DOI: 10.34914/olos:pohtlguqffemljfgngsfbxkavm
title: Evaluating childbirth modes and models of care for women with obesity: a Multi-Criteria Decision Analysis (Prediction and preference matrices)

description: The objective of the study was to systematically evaluate childbirth options for women with obesity (body mass index ≥ 30 kg/m2) across several obstetric scenarios by integrating stakeholder-informed goals of childbirth care and stakeholder preferences for achieving these goals, alongside scientific evidence. 
The study population included women with preconceptional obesity and term, singleton, cephalic pregnancies without compelling indications for cesarean birth in Swiss hospital inpatient childbirth care. 
We employed Multi-Criteria Decision Analysis (MCDA) using Multi-Attribute Value Theory (MAVT). The evaluated options were defined by childbirth modes and models of care, including vaginal birth and intrapartum cesarean birth, with either standard hospital care or continuous midwifery care, and prelabor cesarean birth. Stakeholder-informed goals related to maternal and neonatal complications, physiological childbirth processes, breastfeeding initiation, psychosocial care experience, physical strain for care providers, care setting resource use, and direct healthcare costs. Scenarios accounted for cesarean birth history and maternal comorbidities. 
We analyzed Swiss hospital inpatient data from 22,464 childbirths between 2005 and 2022 among women with obesity meeting the study’s inclusion criteria to predict the options’ performance on the goals related to maternal and neonatal complications, physiological childbirth processes, breastfeeding initiation, resource use, and direct costs. For the goals on maternal and neonatal complications and physiological childbirth processes, weighted composite indices (“mini-MCDAs”) were constructed by combining multiple indicators from the Swiss hospital inpatient data and expert preferences. In the absence of preexisting suitable quantitative data, expert assessments were used to estimate the options’ performance on psychosocial care experience and physical strain for care providers. Extreme preferences from four hypothetical stakeholders and exemplary preferences from three real stakeholders (a woman with obesity, a midwife, and an obstetrician) were incorporated to examine how the options’ overall performance may vary according to stakeholder preferences for making trade-offs between the goals. We aggregated all prediction and preference data into the options’ overall performance using a non-additive MAVT model in the ValueDecisions application (Haag et al., 2022). Further methodological details are provided in the related peer-reviewed article upon publication. 
As the intellectual property rights to the raw Swiss hospital inpatient data analyzed for the predictions are held by the Swiss Obstetric Study Group (Arbeitsgemeinschaft Schweizerischer Frauenkliniken, Switzerland), these data cannot be made publicly available by the contributors. The deposited data therefore contain the prediction and preference matrices for the main MCDA model, as well as the prediction and preferences matrices for the weighted composite indices for maternal complications, neonatal complications, and physiological childbirth processes.