagreement with the following:
 - It is not important for me to have my baby in the same place as I receive antenatal care
 - It is important that my antenatal appointments are at a location close to where I live
 - I would be willing to travel if it meant I would receive higher quality care for my baby and me around the time of birth
 - It is important to me that a midwife helps me to give birth to my baby even if complications develop
 - I would feel unsafe if a specially trained doctor was not immediately available when I am in labour
 - It is not important to me that a midwife I know helps me to give birth to my baby
 - It is important to me to that [sic] a special care baby unit is in the same place that I give birth
 - It is important to me to be able to have an epidural at any time of day or night
 - It is important to me that a pool is available for my labour/birth
 - I want to be looked after by midwives and not have doctors involved
 - I would not want to transfer to a hospital a few miles away if my baby or I develop a problem
Longworth (2001) [18]
Conjoint analysis
 - Have not met midwives prior to labour vs. have met midwives but don’t know them well vs. know midwives well
 - Labour ward vs. maternity unit with a home-like environment vs. home
Pain relief:
 - Gas & air/breathing only, no epidural, no birthing pool vs. gas & air and birthing pool, no epidural vs. all options including epidural
Decision-making during labour and delivery:
 - Midwives and doctors will decide vs. decisions will be made jointly following discussion vs. woman will make own decisions
Probability of transfer to another hospital during labour:
 - No need for transfer if problems develop vs. low probability of transfer vs. high probability of transfer
Pitchforth (2008) [20]
Discrete choice experiment
Model of care:
 - Consultant-led vs. midwife-managed care
 - Pain relief: all methods available vs. no epidurala
Distance (‘time travelled’):
 - Zero (home birth) vs. 30 mins vs. 60 mins vs. 90 mins vs. 120 mins
Rennie (1998) [23]
Questionnaire survey
Aspects of intrapartum care rated by study participants:
 - Birth companion
 - Known midwife
 - In control
 - Few interventions
 - Able to do what you want
 - Same midwife in labour
 - Not to lose control of behaviour
 - Preferences and wishes followed
 - Attendance of midwife:
 - all the time vs. easy access vs. present only when I say
 - Information:
 - constant flow vs. staff to decide vs. only when asked for
 - Option for pain relief
 - pain-free with drugs vs. minimum drugs vs. drug free labour/other
 - Decision-making in labour:
 - staff decides vs. reach decision together vs. woman decides
Rogers (2011) [24]
Questionnaire survey
Women who would use the local AMU when it becomes a stand-alone unit (FMU) were asked to select reasons for their choice:
 - Easy to get to
 - Physical environment
 - Previous bad experience
 - Previous good experience
 - Can use water in labour and for birth
 - Wants natural childbirth
 - Homely/small
 - Family can be involved
 - Other
Women who would not use the local AMU when it becomes a stand-alone unit were asked to select reasons for their choice:
 - Difficult to get to
 - Want an epidural
 - Feel safer
 - Previous bad experience
 - Previous good experience
 - Physical environment
 - Pressure from partner/family/friends
 - Would prefer a midwife-led unit on the same site as the hospital labour ward
 - Concern about transfer
  1. aNote: In Pitchforth’s study, ‘pain relief’ was primarily included to ensure that respondents realised that an epidural was only available with consultant-led care. As such, the levels for this attribute varied in tandem with the levels of the ‘Staff involved’ attribute: the only options that respondents saw were either ‘Midwife-managed care’ and ‘No epidural available’ or ‘Consultant-led care’ and ‘All methods of pain relief’