Preparedness and support, not personality, predict satisfaction in unplanned caesarean births

We evaluated what predicts satisfaction following an unplanned caesarean first-time birth. Two hundred and twenty-seven primiparous women who delivered by unplanned caesarean were surveyed on individual difference variables (the 10-Item Big Five Personality Domains scale, the Desirability for Control Scale), interactional variables (the CollaboRATE scale, and measures of emotional support and decisional inclusion during labour and delivery), perceptions of preparedness, and the Birth Satisfaction Scale-Revised Indicator. A multilinear regression was run using birth satisfaction as the dependent variable. Three variables predicted birth satisfaction: emotional support, being included in the decision-making, and present perception of preparedness (R²=.54, p<.001). Participants reported feeling more prepared before the birth experience than they actually were, as viewed in hindsight (p<.001). How prepared a woman perceives she was for the experience she actually had, together with her perceptions of emotional support and decisional inclusion during birth, predict birth satisfaction when birth deviates from her original expectations.Impact statementWhat is already known on this subject? An unplanned caesarean often leads to dissatisfaction with the birth experience and is emotionally challenging for women, increasing the risk of postpartum depression and acute stress disorder. Some recent work indicates personality may influence the birth experience, and other work suggests the quality of interaction between healthcare provider and the woman may predict satisfaction.What the results of this study add? In this study, we sought to identify predictors of satisfaction in women whose first and only birth experience resulted in an unplanned caesarean delivery. Our research demonstrated that over half of the variation in birth satisfaction can be predicted by how prepared women feel they actually were for their experience, by women's perceptions of healthcare providers' efforts made to emotionally support them and to include them in the decision-making process. Personality and a woman's desire for control did not predict satisfaction. These results indicate that birth satisfaction is heavily influenced by what happens before and during the experience and can be amenable by support from a healthcare provider.What the implications are of these findings for clinical practice and/or further research? Preparing women for the possibility of an unplanned caesarean, emotional support, and inclusion in the decision-making process, may reduce dissatisfaction, and potentially distress, after an unplanned caesarean.