Women’s preferences in the low-risk pregnancy management: Discrete Choice Experiments from Tuscany

Abstract   During the last years, organizational models to assist women during pregnancy have changed. The physiological management of low-risk pregnancy is gaining momentum thanks to increased available evidence. Therefore, a need to assess women’s acceptance of these new proposals is emerging. This study aims to explore women’s preferences during pregnancy and childbirth. We enrolled women from the continuously active survey on the maternity pathway in Tuscany, Italy. We designed Two Discrete Choice Experiments (DCE) and administered them through web-based surveys. We sought to catch women’s preferences on health professionals to be involved, team-based or exclusive assistance, the physical proximity of healthcare services, and cost per service. We also explored women’s decision-making autonomy and pain management during labour and childbirth. Additionally, we investigated women’s information needs on the physiological model of low-risk pregnancy management through qualitative methods. Mixed logit models on the DCEs results show that women prefer being assisted during pregnancy and childbirth by healthcare services that are free of charge, easily accessible from a geographic point of view, and provided by a gynaecologist. The interaction effects reveal statistically significant differences for some sociodemographic variables of respondents and maternity pathway attributes. Besides, qualitative analyses highlight that women are interested in the physiological management of low-risk pregnancy according to their level of knowledge, confidence and safety feelings, and beliefs concerning non-medicalization and autonomy. The main findings of this study point out several implications for policy and managerial practice to effectively implement the physiological model of low-risk pregnancy management. Key messages • This study proves that costs, travel distance, and type of health professional are the main determinants of women’s elicited preferences during pregnancy and childbirth. • Policymakers and healthcare managers should consider these findings in organizing and providing maternal and childbirth health services to foster the physiological management of low-risk pregnancies.


Background:
Evidence suggests that foreign-origin women are at risk of poorer pregnancy outcomes, both worldwide and in Finland. This study examined if foreign-origin women felt adequately supported by healthcare providers during their perinatal care in Finland.

Methods:
Foreign-origin women who gave birth in Finland within the last 3 years were recruited via snowball method as part of the MOM Survey (MS). Data were also extracted from birthing parents' responses to the 2020 national FinChildren Survey (FC), which consisted of data from parents in Finland with 3-6-month-old babies. Only responses submitted to MS from women born outside of Finland (n = 291) and responses submitted to FC by women born in Finland (n = 7984) were analyzed. Reported levels of adequate support from each group were compared using an independent sample proportion ttest. Data were then pooled and analyzed via binomial logistic regression. Results: MS respondents were older, more highly educated, and reported a higher proportion of single parenthood. 70.9% of MS respondents reported receiving adequate support regarding general well-being during pregnancy, compared to 90.2% of FC respondents (p < 0.001). Statistically significant differences (p < 0.001) were also seen in levels of support for parenthood (MS 74.3%, FC 92.8%), depression (MS 68.1%, FC 94.7%), fear of childbirth (MS 81.5%, FC 91.7%), and preparing for childbirth (MS 65.0%, FC 80.6%). After adjusting for age, education, and relationship status, FC mothers were still 4 to 9 times more likely to report receiving adequate support in these areas as compared to their MS counterparts.

Conclusions:
Women born outside of Finland were significantly more likely to report receiving inadequate support in multiple aspects of their perinatal care when compared to Finnish-born women. This held true even after adjusting for demographic differences. More research is needed to better understand this phenomenon and to ensure equitable care in the future.

Key messages:
Minority populations continue to grow in Finland, a country often seen as a global leader in maternal care. Supporting these populations is imperative to ensure quality maternal healthcare for all. Our observation that foreign-origin women felt less supported during pregnancy suggests that new care models or strategies may be needed to address their unique needs in peripartum care.

Background:
Childhood obesity is a global health problem and infancy is an important window of opportunity for promoting healthy weight development. In Denmark, community health nurses cover most families with a new-born child leaving a huge potential for promoting healthy weight development. This study examines parents' perceptions of barriers and facilitators for adhering to advice from the health nurse regarding healthy weight development of their child.

Methods:
Sixteen interviews with parents (children aged 0-2 years) living in Denmark were conducted. Parents were strategically sampled representing variations across child age, family socioeconomic position, ethnicity, and geography. All interviews were based on a semi-structured interview guide, recorded, and transcribed verbatim and analysed using a thematic analysis.

Findings:
Parents generally experience visits from their health nurse positively. Health nurses are emphasized as a confident and trustful relation and the key informant about children's' health. Variations in how parents adhere to advice favouring healthy weight development of their child were found.