Differences in the valuation of birth outcomes among pregnant women, mothers, and obstetricians

Background: Decisions are usually based on the perceived merits of alternative approaches. This process can be quantified by combining the probabilities of expected outcomes with their desirability. We studied differences in the valuation of bir th outcomes among pregnant women, mothers, and obstetricians, and assessed how these would affect a particular obstetric decision. Methods: In a study conducted at Leiden Hospital, Leiden, The Netherlands, 12 obstetricians, 15 pregnant women, and 15 mothers participated in a standard reference gamble to determine the value of 12 different outcomes: 3 types of bir th combined with 4 states of infant outcome. These were then applied to an obstetric decision tree based on the Dublin trial of intermittent auscultation versus electronic intrapartum . fetal heart rate monitoring. Results: Contrary to obstetricians, women valued permanent tt neurologic handicap significantly higher than neonatal death (p < 0.01). Women expressed no overriding preferences for the type of birth, whereas obstetricians were clearly antipathetic to cesarean section. Within-group consistency was significantly higher for pregnant women and mothers than for obstetricians (p < 0.0001). However application of the measured values to the obstetric decision tree merely led to marginal changes in overall expected value of the decision alternatives. Conclusions: Values attached to birth processes and outcomes differ significantly between (expectant) mothers and doctors. These differences should be recognized and respected in obstetric decision making.