Variables related to maternal satisfaction with intrapartum care in Northern Italy

A predicting model for intrapartum cesarean delivery at admission using a nomogram: a retrospective cohort study in China

BACKGROUND

With the implementation of China's three-child policy, an increasing number of Chinese women are not opting for cesarian delivery (CD), with particular concern about intrapartum CD. At the same time, reducing the rate of intrapartum CD is closely associated with a decrease in maternal and neonatal complications, as well as an improvement in maternal satisfaction. Therefore, it is essential to develop a predictive model specifically tailored to Chinese pregnant women to reduce the rate of intrapartum CD.

OBJECTIVE

This study aimed to develop a predicting model for intrapartum CD at admission using the coefficients of Lasso regression analysis, multi-factor logistic regression and a nomogram.

METHODS

This single-center retrospective cohort study involved singleton pregnancies of women willing to undergo vaginal delivery (VD) at admission between August 2021 to March 2022 at the Department of Obstetrics in our hospital. The study cohort comprised 3,025 pregnant women who underwent a trial of vaginal labor at admission, with 378 cases in the intrapartum CD group and 2,647 cases in the VD group. These cohorts were divided into a training and a test cohort (7:3 ratio). A predictive model was developed using the training cohort to estimate the risk of intrapartum CD, incorporating coefficients of Lasso regression analysis, a nomogram and multivariate logistic regression (MLR). A Decision Curve Analysis (DCA) was conducted to evaluate the clinical utility and net benefit of the nomogram in the training cohort. The receiver operating characteristic (ROC) curve, along with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), accuracy and precision were used to evaluate clinical utility of the prediction models in both the training and test cohorts.

RESULTS

Nine factors in the training cohort were identified as independent predictors of intrapartum CD, including BMI before labor (OR = 1.07, p = 0.006), maternal height(OR = 0.94, p < 0.001), gestational age at delivery(OR = 1.13, p = 0.120), fetal weight by last ultrasound before labor (OR = 1.00, p = 0.003), previous VD history (OR = 0.09, p < 0.001), previous CD history (OR = 2.53, p = 0.020), spontaneous labor(OR = 2.01, p < 0.001), cervical Bishop scores(OR = 0.73, p < 0.001), and Hypertensive disorder complicating pregnancy(OR = 2.08, p = 0.001). Additionally, a DCA was conducted to evaluate the clinical utility and net benefit of the nomogram in the training cohort. The area under the curve (AUC), sensitivity, specificity, PPV, NPV, accuracy and precision were 0.793 (95%CI 0.768-0.819), 84.9%, 60.1%, 23.8%, 96.4%, 63.2% and 23.8%, respectively in the training cohort, and 0.753(95%CI 0.703-0.798), 81.3%, 59.3%, 21.0%, 96.0%, 61.9% and 21.1% respectively in the test cohort. These results indicate that the mode demonstrated good predictive performance in both datasets.

CONCLUSION

Our model, which utilized admission indicators, performed well in predicting the risk of intrapartum CD using a nomogram. These findings have significant practical implications for physicians seeking to reduce the rate of intrapartum CD.

Gap analysis of maternity service quality and associated factors at a maternity hospital in northwest Iran: a cross-sectional survey using SERVQUAL and HEALTHQUAL questionnaires

BACKGROUND

Concerning maternity service, the mother's quality assessment is central because emotional, cultural, and respectful support is vital during labour and the delivery process. Studies concerning the perceived quality of maternity services from the perspective of mothers have rarely been carried out in Iranian hospital settings. Therefore, this study aimed to measure the gap between the expectations of patients with maternity services and their perceptions of the service and identify associated factors at a maternity hospital in northwest Iran using service quality (SERVQUAL) and health quality (HEALTHQUAL) questionnaires.

METHODS

This cross-sectional study consists of 350 randomly selected participants visiting a maternity hospital in Tabriz, Iran between November 2022 and February 2023. Admitted patients responded to two questionnaires adopted from the SERVQUAL and HEALTHQUAL instruments. The questionnaire was provided on hospital admission for expectation and before hospital discharge for perception. The quality gaps between the expectations and perceptions of participants were analyzed. Data were analyzed using SPSS (Version 24) through descriptive analyses, paired t-tests, and multivariate linear regression.

