Hi Andrew,

I guess it is true what Edwin says. My research about women and antenatal
care in Europe is still ongoing. I think I can represent what they say, but
really you should need a "user" ( my words are client or women).
My main categories are " confidence", "autonomy" and" responsibility". In
"confidence" some of my women ( depends on country and system ) meet "risk".
Of course this does not give them the confidence they need, but more
anxiety. "Edwin's women" rely on "sliced bread" which mean something that
they know for sure is giving them confidence ( See his/ their article).
My research is pointing in a direction that women who regain no confidence,
will not be able to make a choice themselves... Which also would confirm the
latest results of Mavis Kirkham about Informed Choice.
The part you want about consumer and choice will certainly be a very "
British" issue
( for instance in Switzerland is it less important, in Holland it is
important, but in a different way). So you will be looking then, for a
client who is very much "informed", otherwise it will be less an issue. This
might be a bias.
In my study those people are: first pregnancy, higher level of education and
people lacking a part of their "social environment". This means: as Edwin
states, women will chose what they know ( social environment ( Rubin: role
model), former experiences)). Risks certainly start to play, when they know
more about things in detail ( more information), or when their careprovider
tells them ( System, trust- relationship)).

I hope you can find someone who will tell you, but it might also be a bias.
I think, it is worth a whole research study, more than just one person
telling you.

With regards,

Ans Luyben,
Programmleader Midwifery Chur,
PhD Student GCal Glasgow,
Chur,
Switzerland

-----Oorspronkelijk bericht-----
Van: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]]Namens van
Teijlingen, Edwin
Verzonden: Donnerstag, 8. April 2004 16:30
Aan: [log in to unmask]
Onderwerp: Re: Risk and choice


Andrew,

there must be plenty of women in Dundee who thinks Ninewells Hospital
approach to maternity care and birth is the best thing since sliced bread?!?


Edwin

-----Original Message-----
From: Andrew Symon
To: [log in to unmask]
Sent: 08/04/2004 14:58
Subject: Re: Risk and choice

Thanks Jane.
What I really need is a 'user' (as opposed to an academic or
clinician) who would be prepared to write something along these
lines. Can you think of anyone?
Best wishes,
Andrew

On 8 Apr 2004 at 14:29, Jane sandall wrote:

