Birth satisfaction among low risk women in a Public Healthcare Center in India

Lumchio Levis Murry; Philomina Thomas; Gita Razdan; Ravneet Kaur; Shashi Maward

doi:10.4103/IJCN.IJCN_21_19

RESEARCH ARTICLE

Year : 2020 | Volume : 21 | Issue : 2 | Page : 176-180

Birth satisfaction among low risk women in a Public Healthcare Center in India

Lumchio Levis Murry¹, Philomina Thomas², Gita Razdan³, Ravneet Kaur⁴, Shashi Maward¹
¹ Associate Professor, College of Nursing, AIIMS, New Delhi, India
² Tutor, College of Nursing, AIIMS, New Delhi, India
³ Assistant Professor, College of Nursing, AIIMS, New Delhi, India
⁴ Associate Professor, Centre for Community Medicine, AIIMS, New Delhi, India

Date of Submission	26-Dec-2019
Date of Decision	29-May-2020
Date of Acceptance	25-Aug-2020
Date of Web Publication	19-Feb-2021

Correspondence Address:
Mrs. Lumchio Levis Murry
College of Nursing, AIIMS, Ansarinagar - 110 029, New Delhi
India

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCN.IJCN_21_19

Abstract

Women's satisfaction with the care they receive during childbirth has gained importance in recent years. Factors such as women's stress experienced during labour, anxiety and feeling of being in control during labour have not been widely studied in India even though these factors influence satisfaction with birth. This study aims to assess women's satisfaction with care following normal birth in a secondary level public facility using the Birth satisfaction Scale Revised (BSS R). Consecutive samples of 273 low risk women who have had spontaneous vaginal birth were enrolled within 1 week of childbirth. Demographic profile was collected, and women were assessed for satisfaction at birth using the BSS R. The total birth satisfaction score was 21.4 (±4.5), which is just around the mean of the total score. The women scored below average in the sub domain of stress experiences during labour (7.0 ± 2.6). The domain on women's' personal attributes was also rated poorly (2.8 ± 1.5). The quality of care provision was rated above average by the women (11.6 ± 2.7). A significant difference in the mean score of BSS R was seen in relation to educational status of the women and the type of family they belonged to (P < 0.05). Assessment of birth satisfaction can assist in focusing on areas where improvement in care is required. Midwives need to educate and partner with women right from the antenatal period to make labour and childbirth a satisfying experience for the woman.

Keywords: Birth, experiences, stress, women

How to cite this article:
Murry LL, Thomas P, Razdan G, Kaur R, Maward S. Birth satisfaction among low risk women in a Public Healthcare Center in India. Indian J Cont Nsg Edn 2020;21:176-80

How to cite this URL:
Murry LL, Thomas P, Razdan G, Kaur R, Maward S. Birth satisfaction among low risk women in a Public Healthcare Center in India. Indian J Cont Nsg Edn [serial online] 2020 [cited 2021 Feb 28];21:176-80. Available from: https://www.ijcne.org/text.asp?2020/21/2/176/309857

Introduction

The provision of high quality of care has become essential in today's health-care system. Patient's satisfaction has been used in healthcare as an indirect indicator of the quality of care.^[1],[2] Women's satisfaction with the care they receive during birth has gained importance in recent years.^[3],[4] Women tend to view their birthing as a positive experience when they get support from caregivers and family members.^[5],[6] Factors like having a companion during labour, waiting time, privacy, immediate condition following delivery and availability of spaces are associated with women's satisfaction following birth whereas, women are most dissatisfied with separation from their babies, continuous monitoring using machines, pain management and cesarean births.^[7],[8],[9] Increased satisfaction with care received at birth has been associated with better maternal infant bonding, better self-esteem and confidence in the mother, and possibly, better maternal and infant well-being.^[10],[11] With the increase in women opting for institutional delivery largely due to incentive linked schemes rolled out by the government, labour rooms have become increasingly crowded, and quality of care remains largely unmeasured and, most often, ignored.^[12],[13] To address this, the government of India has launched a labour room quality improvement initiative (Laqshya) which aims to improve the quality of care during childbirth and the immediate postpartum period.^[14] One of the objectives of the program is to enhance the satisfaction of beneficiaries visiting the health facilities and provide respectful maternity care to all pregnant women attending the public health facility. However, there is a lack of clarity on how to assess the satisfaction of women attending these facilities.