RESULTS

Based on the SERVQUAL questionnaire, the overall score for expectation and perception were 3.69 and 4.15, respectively and the overall gap in service quality was - 0.45. Similarly, according to the HEALTHQUAL questionnaire, the overall score for expectation and perception were 3.66 and 4.53, respectively, and the overall gap in service quality was - 0.87. In addition, the results indicated that the highest gap was observed for the Effectiveness and Assurance dimensions with gap scores of - 1.20 and - 0.69, respectively. Older patients, having an academic education, women who were residents in urban and those who visited for the first time were found to have significantly higher expectations compared with their perceived quality of care (P < 0.005).

CONCLUSIONS

The results of the current study confirmed that there is a negative gap between maternity service women's expectations and their perceptions. These results suggest there is capacity for improvement in the quality of health service delivery from the patient's perspective. Therefore, hospital managers need to develop several strategies to improve the interpersonal skills of staff and communication, strengthen trust between patients and health providers, and meet the psychological and emotional needs of patients.

Does maternity care in Australia align with the national maternity Strategy? Findings from a national survey of women's experiences

BACKGROUND

Women Centred Care: Strategic directions for Australian maternity services (the Strategy), released in November 2019, provides national guidance on effective maternity care provision. The Strategy is structured around four core values (safety, respect, choice, and access) underpinning twelve woman-centred care principles.

AIM

To explore whether the experiences of women who accessed Australian maternity services were aligned with the Strategy's values and principles.

METHODS

Women who had completed an entire maternity care episode in Australia between January 2020 and June 2023 were invited to participate in an online survey. Women's experiences according to the Strategy's values and principles and their association with model of care, age, place of residence, educational attainment, and household income are reported.

FINDINGS

The survey was completed by 1750 women. A proportion of women perceived the Strategy's values were not reflected in the care they experienced. At its lowest, only 50.3 % of women received an aspect of care that mostly or always aligned with the values, and 85.9 % at its highest. Women in private models of care were more likely to experience care according to the Strategy. Women in standard and high-risk public hospital care, rural/remote dwelling women, and younger women were less likely to experience care accordingly. Care was universally perceived to be worse in the postnatal period.

CONCLUSION

Despite articulating how Australian maternity care should be provided, the intent of the Strategy has not been fully realised. Inequities exist in women's access to and experiences of care across the entire maternity episode.

A cross-sectional study of low birth satisfaction during the COVID-19 epidemics' fifth wave

AIM

To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID-19 epidemics' fifth wave.

DESIGN

A cross-sectional study.

METHODS

This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction.

RESULTS

The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC-19S (14.7 ± 7.5), WHO-5 (67.5 ± 13.0) and BSS-R (28.6 ± 7.3). Sixty-five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well-being score < 50, fear of COVID-19, low satisfaction with pregnancy and low satisfaction with spouse's support. The overall proportion of the variance in birth satisfaction explained by all variables is 17.4%. Labor and birth variables explained 12.2% of the variance in birth satisfaction.

PATIENT OR PUBLIC CONTRIBUTION

None.

Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model

INTRODUCTION

Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors.

METHODS

Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions.

RESULTS

The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = -0.60), admission timing (β = -0.41), continuity of midwifery care (β = -0.43), physician's gender (β = -0.62), active labour duration (β = 0.37), and pain management (β = -0.33) to be the key determinants of the overall quality gap in intrapartum care.

CONCLUSION

Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan.

PATIENT OR PUBLIC CONTRIBUTION

This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.

Intrapartum Quality of Care among Healthy Women: A Population-Based Cohort Study in an Italian Region

Although the quality of care during childbirth is a maternity service's goal, less is known about the impact of the birth setting dimension on provision of care, defined as evidence-based intrapartum midwifery practices. This study's aim was to investigate the impact of hospital birth volume (≥1000 vs. <1000 births/year) on intrapartum midwifery care and perinatal outcomes. We conducted a population-based cohort study on healthy pregnant women who gave birth between 2018 and 2022 in Lombardy, Italy. A total of 145,224 (41.14%) women were selected from nationally linked databases. To achieve the primary aim, log-binomial regression models were constructed. More than 70% of healthy pregnant women gave birth in hospitals (≥1000 births/year) where there was lower use of nonpharmacological coping strategies, higher likelihood of epidural analgesia, episiotomy, birth companion's presence at birth, skin-to-skin contact, and first breastfeeding within 1 h (p-value < 0.001). Midwives attended almost all the births regardless of birth volume (98.80%), while gynecologists and pediatricians were more frequently present in smaller hospitals. There were no significant differences in perinatal outcomes. Our findings highlighted the impact of the birth setting dimension on the provision of care to healthy pregnant women.

