Maternal satisfaction with the birth experience: A prospective comparison of water immersion and epidural analgesia

Maternal satisfaction during childbirth is an essential indicator of quality and is influenced by multiple factors, including pain management. Understanding the impact of epidural analgesia and water immersion on maternal satisfaction is key to guiding strategies that promote more positive birth experiences.

The objective was to compare satisfaction during childbirth between women who choose an epidural analgesia (EA) and those who opt for water immersion (WI), and to identify factors that predict a satisfactory experience.

This is a prospective cohort study undertaken in a Spanish public hospital with low-risk women (n = 552). An amended version of the Mackey Childbirth Satisfaction Rating Scale (MCSRS) was used to assess five dimensions of satisfaction. Multivariate analysis of variance (MANOVA) and multiple linear regressions were carried out to explore the differences between groups and predictors of overall satisfaction.

Women in the WI group reported significantly higher overall satisfaction than those who used EA (mean difference = 3.19, 95% CI: 2.68 to 3.70; p < 0.001). In the multivariate stepwise regression model, analgesia method remained the strongest predictor of global satisfaction (B = 1.043, β = 0.520, 95% CI: 0.87 to 1.22; p < 0.001). Mode of birth (β = -0.335), duration of the second stage (β = -0.088), pain during the second stage (β = -0.085), and continuity of care by the same midwife (β = 0.074) also independently contributed to the model. The final model explained 34.7% of the variance in overall satisfaction (R² = 0.347), indicating a moderate explanatory capacity. A post-hoc power analysis indicated high sensitivity to detect the observed effect size, although this does not replace an a priori power calculation.

This study highlights the importance of woman-centred, low-intervention maternity care that promotes informed choice and continuous support. Expanding access to water immersion may enhance women's birth experiences. Furthermore, the positive association between continuity of midwifery care and satisfaction supports organisational models that facilitate consistent, relationship-based care beyond the choice of analgesia.