Association between maternal satisfaction and other indicators of quality of care at childbirth: a cross-sectional study based on the WHO standards

Abstract

Objectives: This study aimed to explore the association between maternal satisfaction and other indicators of quality of care (QoC) at childbirth, as defined by WHO standards.

Design: Cross-sectional study.

Setting: Referral hospital in Northeast Italy.

Participants: 1244 consecutive mothers giving birth in the hospital participated in a survey.

Data collection and analysis: Univariate analyses were performed to evaluate the association between maternal satisfaction and 61 variables, including measures of 'provision of care', 'experience of care', 'availability of resources' and other maternal characteristics. Exploratory factor analysis was performed to create groups of correlated variables, which were used in multivariate analysis.

Results: Overall, 509 (40.9%) of women were >35 years of age, about half (52.7%) were highly educated, most (95.2%) were married/living with partner and employed (79.3%) and about half (52.9%) were primiparous. Overall, 189 (15.2%) were not born in Italy and 111 (8.9%) did not have Italian citizenship. Most women (84.2%) were highly satisfied (score ≥7/10) with the care received. Among the 61 variables explored, 46 (75.4%) were significantly associated with women's satisfaction, 33 with higher satisfaction and 13 with lower satisfaction. Multivariate analysis largely confirmed univariate findings, with six out of eight groups of correlated variables being statistically significantly associated with women's satisfaction. Factors most strongly associated with women's satisfaction were 'effective communication, involvement, listening to women's needs, respectful and timely care' (OR 16.84, 95% CI 9.90 to 28.61, p<0.001) and 'physical structure' (OR 6.51, 95% CI 4.08 to 10.40, p<0.001). Additionally, 'victim of abuse, discrimination, aggressiveness' was inversely associated with the wish to return to the facility or to recommend it to a friend (OR 0.35, 95% CI 0.17 to 0.70, p<0.003).

Conclusion: This study suggested that many variables are strongly associated with women's satisfaction with care during childbirth and support the use of multiple measures to monitor the QoC at childbirth.

Keywords: maternal medicine; quality in health care; reproductive medicine.

Figure 1

Association between ‘women’s overall satisfaction’ and sociodemographic and clinical characteristics. RMC, respectful maternity care.

Figure 2

Association between ‘women’s overall satisfaction’ and indicators of provision of care. CTG, cardiotocography. All variables were WHO quality measures, except for ‘induction of labour’ and ‘private assistance’, which resulted significantly associated with a low maternal satisfaction.

Figure 3

Association between ‘women’s overall satisfaction’ and indicators of experience of care. HWs, health workers.

Figure 4

Association between ‘women’s overall satisfaction’ and indicators of availability ofresources. HWs, health workers. All variables were WHO quality measures, except for ‘organisation of hospital routine’ (timings of follow-up visits, medications, etc) and ‘areas for visitors and timing’, which resulted significantly associated with a high maternal satisfaction.