The Association of Maternal Satisfaction with Childbirth by Length of Second Stage

OBJECTIVE

The aim of this study was to quantify patient satisfaction by hour of second stage of labor and subsequent delivery mode.

STUDY DESIGN

Pilot cross-sectional study of nulliparous women delivered at George Washington University Hospital between April 2018 and March 2019. Patients completed three survey questionnaires in the immediate postpartum period: Patient Perception Score (PPS), Consumer Satisfaction Questionnaire (CSQ), and Six Simple Questions (SSQ). Length of second stage was divided into 2 groups (≤3 hours and >3 hours). Data on maternal characteristics, maternal outcomes, and neonatal outcomes were collected in REDCap and statistical analysis was performed using SAS version 9.4.

RESULTS

Survey response rate was 100% (n = 100). Seventy-one patients had a normal second stage and 29 patients had a prolonged second stage. Prolonged second stage was significantly associated with a lower proportion of NSVD (65.5 vs. 90.1%; p <0.01) and a higher proportion of epidural (82.8 vs. 60.6%; p = 0.03) in comparison to a normal second stage. Length of second stage had a statistically significant negative correlation with overall PPS scores (ρ =  - 0.25, p ≤0.01). Length of second stage was not correlated with the SSQ (ρ = 0.05, p = 0.25) or CSQ (ρ =  - 0.18, p = 0.11) surveys. CSQ scores were statistically significantly lower in women who underwent second stage cesarean delivery.

CONCLUSION

Maternal satisfaction with childbirth and health care experience was high regardless of length of second stage. Only the PSS survey showed that shorter length of second stage was correlated with higher satisfaction. Cesarean delivery in the second stage was significantly associated with decreased maternal satisfaction. Future studies with larger cohorts are needed to confirm our findings.

KEY POINTS

· There is limited data on maternal satisfaction with childbirth.. · Mode of delivery may affect maternal satisfaction.. · Shared decision-making about delivery mode and timing is crucial..

Effect of implementation of the WHO intrapartum care model on maternal and neonatal outcomes: a randomized control trial

BACKGROUND

In 2018, the World Health Organization published a set of recommendations for further emphasis on the quality of intrapartum care to improve the childbirth experience. This study aimed to determine the effects of the WHO intrapartum care model on the childbirth experience, fear of childbirth, the quality of intrapartum care (primary outcomes), as well as post-traumatic stress disorder symptoms, postpartum depression, the duration of childbirth stages, the frequency of vaginal childbirth, Apgar score less than 7, desire for subsequent childbearing, and exclusive breastfeeding in the 4 to 6 weeks postpartum period (secondary outcomes).

METHODS

This study was a randomized controlled trial involving 108 pregnant women admitted to the maternity units of Al-Zahra and Taleghani hospitals in Tabriz-Iran. Participants were allocated to either the intervention group, which received care according to the ' 'intrapartum care model, or the control group, which received the' 'hospital's routine care, using the blocked randomization method. A Partograph chart was drawn for each participant during pregnancy. A delivery fear scale was completed by all participants both before the beginning of the active phase (pre-intervention) and during 7 to 8 cm dilation (post-intervention). Participants in both groups were followed up for 4 to 6 weeks after childbirth and were asked to complete questionnaires on childbirth experience, postpartum depression, and post-traumatic stress disorder symptoms, as well as the pregnancy and childbirth questionnaire and checklists on the desire to have children again and exclusive breastfeeding. The data were analyzed using independent T and Mann-Whitney U tests and analysis of covariance ANCOVA with adjustments for the parity variable and the baseline scores or childbirth fear.

