La soddisfazione materna come indicatore di qualità dell’assistenza ostetrica al parto

Abstract Introduction The World Health Organization in the “Intrapartum Care for a positive Childbirth Experience” states that, in addition to clinical care and quality indicators, it is necessary to take into account the psychological well-being and the personal satisfaction of women after childbirth in order to assess the quality of midwifery care. Maternal satisfaction is a multidimensional construct influenced by several factors and is not related only to the absence of adverse events. High maternal satisfaction appears to be associated with numerous long-term positive effects on both mother and newborn health, both physical and psychological. Women who experience childbirth negatively are significantly more at risk of developing post-partum depression and have more difficulty in establishing a positive bond with the newborn. The Italian translation of the english BSS-R questionnaire was presented in a recently published study. This test was examined and validated in different countries, and it is considered a reliable tool to measure maternal satisfaction at childbirth. Aim of the study The purpose of this study is to evaluate maternal satisfaction at childbirth through the administration of BSS-R, translated and validated in Italian, to a sample of women who gave birth in Clinica Mangiagalli of Milan. Materials and Methods The sampling was convenient, and the data were collected through consultation of the medical records and administration of the I-BSS-R questionnaire to the selected women after obtaining their informed consent. The data collection took place between June and September 2019. Results The sample consists of 100 mostly Italian women (77%). Of these women, 55% are first time mothers and 45% are multiparous. 89% of these women gave birth spontaneously, 5% with operative delivery and 6% had a caesarean section in labour. Among the women who gave birth spontaneously, 52% had a spontaneous tear, 39% had an episiotomy, 8% had an intact perineum and 1% a complicated tear. 77% of the women in the sample required epidural analgesia. The averages of the total scores and those of the scores subdivided in the three dimensions of the Italian BSS-R were compared with the same scores of the English and Spanish studies; the Italian women appear, on average, less satisfied. The mean of the scores of subgroups in the sample were then compared by identifying a specific variable. In particular, the multiparous appear to have average scores higher than the nulliparous in the dimensions “stress experienced during labour” and “women’s personal attributes” and in the total score. Women who have given birth spontaneously appear to have higher average scores in all the dimensions of the test than women who have faced an operating birth or a C-section in labour. There was also a difference in the scores of I-BSS-R in relation to perineal outcomes: women who gave birth with intact perineum or spontaneous tear have higher scores in dimensions “stress experienced during labour” and “women’s personal attributes” and in total score. Women who have not required epidural analgesia are best performing in the “stress size experienced during labour” and “quality of care provision” dimensions and in the total score. In this study the participation in childbirth preparation course, contrary to previous published studies, does not positively affect the overall satisfaction of women in childbirth. Finally, it seems that women with a higher cultural level have higher average satisfaction scores than women with a lower or higher secondary school diploma Conclusions Maternal satisfaction appears to be affected both by factors relating to labor and childbirth and by factors relating to the history of women, such as participation in the childbirth preparation course or their qualification. The scores obtained with I-BSS-R are on average lower than the scores reported by the Spanish and English study, and this result could identify the need to implement measures to increase women’s satisfaction. The first step on the part of health professionals could be to minimize medical interventions during labour and childbirth, as recommended by the WHO(4). Improvement and reinforcement of childbirth preparation course could also contribute to increase safety and improve women’s expectations, and also have a positive influence on their satisfaction after childbirth.