Table 1.
Scenario descriptions and order of presentation for time trade-off utility assessments
| Brief Description | Full Scenario Presented to Participants | Group 1 Order | Group 2 Order |
|---|---|---|---|
| TOLAC common outcomes | |||
| TOLAC, VBAC, no interventions or complications (assigned a value of 1 when TOLAC is preferred) | You choose to have a trial of labor. You go into labor and at the hospital your labor progresses as expected. You have a vaginal birth. You and your baby go home 2 days later. Full physical recovery takes 1–2 weeks. |
1 | 9 |
| TOLAC, oxytocin augmentation, VBAC | You choose to have a trial of labor. You go into labor but at the hospital your labor stops progressing. You get an IV medicine (Pitocin)1 to make your contractions stronger and more frequent. You have a vaginal birth. You and your baby go home 2 days later. Full physical recovery takes 1–2 weeks. |
2 | 10 |
| TOLAC, chorioamnionitis, VBAC | You choose to have a trial of labor. During labor, you develop a fever and are given antibiotics. You have a vaginal birth. Because of the fever, your baby needs antibiotics after the delivery. You and your baby go home 2 days later. Full physical recovery takes 1–2 weeks. |
3 | 11 |
| TOLAC, VBAC, 3rd or 4th degree laceration | You choose to have a trial of labor. You have a vaginal birth. During the delivery, a tear occurs in the vagina and muscles around the anus, which is repaired with stitches. You and your baby go home 2 days later. You have discomfort from the tear for the first 1–2 weeks. You have an increased chance of losing stool beyond your control in the future. |
4 | 12 |
| TOLAC, CD, no complications | You choose to have a trial of labor. While you are in labor, your provider determines that you need a C-Section. You have a C-Section without complications. You and your baby go home 4 days later. Full physical recovery takes about 6 weeks. |
5 | 5 |
| TOLAC rupture outcomes | |||
| TOLAC, rupture, CD with rupture easily repaired | You choose to have a trial of labor. While you are in labor, your provider determines that you need a C-Section. During the delivery, the doctor sees that the uterine scar from your previous C-Section has opened. The opening is easily repaired and your baby does not have any complications. You and your baby go home 4 days later. Full physical recovery takes about 6 weeks. |
6 | 6 |
| TOLAC, rupture, CD, hysterectomy (no infant complications) | You choose to have a trial of labor. While you are in labor, your provider determines that you need a C-Section. During the delivery the doctor sees that the uterine scar from your previous C-Section has opened. The opening cannot be repaired, and a hysterectomy is necessary. This means that you will not be able to get pregnant in the future. Your baby does not have any complications. You and your baby go home 4 days later. Full physical recovery takes about 6 weeks. |
7 | 7 |
| TOLAC, rupture, CD, severe infant complication (HIE or death) | You choose to have a trial of labor. While you are in labor, your provider determines that you need a C-Section. During the delivery your doctor sees that the uterine scar from your previous C-Section has opened. The opening is repaired. However, your baby has serious complications related to the delivery and has to stay in the hospital. In some cases, your baby may die; if he or she survives, he or she will have serious, lifelong medical problems. |
8 | 8 |
| ERCD outcomes | |||
| ERCD, no complications (assigned a value of 1 when CD is preferred) | You choose to have a scheduled C-section. You have a C-Section without complications. You and your baby go home 4 days later. Full physical recovery takes about 6 weeks. |
9 | 1 |
| ERCD, minor surgical complications (surgical site infection/wound dehiscence) | You choose to have a scheduled C-section. 3 days after surgery, your surgical incision becomes infected and the skin opens up. Your baby does not have any complications. You and your baby go home 6 days later. You have to get daily wound care at home for 2–4 weeks. Full physical recovery takes about 6 weeks. |
10 | 2 |
| ERCD, transient neonatal complications (transient tachypnea of the newborn) | You choose to have a scheduled C-section. Your baby has difficulty breathing and is admitted to the neonatal intensive care unit for 24 hours. Your baby recovers well and you both go home 4 days later. Full physical recovery takes about 6 weeks. |
11 | 3 |
| ERCD, CD, future complications (accreta with late preterm birth) | You choose to have a scheduled C-section. You and your baby go home 4 days later. Full physical recovery takes about 6 weeks. Two years later, you decide to have another baby. During that pregnancy, you are told that your placenta is covering the birth canal and appears to have grown too deeply into the uterus as a result of your prior C-sections. You are told that you are at increased risk of having a premature baby. You deliver about 5 weeks before your due date. Your baby stays in the hospital for 3 weeks. You have a hysterectomy at the time of your delivery because of the placental problem. This means that you will not be able to get pregnant in the future. |
12 | 4 |
1
”Pitocin” was used rather than oxytocin as during the development/pretesting of these materials, participants were not all familiar with the generic term
2
To minimize potential bias due to the order in which scenarios were assessed, participants were randomly assigned to evaluate scenarios in different sequence