RESULTS

The average score for the childbirth experience total was notably higher in the intervention group (Adjusted Mean Difference (AMD) (95% Confidence Interval (CI)): 7.0 (0.6 to 0.8), p < 0.001). Similarly, the intrapartum care quality score exhibited a significant increase in the intervention group (AMD (95% CI): 7.0 (4.0 to 10), p < 0.001). Furthermore, the post-intervention fear of childbirth score demonstrated a substantial decrease in the intervention group (AMD (95% CI): -16.0 (-22.0 to -10.0), p < 0.001). No statistically significant differences were observed between the two groups in terms of mean scores for depression, PTSD symptoms, duration of childbirth stages, frequency of vaginal childbirth, Apgar score less than 7, and exclusive breastfeeding in the 4 to 6 weeks postpartum (p > 0.05).

CONCLUSION

The intrapartum care model endorsed by the World Health Organization (WHO) has demonstrated effectiveness in enhancing childbirth experiences and increasing maternal satisfaction with the quality of obstetric care. Additionally, it contributes to the reduction of fear associated with labor and childbirth. Future research endeavors should explore strategies to prioritize and integrate respectful, high-quality care during labor and childbirth alongside clinical measures.

Factors Affecting Women's Assessment and Satisfaction with Their Childbirth

Background and Objective: Childbirth is one of the most significant experiences in a woman's life. The manner in which childbirth unfolds and is experienced can be influenced by various factors, including the birthing environment and the woman's attitude and preparation. Taking a holistic view of childbirth, it becomes apparent that addressing the basic physiological needs during childbirth can significantly influence the comfort and sense of security of laboring women. The aim of this research was to assess the level of satisfaction among women with their experience during childbirth and to identify its determinants. Materials and Methods: This study included 275 women who had given birth within the past 15 years and were up to 40 years of age. The research method employed was a diagnostic survey, involving a self-designed questionnaire. Results: discussing the birth plan with the midwife, the ability to ask questions during labor, consuming meals during labor, water immersion, listening to music during labor, assuming vertical positions during the second stage of labor, and skin-to-skin contact are associated with increased satisfaction with the childbirth experience. Conclusions: The study findings revealed that the highest levels of satisfaction were reported in connection with the interactions with medical staff during childbirth and the quality of facilities available during delivery. Conversely, the lowest levels of satisfaction were associated with the possibility of using pain relief methods during labor.

Risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised

OBJECTIVE

To evaluate the risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised (BSS-R) questionnaire.

METHODS

A cross-sectional study including women who gave birth at a single tertiary hospital between February 2021 and January 1, 2022. Birth satisfaction was measured using the BSS-R questionnaire. Maternal, pregnancy, and delivery characteristics were collected. Negative birth experience was defined as a BSS-R score lower than the median. Multivariable regression analysis was used to examine the association between birth characteristics and negative birth experience.

RESULTS

A total of 1495 women answered the questionnaire and were included in the analysis; 779 women comprised the positive birth experience group and 716 women comprised the negative birth experience group. Prior deliveries, prior abortions, and smoking (adjusted odds ratio [aOR], 0.52 [95% confidence interval (CI), 0.41-0.66]; aOR, 0.78 [95% CI, 0.62-0.99]; aOR, 0.52 [95% CI, 0.27-0.99], respectively) were independently associated with lower risk of negative birth experience. Immigration, answering the questionnaires in person, and cesarean delivery were independently associated with increased negative birth experience risk (aOR, 1.39 [95% CI, 1.01-1.86]; aOR 1.37 [95% CI, 1.04-1.79]; aOR, 1.92 [95% CI, 1.52-2.41], respectively).

CONCLUSION

Parity, prior abortions, and smoking were associated with a lower risk of negative birth experience, while immigration, answering questionnaires in person, and cesarean delivery were associated with a higher risk of negative birth experience.

