Patient perception of involvement in medical care during labor and delivery.

BACKGROUND

Patients who feel involved in their treatment have better outcomes than those who do not.

OBJECTIVE

To identify determinants of perceived patient involvement in obstetric care.

METHODS

A retrospective study was undertaken in 1,452 (83%) of 1,750 women sampled in November 1995 from maternity wards of 14 general hospitals in Israel. A postal and telephone survey using a self-administered questionnaire included the following variables: hospital (identity number), patients' age, self-reported complications, previous deliveries, education, ethnicity, and number of obstetric interventions performed and/or considered. The main outcome measured was the reported involvement in decisions for obstetric interventions.

RESULTS

Reported full involvement varied from 72% for epidural analgesia to 13% for forceps/vacuum extraction. Factor analysis identified two dimensions of perceived involvement: one for "routine" interventions (enema, monitoring, IV line and episiotomy), which are performed in Israel mostly by midwives, and another for "special" interventions (forceps/vacuum extraction, epidural or other analgesia, and cesarian section) performed by physicians. Logistic regression identified hospitals, younger age, number of interventions, and Arab ethnicity as correlates of a perceived non-involvement in decisions for "special" interventions.

CONCLUSIONS

Clinical setting, age and ethnicity affected patient perception of involvement in decisions for obstetric interventions.