Maternal satisfaction with childbirth services among postnatal mothers at a primary health center

INTRODUCTION

United Nations sustainable development goal (SDG) aims to reduce the global maternal mortality ratio (MMR) to less than 70 per 100000 by 2030.¹ For 2017-2019 the MMR estimate for India is 103.² India looks all set to achieve the SDG target. India has made considerable progress in reducing the maternal and newborn mortality and morbidity in the last 2 decades.

Efforts by the Ministry of Health and Family Welfare have led to increased utilization of public health facilities and boosted the confidence of the public in the public health facilities. Various schemes like Janani Suraksha Yojna have led to increased institutionalization of deliveries.³ Mere increased utilization is not an indicator of quality services as incentivizing lures the public for utilization of the facilities.

Maternal satisfaction is considered as an important indicator of maternal and newborn care received by the mother during her childbirth. Satisfaction of the mother with childbirth services increases the chances of optimum utilization of the available services and compliance to treatment. Women who are satisfied with their childbirth experiences tend to have a better self-esteem and an improved maternal neonatal bonding and are more likely to breast-feed the newborn exclusively.

Several factors influence the satisfaction of the mothers regarding childbirth services. Perception of safety of mother and baby at a health care facility also adds to the satisfaction of the mother and motivates them to choose for a health facility for delivery.⁴ Maternal satisfaction is also seen to be influenced by the outcome of the labor process.

A cross sectional survey conducted by Jha et al exploring the satisfaction with childbirth services in public health facilities including 2 district hospitals and 15 community health centers among postnatal women in Chhattisgarh concluded that most of the women (68.7%) were satisfied with overall childbirth services received. Mothers reported least level of satisfaction regarding the process around meeting their neonates. interaction with care providers, provision of privacy, being free of fear of childbirth and monetary incentive had a positive influence on overall satisfaction of mothers.⁵

All components of the Donabedian model of quality of care including the structure, process and outcome are known to influence the maternal satisfaction but the process of care is found to be the most influencing one.⁶

This study aims to explore the satisfaction of mothers with childbirth services at a primary health center.

METHODS

Exploratory study design was adopted for the present study. As a pilot project for the main study 1 primary health center Keru of Jodhpur district of Western Rajasthan was selected by convenience sampling and 36 postnatal mothers who have delivered at the selected primary health center by normal vaginal delivery were included and mothers with a still birth were excluded. Keru is situated in the Mandor block and is at a distance of 25 km from city headquarter. The data collection was done during June 2021.

Mothers who have delivered at the primary health center and those who have not completed 7 days after delivery were interviewed by face-to-face interview/telephonic interview by using the Hindi translated SMMS – normal birth scale. SMMS – normal birth Hindi translated scale for measuring maternal satisfaction for normal birth. It is a standardized tool with 36 items to assess the maternal satisfaction with childbirth services. Scale for measurement of maternal satisfaction is originally a Turkish tool.⁷ The psychometric properties of SMMS - normal birth have already been tested in the Indian context. SMMS – normal birth is a valid and reliable tool to assess maternal satisfaction in Indian context.⁸ 105.5 was taken as the cut off score. It is one of the valid and reliable instruments to assess the maternal satisfaction. The scale is developed to measure experience of care and emotional experience of childbirth as a measure of satisfaction.⁹

Data were cleaned coded and descriptive and inferential statistics was used for data analysis. Ethical clearance was obtained from the institutional ethics committee and permission was taken from the district health administration for collection of data at a public health facility.

RESULTS

36 mothers were selected by convenient sampling who delivered by a normal vaginal delivery at the selected primary health center. Average age of mothers was 25.28 years (SD=2.4). 4 (11.11%) mothers were primigravidae and 32 (88.9%) mothers were multigravida. 20 (55.55%) mothers had no formal education (Table 1).

All (100%) mothers were satisfied with their child birth experience (overall mean score 143.3 and SD 5.68) (Table 2).

Data presented in Table 3 describes that the mothers expressed their highest level of satisfaction with the childbirth experience as one of their best experiences (sub scale mean 4.9 and SD 0.3), they agreed that doctors did all interventions they could do (mean sub scale score 4.8 and SD 0.4) and also, they said that doctors and nurses explained them about all new situations related to labor (mean sub scale score 4.4 and SD 0.5).

Findings showed that the mothers were least satisfied with the management of labor pain (mean sub scale score 1.9 and SD 1). Nurses could have given them a little more time to start their breast feed (mean sub scale score 3.1 and SD 0.8) and if they could have started breast feeding a little early (mean sub scale score 3.2 and SD 1.2).

DISCUSSION

In the present study average age of mothers was 25.28 years (SD=2.4) that was consistent with the findings of a study conducted in primary health centers of Assam district.¹⁰

Findings from the present study reveal that all women (100%) were satisfied with the childbirth services available at the primary health center. These findings are almost consistent with the results of Misra in their study on client’s perspective of obstetric care at primary health center and reported satisfaction rate of 89%.¹¹

We agree with the observations that the outcome of the birth that is a safe delivery influences the overall satisfaction. The major area of concern was identified so as to imrove the interpersonal communication to imrove maternal satisfaction. Similar findings haven been reported by Jha in their study on satisfaction with childbirth services provided in public health facilities among postnatal women in Chhattisgarh, India.⁵

Findings showed that the mothers were least satisfied with the management of labor pain (mean sub scale score 1.86 and SD 0.9) These findings are consistent with the findings of Bhattacharya that reports women wish their pain should be addressed during their delivery.¹² Mothers and families that choose to deliver at a public health facilities have their own expectations and when these expectations are met their childborth experience becomes memorable.¹³

Major limitation of the study is halo effect of completing the pregnancy with the delivery of newborn influences the satisfaction of the mother. When mothers hold their baby in their hand and discover that they have safely delivered they feel satisfied with their delivery experience as a whole.

CONCLUSION

Satisfaction is an important indicator of the quality of maternal and newborn services. Awareness regarding the determinants of maternal satisfaction can help the facilities to improve their services as increased satisfaction leads to increased utilization of the services as well as better compliance to treatment. Present study concludes that availability of skilled care and involvement of mother in care is an important determinant of maternal satisfaction.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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