Assessment of women's satisfaction at birth using standardised instruments is scarce in India.^[8] Factors like women's stress experience during labour, anxiety and feeling of being in control during labour have not been widely studied in India even though these factors influence satisfaction with birth. Thus, this study aims to assess women's satisfaction with care following normal birth in a secondary level public facility, using a standardised scale. This study will help in understanding women's' perspective on the quality of care received by them during childbirth, which is a highly significant event in a woman's life. The study can also be used as baseline data to improve care in the facility.

Materials and Methods

Data were collected from the postpartum ward of a 50 bedded district hospital with 24 h emergency and obstetric facilities and yearly total childbirth of around 3000. Most of the deliveries in the center are normal vaginal deliveries attended by nurses. The obstetrical risk status of women presenting at labour is decided by attending physician. Women without risk factors during the present pregnancy and with no bad obstetric history are admitted for delivery. Women considered high risk are referred to higher center. This is because deliveries are primarily done by nurses, and only a single resident doctor is available on call at any given point of time, and the centre is not fully equipped to handle high-risk deliveries. An estimated sample size of 300 was calculated with a population of 3000 deliveries per year at 95% confidence interval and 5% margin of error. The final sample size consisted of a consecutive sample of 273 women who have had spontaneous vaginal birth were enrolled within 2 days of childbirth for the study. Women are kept in the postpartum ward for a minimum 48 h as per government policy and data for this study was collected during this time using face-to-face interview. All of the respondents were conversant in the Hindi language, which was used to obtain information. Women who had postpartum complications and whose newborn is sick were excluded. Written informed consent was obtained before data collection. Data were collected from August 2018 to December 2018.

Women's satisfaction with birth was assessed by the Birth Satisfaction Scale-Revised (BSS-R), which is a standardised tool with reported reliability and validity (Cronbach alpha = 0.79).^[15] It measures thee sub-attributes of satisfaction, namely, stress experienced during labour (Item 1, 2, 7, 9) with a score range of 0–16, women's personal attributes (Item 4, 8) with a score range of 0–8, and quality-of-care provision (Item 3, 5, 6, 10) with a score range of 0–16. It is a revised version of the BSS, which originally had 30 items. It is recommended by the International Consortium for Health Outcomes Measurement for assessing satisfaction with care during childbirth.^[16] Permission was obtained from the concerned authority for using the tool. The tool was translated into Hindi to be used for the present study by a language expert. The translated version was retranslated back into English to validate the original meaning. Ethical approval for the study was taken from the institutional Ethics Committee. Data were entered in Microsoft Excel spreadsheet and then imported to STATA software version 13.1, StataCorp, College Station, Texas 77845 USA. Descriptive statistics were used to analyze data. Unpaired t-test and ANOVA were used to determine the association between sociodemographic characteristics and the mean score of BSS-R.

Results

Sociodemographic characteristics of the study participants are given in [Table 1]. The mean age of the postpartum women was 24.4 years. Majority of them were Hindus (89.7%), had been schooled till secondary level (42.5%), were native to the place (90.1%), were housewives (97.1%), and lived in joint families (61.5%). Majority had a monthly income of 5000 INR to 20,000 INR (45.6%). They were married for an average of 4 years, and most of them had delivered either their first or second child recently (38.8% vs. 37%). There was a significant difference in the mean score of BSS-R among women belonging to joint families as compared to nuclear families (P < 0.05). A significant difference in the mean score of BSS-R was also seen in relation to the educational status of the women (P < 0.05).