> MessageDear Andrew,
> There are arguments about how women use and feel about the use of
> reproductive technologies within medical sociology. Most centre around
> a) women not being dupes and being intelligent enough to decide what
> kind of technologiy they will use and not use (and not just well
> educated women see Hunt reference) b) women using tech to take control
> This literature tends to  challenge the moral evaluations that assume
> natural is a 'good' thing (macintyre). Some references are:
>
> Annandale E. , a. C. J. (1996). "What is gender? Feminist theory and
> the sociology of human reproduction." Sociology of Health and Illness
> 18(1): 17-44.
>
> Campbell, R., Porter, S (1997). "Feminist theory and the sociology of
> childbirth: a response to Ellen Annandale and Judith Clark." Sociology
> of Health and Illness 19(3): 348-358.
>
>                            Annandale, E. C., Clark, J (1997). "A reply
>                            to Rona Campbell and Sam Porter,."
>                            Sociology of Health and Illness 19(4):
>                            521-532.
>
>                     Lewando-Hundt G., Shoham-Vardi I., Beckerleg S.,
>                     Belmaker I., Kassem F., Abu Jafar A.
>
>                             'Knowledge, Action and Resistance:
>                             Prenatal Screening amongst the Bedouin of
>                             the Negev, Israel Social Science and
>                             Medicine 2001 52;4: 561-569
>
>
>
>                         Macintyre, S. (1977). "The myth of the golden
>                         age." World Medicine 12(18): 17-22.
>
>
>
> We are looking at this issue in some current ESRC/MRC funded research
> looking at the impact a new one stop first trimester prenatal
> screening programme in an NHS setting. For more info see our research
> group web page.
>
> http://www.kcl.ac.uk/nursing/research/women.html
>
> Best wishes
>
> Jane
>
> Dr  Jane Sandall
> Professor of Midwifery and Women's Health
> Women & Family Health Research Group,
> King's College, Waterloo Bridge Wing,
> Franklin-Wilkins Building,
> 150 Stamford Street,
> London, SE1 9NN
> Tel: 020 7848 3605
> Fax: 020 7848 3764
> e-mail:[log in to unmask]
>
>
> ----- Original Message -----
>
>   From: Vanora Hundley
>   To: [log in to unmask]
>   Sent: Thursday, April 08, 2004 2:13 PM
>   Subject: Re: Risk and choice
>
>
>             Hi Andrew,
>     I've done a couple of studies which might be of use to you. The
>     first was a preference study looking at women's preferences for
>     two types of care - a midwife-led unit and a consultant-led labour
>     ward. Both were described using the findings of an RCT and women
>     were given the odds of having intervention or monitoring
>     (obviously the odds were higher in the labour ward). Although most
>     women preferred the midwife-led unit, a small number of women
>     expressed a preference for the labour ward and this group felt
>     more strongly about their preference (as indicated by a higher
>     willingness to pay). The reasons women gave for this choice
>     included availability of technology and more intervention.
>
>
>
>          Donaldson C, Hundley V, Mapp T. (1998) Willingness to pay: a
>          new method for measuring patients' preferences? Birth 25:
>          33-40.
>
>
>
>     More recently we looked at women's preferences for intrapartum
>     care using rating scales and a discrete choice experiment. A DCE
>     involves describing a service in terms of its characteristics or
>     attributes and respondents choose the type of care which they
>     prefer. So in one scenario you might describe two units, one uses
>     intermittent monitoring while the other uses continuous
>     monitoring. The respondent who prefers intermittent monitoring
>     should choose the first unit. However, each choice has a number of
>     other attributes too - we used 6: continuity of carer, involvement
>     in decision making, availability of pain relief, type of
>     monitoring, involvement of medical staff, appearance of the unit.
>     So the respondent's choice should take these into account and from
>     this it is possible to work out their strength of preference for
>     individual attributes.
>
>
>
>     This study was interesting because with the rating scales women
>     tended to express preferences for low-tech care: intermittent
>     monitoring, availability of medical staff only if needed. However,
>     when it came to the DCE where women had to make choices about the
>     attributes, there was a trend towards continuous monitoring and
>     presence of medical staff.
>
>
>
>     Hundley V, Ryan M and Graham W (2001) Assessing women's
>     preferences for intrapartum care. Birth 28 (4): 254-263.
>
>
>
>     I hope these are helpful. I'm happy to discuss further off-list.
>
>
>
>     Best wishes
>
>
>
>     Vanora
>
>
>
>
>
>     Original Message-----
>     From: A forum for discussion on midwifery and reproductive health
>     research. [mailto:[log in to unmask]] On Behalf Of
>     Andrew Symon Sent: Thursday, April 08, 2004 4:27 AM To:
>     [log in to unmask] Subject: Risk and choice
>
>
>     Apologies for cross-postings.
>
>     I'm putting together a book on risk and choice in maternity care.
>     This will explore contrasting views of the risk debate.
>
>     It's proving a little difficult to find a 'consumer' view arguing
>     that intervention / routine monitoring etc. is a good thing.
>
>     There's plenty in the literature about tocophobia, caesareans on
>     demand and the like, but all written by academics and clinicians.
>     I know I've seen newspaper articles about how wonderful modern
>     technology is at reassuring pregnant women, and how they should be
>     able to have everything going, but I would rather get a 'user'
>     view than a journalist if possible.
>
>     Can anyone think of someone who's brave enough to stand up and
>     argue this corner?
>
>     Answers in confidence if you'd rather not publicise their names
>     for the whole list to see:
>
>     [log in to unmask]
>
>     Thanks
>
>     Andrew Symon
>
>     University of Dundee
>
>     Scotland
>