Women's satisfaction with intrapartum care - a pattern approach

This paper is a report of a study to investigate women's satisfaction with intrapartum care along three distinct dimensions simultaneously (interpersonal care, information and involvement in decision-making and physical birth environment) and to describe the characteristics of women with different patterns of satisfaction.

Patient satisfaction is an important outcome in the evaluation and development of healthcare services. Studies of satisfaction have often used single global ratings but such ratings may not capture the multidimensionality of care during childbirth.

A cluster analytic technique was used to establish a finite set of response patterns. Data were obtained from a longitudinal population-based Swedish survey including 2605 women who completed questionnaires in early pregnancy, and 2 months and 1 year after the birth. Data collection commenced in March 1999 and was completed in April 2002.

Nine different clusters, or patterns of satisfaction/dissatisfaction, were found. Nearly half of the women (47%) were in clusters that were satisfied or very satisfied with at least one dimension of care, 20% in clusters that were fairly satisfied (average), and 33% in less than satisfied clusters. Fifteen per cent were mainly dissatisfied with the physical environment, 8% mainly with interpersonal care, 7% only with information and decision-making and 3% with all dimensions. Women in the different clusters differed statistically significantly in psychological health in early pregnancy, emotional reactions during labour and in labour outcomes, but not in background characteristics.

Looking at different dimensions of care instead of a single global measure gave a richer, more diverse, and also a more negative picture of women's experiences of intrapartum care.