Table 1: Sociodemographic characteristics (n=273)

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[Table 2] summarises the item-wise response to the BSS-R, and [Table 3] outlines the subscale scores. The total birth satisfaction score was 21.4 (±4.5), which is just around the mean of the total score. The women scored below average in the sub-domain of stress experiences during labour (7.0 ± 2.6). While one-third of them (33.7%) agreed that they came through birth virtually unscathed, an almost equal proportion disagreed with the statement (30.8%). Majority of the women agreed (53.1%) and strongly agreed (14.6%) that their labour was excessively long and agreed that giving birth was a distressing experience (56%), whereas 39.2% of them agreed that they were not distressed at all during labour. The domain on women's personal attributes was also rated poorly (2.8 ± 1.5). Majority of the women agreed or strongly agreed to have felt very anxious during labour and birth (60.4%, 19.8%), and around half of them agreed or strongly agreed to have felt out of control during the birth experience (41.8%, 9.2%). Quality-of-care provision was rated above average by the women 11.6 (±2.7). The majority of the women agreed that the delivery room staff encouraged them to make decisions about how they wanted the birth to progress (52%). They also felt well supported by staff (60.1%), and that the staff communicated with them well (61.2%). Most of them also agreed that the delivery room was clean and hygienic (59.7%).

Table 2: Item-wise score of birth satisfaction scale-revised (n=273)

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Table 3: Subscale scores of birth satisfaction scale-revised (n=273)

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Discussion

The findings of this study suggest a moderate level of satisfaction with birth among postpartum women in the 1^st week following childbirth, with comparatively better scores in the subdomain of 'quality of care provision'. This finding is in agreement with previous literature, which suggests that women have few expectations from a public institutional facility, and when these expectations are met, she perceives her birth experience as satisfactory.^[13],[15] These expectations can be as basic as the survival of both herself and her baby. The relationship between women's personal expectations and their satisfaction with health care has been reported in other studies also.^{[8],[17],[18]} Women who had attained primary and secondary education had significantly lower mean scores as compared to those who were illiterate. This can be because of higher health-care expectations among those who are educated and has been observed in other studies too.^[10] Women from joint families also had significantly lower mean scores as compared to those from nuclear families. Perceived social support has been identified as a predictor of childbirth experiences,^[19] and it can be argued that women from nuclear families probably had support from extended family members and relations. This finding needs further exploration in regard to the influence of family structure on childbearing women and their satisfaction with birth.

The low score in the subdomain of 'stress experiences during labour' suggest reduced personal control, anxiety and stressful birth experience. The majority of the women agreed or strongly agreed to the statement that they came through birth virtually unscathed (52%). This may be explained by the fact that all of them had a spontaneous vaginal birth with no instrumentation. Experience of pain during labour can be viewed as both positive as well as negative by women based on their attitude and personal experience.^{[20],[21],[22]} Studies undertaken with Indian women have shown that pain is perceived as more of a positive experience in labour.^[23],[24] The majority of the women also agreed that their labour was excessively long and found giving birth a distressing experience. Women may not be aware of the fact that stressful experiences of labour can be minimised by partnership with health-care providers. There is a need for a paradigm shift in the way women are cared for during labour so that both women and health-care providers can adopt a partnership approach to make childbirth less distressing for women.

Women's personal attributes in this scale refer to the anxiety felt by the women during labour and birth and a feeling out of control during birth. This subdomain also received a low score (2.8 ± 1.5). Lack of information and the fear of the unknown can lead to anxiety.^[25] Preparation for birth through education and counseling should be an integral part of antenatal care to reduce anxiety. Midwives need to model open communication and involve the woman in decision making so that labouring women feel more in control of the situation they are going through.

Conclusion

Childbirth is a life-changing event for a woman and is largely viewed as a physiological process. However, women are usually encouraged to go to health-care facilities for childbirth, and this inadvertently puts them in a position of care receiver or patient from that of someone who can take control of changes happening within her body during labor and childbirth. Women become passive participants to an event which could have been an empowering process if she had the awareness and necessary support. Assessment of birth satisfaction can assist in focusing on areas where improvement in care is needed. Midwives need to educate and partner with women right from the antenatal period to make labor and childbirth a satisfying experience for the woman.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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