What do we know about families’ satisfaction with various maternity care options? Here is some data that can inform us.
Seattle area postpartum survey
A few years ago, we surveyed women in the Seattle area about their birth experience. (It’s important to note that this was an informal survey that parents opted into. We recruited participants from those who had taken part in childbirth classes, used a doula, or participated in postpartum support groups, so they are heavier users of maternity services than the average birthing woman and may not be representative of all.)
They were asked to rate their overall satisfaction with their birth, on a scale from 0 to 10, where 0 = not satisfied and 10 = very satisfied. Amongst our full pool of respondents (n=588), the average satisfaction rating was 8.2. The majority (58%) had high satisfaction, rating their overall satisfaction as a 9 or a 10. But let’s look at how each choice they made affected average satisfaction:
Birth place: Amongst those who birthed at the hospital where they had planned to give birth (n=462), average overall satisfaction was 8.2. Of those who birthed at their home or a birth center as planned (n=95), average overall satisfaction was 9.6.*
- If we look at those who had the best possible experience, 79% of those giving birth in an out of hospital birth center rated their birth as 10 out of 10 vs. 74% of home birthers and 28% of hospital birthers
- If we look at negative experiences, those who had satisfaction ratings of 6 or less, that happened for 21% of those giving birth in the hospital, 3% of those giving birth at home, and 0% of those birthing at an out of hospital birth center.
Care provider: Those whose primary provider was an OB or Family Practice Doctor averaged 8.3. Amongst midwifery clients whose birth took place where planned, satisfaction averaged 8.8.*
- 47% of those who used a licensed midwife rated their birth 10 out of 10 vs. 39% of family practice clients and 33% of both nurse-midwifery clients and OB clients
Doula: Those without a doula rated satisfaction at 8.3. Those with a doula averaged 8.6.*
- 38% of those using a birth doula rated their birth a 10 out of 10 vs. 32% of those who had considered using a doula but chose not to
* Note: families who planned an out-of-hospital birth but actually gave birth in a hospital are not included in these numbers. Those who transferred to a hospital tended to have lower satisfaction than families whose birth took place where they had planned.
Caveat: It seems fair to say that the circumstances of the birth also affect satisfaction. People who experienced an uncomplicated birth are more likely to have a satisfying birth than those with complicated births. We asked respondents “From your point of view, how complicated do you believe your labor and birth was?” Of those who had “smooth sailing” or only minor complications, 92% rated their satisfaction 7 or higher, and just 8% rated their satisfaction as 6 or less. Of those who had major complications or life threatening circumstances, 55% rated it 7 or higher, and 45% rated their satisfaction as 6 or less.
Childbirth Classes: We asked: “Looking back, how well prepared were you for what labor and birth would really be like? Rate on a scale from 0 (I was completely unprepared and didn’t have any of the information I needed) to 10 (I was very well prepared and had all the information I needed).” Those that did not take childbirth classes averaged 7.4. Those who took condensed classes (less than 8 hours), the average was 8.0. Those who took a full series of classes averaged 8.2.
Some of the published research on satisfaction
Childbirth Preparation Classes:
- Study showing expectant fathers felt more prepared after taking childbirth classes: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1595209/;
- Study showing parents who were taught the Bonapace method has less labor pain than those who took traditional childbirth classes: https://transitiontoparenthood.wordpress.com/2015/04/03/bonapace-method/
- A discussion: www.glowm.com/section_view/heading/Education%20for%
- A summary of available research, showing mixed results of education: here
- The Cochrane review, which concludes that there need to be more high quality studies of prenatal education: http://www.cochrane.org/CD002869/PREG_individual-or-group-antenatal-education-for-childbirth-or-parenthood-or-both
Doula support leads to higher satisfaction:
Satisfaction higher for out-of-hospital births