Knowledge of and preference for the DOMINO delivery option

To examine women's knowledge of and preference for the DOMINO (Domiciliary In and Out) delivery option in order to explain why uptake is lower than might be expected.

Descriptive study using a self completion postal questionnaire.

Mid Staffordshire Health Authority (now part of South Staffordshire Health Authority).

A systematic random sample of 1568 women aged 16-44 drawn from the Staffordshire Family Health Services Authority register of patients registered with a general practitioner. All women were included, regardless of childbirth experience.

Preference and knowledge levels for this delivery option.

The response rate was 74%. Thirty-nine per cent had heard of the DOMINO option prior to receiving the questionnaire. Sixteen per cent expressed a preference for this option (95% CI 11.1-21.9). Some women who expressed a preference were excluded owing to high risk factors, giving an adjusted preference of 11% (95% CI 5.2-16.4). Preference was not related to either age, pregnancy experience or previous knowledge.

More women expressed a preference for the option than would be expected from examination of national and local uptake figures. Lack of knowledge appears to be an important factor in explaining the low uptake. Purchasers, therefore, need to set contracts reflecting more realistic preferences and ensure that women have information on all options available to them, so that at the beginning of pregnancy women are enabled to make a shared decision on the choice of delivery. Both purchasers and providers need to monitor uptake and levels of knowledge.