Satisfaction with childbirth care in Brazilian maternity hospitals participating in the Stork Network program: women's opinions

This study aimed to describe maternal satisfaction with their experience during childbirth and birth and their association with sociodemographic, clinical and obstetric, and good practice characteristics during childbirth care. The sample included 2,069 women who wanted to express their opinions at the end of the interview of the Stork Network Assessment survey. Exploratory factor analysis was performed to summarize the variables of interest, creating latent variables, for input in the multiple logistic regression model. Six factors were created and tested in the model. Respect for the puerperal women was associated with satisfaction (vaginal delivery: 1.40; cesarean section: 1.47). Regarding those who underwent a cesarean section, satisfaction was associated with living in the Central-West (1.91) and South (2.00) regions and the presence of a companion during hospitalization (1.25). However, for women who had vaginal delivery, satisfaction was inversely associated with large hospitals (0.62) and undergoing interventions during labor and delivery (0.83), but positively with multiparity (1.98), receiving good care practices for labor and delivery (1.24), and having immediate contact with the newborn (1.20). The better understanding of the factors associated with mothers' care satisfaction for labor and delivery can improve care quality provided in public hospitals in the Brazil.

Pain Intensity, coping and maternal satisfaction in Low-Risk labouring Women: A prospective descriptive correlational study

OBJECTIVES

The primary aim of the study was to explore pain intensity (PI) and pain coping (PC) scores and the relationship between them. The secondary aim was to explore the correlation between PI and PC scores with labour progress, parity, labour acceleration, labour augmentation and maternal satisfaction.

METHODS

A prospective descriptive correlational study was conducted in a maternity hospital in Northern Italy. The sample included 54 low-risk women in active labour at term of pregnancy. A data record sheet was used to collect the relevant variables and the Italian Birth Satisfaction Scale Revised (I-BSS-R) was administered to participants at least 24 h after birth.

RESULTS

In the first labour stage, the average PI score was 6.99 (SD = 1.95) and the average PC score was 6.5 (SD = 2.22). During the second labour stage, the average PI score was 7.75 (SD = 1.74) and the average PC score was 4.97 (SD = 2.76). The average PI score trend increased with labour progress. The average PC score improved between 4 and 7 cm of cervical dilatation. A significant positive correlation between PI scores and oxytocin augmentation (p < 0.001) and labour progression (p < 0.001) was noted. A significant positive correlation between PC scores and oxytocin augmentation (p = 0.02) was also observed. No significant differences were found for maternal satisfaction in regard to PI and PC scores.

CONCLUSION

coping in labour do not solely depend on PI but also on labour progress and oxytocin augmentation. Additional support to empower women to cope with pain may be required in case of labour augmentation.

Intrapartum pudendal nerve block analgesia and childbirth experience in primiparous women with vaginal birth: A cohort study

BACKGROUND

A negative childbirth experience has short- and long-term consequences for both mother and child. This study aimed to investigate the association between intrapartum pudendal nerve block (PNB) analgesia and childbirth experience.

METHODS

Primiparous women with a singleton cephalic vaginal live births at term at Oslo University Hospital from January 1, 2017, to June 1, 2019, were eligible for inclusion. The main outcome was total score on a childbirth experience questionnaire (range 1.0-4.0, higher score indicates better childbirth experience). An absolute risk difference of 0.10 was considered clinically relevant. Propensity score matching was used to adjust for differences in baseline characteristics between women with and without PNB. The analyses were stratified by spontaneous vs instrumental birth. Subanalyses of the questionnaire's domains (own capacity, professional support, perceived safety, and participation) were performed.

RESULTS

Of 979 participating women, mean age was 32 years. Childbirth experience did not differ between women with and without PNB, either in spontaneous (absolute risk difference of the mean: -0.05, P value 0.36) or in instrumental birth (absolute risk difference of the mean: 0.03, P value 0.61). There were no statistically significant differences between PNB group scores for the separate domains.

CONCLUSIONS

Women's childbirth experiences did not differ between birthing people with or without PNB, either in spontaneous or in instrumental births. The clinical implications of our study should be interpreted in light of the pain-relieving effects of PNB.PNB should be provided on clinical indication, including for individuals with severe labor pain.

Childbirth experience and practice changing during COVID-19 pandemic: A cross-sectional study

AIM

To evaluate mothers' satisfaction with childbirth experience in a cohort of women who delivered during COVID pandemia and to compare them to a pre-COVID cohort.

DESIGN

We performed a cross-sectional study in a low-risk Maternity Unit.

METHODS

Women who delivered during COVID-19 pandemic were compared to a pre-COVID cohort recruited in 2018 in the same setting. Italian version of the Birth Satisfaction Scale-Revised (I-BSS-R) was used.

