Mode of delivery and its influence on women's satisfaction with childbirth

Many factors affect women's satisfaction with the experience of childbirth. Some of these are known, but most have not been fully evaluated. The influence of the mode of delivery is unclear. This study investigated the extent to which satisfaction with childbirth depends on the mode of delivery, and evaluated factors determining postpartum satisfaction.

Women with singleton pregnancies at term were included prospectively. After childbirth, all women meeting the inclusion criteria received a standardised questionnaire - the German version of Salmon's Item List (SIL-Ger) - for completion before discharge to evaluate the birth experience. The chi-squared test, Fisher's exact test, and Kruskal-Wallis test were used for statistical analysis. Univariate and multivariate linear regression analyses were used to assess associations between demographic and pregnancy-associated variables and variables influencing the perception of childbirth in the total SIL-Ger score. Univariate and multivariate binary logistic regression models were used to evaluate effects of demographic and clinical parameters on SIL-Ger scores of <70 versus SIL-Ger scores of ≥ 70. All covariates with a P value ≤ 0.10 in the univariate analysis were included in multivariate logistic regression models. All tests were two-sided, and P values<0.05 were considered statistically significant.

The analysis included 335 questionnaires. No differences were observed between different modes of delivery (normal 84.5 ± 14.6, primary caesarean 87.0 ± 13.5, secondary caesarean 83.2 ± 13.8, emergency caesarean 79.3 ± 7.3, operative vaginal delivery 83.9 ± 13.6; P=0.503). Multivariate analysis identified two independent factors associated with higher SIL-Ger scores: good/very good satisfaction with childbirth (P<0.001) and good/very good involvement in decision-making afterwards (P=0.005). Severe pain perception during childbirth was associated with lower SIL-Ger scores (P=0.003). Absence of a person of trust during childbirth was linked with scores<70 (P=0.005), indicating a negative experience. Good/very good satisfaction with childbirth (P<0.001) reduced the probability of a score<70.

Mode of delivery does not directly influence women's satisfaction with childbirth. Involvement in decision-making, support during labour and effective analgesia appear to be the most important factors that improve women's birth experience.