Predicting style-of-care preferences of obstetric patients. Medical vs. midwifery model

To identify patient populations preferring more medically oriented vs. more midwifery-oriented medical care in order to provide an institutional resourcing model.

Questionnaires were distributed to pregnant women regarding possible concerns related to style of care and length of hospitalization for obstetric delivery. Responses from the 135 usable surveys were analyzed by cluster analysis to search for common demographic or ideologic concerns that might distinguish two or more groups of patients according to style-of-care preferences.

Four clusters were identified and categorized based on the initial hypothesis as midwifery preference, medical preference, passive and wanting both. Cluster membership could not be predicted by any demographic or historical variable studied, and the most significant style-of-care discriminator was related to preferred length of postpartum hospital stay, with 80% of the midwifery preference cluster desiring a short (< 24 hour) stay as compared to a single patient (2%) in the medical preference cluster.

While obstetric care is often offered in distinctly stylized packages according to the training of the provider, our study suggests that patient preferences are much more complex and may contain many elements of both midwifery and medical styles of care. Broadening access to obstetric care will involve moving from our own preconceived notions of appropriate packaging into a patient-based and multi-option setting for delivery of these services.