Maternal satisfaction and perceived quality of care during childbirth in a tertiary care Italian Obstetrics Unit: a cross-sectional study

Maternal satisfaction is a widely used indicator for evaluating the quality of maternity services and is linked to important psychological and relational outcomes. In Italy, limited data have been published on women's childbirth experiences, generally showing high satisfaction, but highlighting areas needing improvement, such as communication and pain management, especially during emergency cesarean section or operative vaginal delivery. This study primarily aimed to assess women's overall evaluation of their labor and delivery experiences. Additionally, we examined sociodemographic and obstetric factors that may influence maternal satisfaction and explored satisfaction across specific experiential domains.

This is an observational, cross-sectional, non-pharmacological, non-profit, monocentric study conducted between June and October 2024 at the Unit of Obstetrics and Maternal Fetal Medicine, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan. A total of 696 women were consecutively recruited during their postpartum hospital stay. Participants completed a pseudonymized questionnaire which consisted of three sections: sociodemographic data, obstetric history, and birth experience evaluation using a 5-point Likert scale. Maternal satisfaction was operationalized as a retrospective self-reported appraisal of care. We used logistic regression to estimate prevalence odds ratios (OR) and the corresponding 95% confidence intervals (CI) for the associations between dissatisfaction and selected maternal and obstetric factors.

Overall, 85.3% (95% CI: 82.7%-88.0%) of women reported satisfaction with their labor and delivery experience. Previous childbirth was inversely associated with dissatisfaction (OR=0.53, 95% CI: 0.29-0.97). In contrast, higher maternal age (OR=1.05, 95% CI: 1.00-1.10), labor induction (OR=2.18, 95% CI: 1.31-3.61), and operative delivery (OR=3.37, 95% CI: 2.06-5.51) were positively associated with dissatisfaction. The main concerns reported by dissatisfied women included inadequate pain management, lack of perceived control, and insufficient emotional support.

Despite high overall maternal satisfaction, relevant gaps persist in communication, emotional support, pain management, and perceived control during childbirth. Interventions promoting shared decision-making, structured communication, and systematic use of satisfaction surveys and birth plans may support a more woman-centered approach to maternity care, potentially improving both women's evaluation of care and the quality of intrapartum services.