RESULTS

Three hundred and seventy-seven women were included (277 pre-COVID and 100 during COVID pandemic). No differences in terms of satisfaction at birth were reported (I-BSS-R mean 27.0, SD 5.3 versus mean 27.6, SD 6.1, p 0.34), despite an increased rate of active intrapartum interventions. Intrapartum variables that significantly reduced satisfaction were the same in the two groups: epidural analgesia (p < .0001 in both groups), prolonged active phases (p < .0001 in both), oxytocin administration (p < .0001 in both) and operative delivery (p 0.0009 versus p 0.0019).

Predictors of low birth satisfaction among Iranian postpartum women: A cross-sectional study

Aim

To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women.

Design

This was a cross‐sectional study.

Methods

This study was conducted on 767 postpartum women using a convenience sampling method between June and September 2019. We collected data on socio‐demographic variables, maternal well‐being, fear of childbirth and birth satisfaction. We used multiple linear regression analyses to determine predictors of low birth satisfaction.

Results

The women who gave birth by elective caesarean, emergency caesarean and vaginal birth were 13.2%, 19.06% and 67.8%, respectively. Predictors of low birth satisfaction were primiparity [Beta = −0.131, CI (−2.745, −1.021)], low level of well‐being [−0.119, (−2.514, −0.844)], low [−0.193 (−5.052, −2.568)] and moderate [−0.143 (−2.999, −1.199)] satisfaction with pregnancy, moderate satisfaction with spouse's emotional/financial support [−0.150 (−3.718, −1.595)], emergency caesarean [−0.086 (−2.713, −0.360)], severe fear of childbirth [−0.315 (−5.701, −3.911)] and long interval between admission to hospital and giving birth [−0.188 (−0.233, −0.119)].

Satisfaction with maternity care among recent migrants: an interview questionnaire-based study

OBJECTIVE

To examine factors associated with recently migrated women's satisfaction with maternity care in urban Oslo, Norway.

DESIGN

An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire.

SETTING

Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020.

PARTICIPANTS

International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries.

PRIMARY OUTCOME

Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences.

SECONDARY OUTCOME

Negative healthcare experiences and their association with reason for migration.

RESULTS

A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification.

CONCLUSIONS

Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.

Coping With the Unexpected in Childbirth: A Thematic Analysis

This article reports original research that describes new mothers' experiences of birth and maternity care. Qualitative data were collected through a survey on birth satisfaction, which included space for women to provide comments about their birth and experience of care. Thirty-nine women provided comments that were analyzed using the thematic analysis method. Two themes emerged from the women's experiences: "Unexpected birth processes: expectations and reality" and "Coping with birth: the role of health-care staff." Participants described unexpected birthing processes, their experiences of care, and maternity care staff's contributions to coping with birth. Implications for practice for childbirth professionals include promotion of physiologic birth, respectful person-centered care during all phases of perinatal care, and the value of childbirth preparation.

The Age at Which a Woman Becomes a Mother and Her Satisfaction with the Process of Pregnancy, Childbirth and the Puerperium

This study assessed the effect of maternal age on satisfaction at each stage of pregnancy, childbirth and puerperium, and globally. An observational study was carried out in five hospitals of the Andalusian public health system with older primiparous women, from May 2016 to May 2018. Using a pre-piloted questionnaire, information was collected on pregnancy, childbirth, puerperium, newborn variables and degree of satisfaction with the care received. Crude and adjusted mean differences and the standard error of the mean were calculated. A total of 373 women participated. In total, 43.0% of the sample were very satisfied with the care received during pregnancy, and 74.2% with the care received during childbirth. During the puerperium, the highest percentage (60.4%) was found among the women who reported being quite satisfied, although the results were not significant in any of these stages (p > 0.05). No significant differences were established between women’s different age strata and maternal satisfaction. However, the average given by women regarding their satisfaction with the process, on a scale from 0 to 4, was: 3.5 ± 0.5 in general, 3.2 ± 0.8 regarding pregnancy, 3.7 ± 0.5 in childbirth and 3.1 ± 0.6 in the postpartum period. The woman’s satisfaction with the follow up and health care received during pregnancy, childbirth and puerperium is independent of the mother’s age.