Effect of Maternity Units' Organizational Levels on Maternal Birth Satisfaction: A Multicentric Cohort Study

Introduction: Maternal birth satisfaction is correlated to long-term outcomes and is influenced by the place of birth. In Italy, most births occur in hospitals. Our study aimed to assess whether the organizational level (I vs. II) of the Maternity Unit (MU) had any impact on birth satisfaction. Methods: A multicentric cohort study was conducted in 11 Italian MUs, classified as Level I (for low-risk pregnancies or with minor complications) or Level II (for low and high-risk women) according to organizational, structural, and technical standards. Birth satisfaction was measured using the Italian version of the BSS-R, composed of three sub-scales. Data analysis was performed using Stata/MP18.0. Results: Among 1642 participants, maternal satisfaction was similar in I and II level MUs (27.7 vs. 27.2; p-value 0.096). Women who gave birth in an I level MU were found to have a greater Quality of care sub-scale score compared to participants who gave birth in a II level MU (14.28 vs. 13.87; p-value < 0.001). The three sub-scales contributed differently to the total score, with a minor contribution given by the Stress Experienced (8.65/16) and the Women's Attributes sub-scales (4.72/8). Conclusion: This study contributes to understanding how the level of the MU might impact women's birth satisfaction. Factors affecting the Women's Attributes and the Stress Experienced sub-scales' scores should be considered to increase maternal satisfaction with birth, improving the quality of maternity services.