Perceived control and maternal satisfaction with childbirth: a measure development study

Abstract

The purpose of this study was to develop and validate two instruments: one to assess patient perceptions of control of the childbirth environment and the other, global satisfaction with the childbirth experience. Participants were 187 women recruited from obstetric clinics, breast-feeding support groups and online who had given birth in the past 4 months. Scale development involved item construction, exploratory factor analysis (EFA) of the Perceived Control in Childbirth Scale (PCCh), confirmatory factor analysis (CFA) of the Satisfaction with Childbirth Scale (SWCh), reliability analysis and construct validity analyses. EFA identified a single factor underlying a set of items reflecting the patient’s belief that her actions influenced the birth environment (i.e. perceived control). CFAs supported a single-factor model reflecting the degree to which the birth experience met the patient’s ideal (i.e. satisfaction). Perceived control was associated with childbirth self-efficacy. Childbirth satisfaction was associated with both affective reactions to birth and childbirth-related posttraumatic stress disorder (PTSD) symptoms. Results support the validity and reliability of two new scales that assess perceived control of the birth environment and global satisfaction with childbirth.

Keywords::

• Childbirth
• perinatal mental health
• pregnancy
• psychological well-being

Declaration of interest: The authors declare no conflict of interest.

Current knowledge on the subject

• The childbirth experience has clear implications for postpartum mental health.

• Childbirth satisfaction is conceptualized in terms of affective reactions as well as cognitive evaluations.

• Although perceived control appears to be an important component of childbirth appraisals, extant instruments that assess women’s perceptions of the birth experience are atheoretical.

What this study adds

• Factor analyses revealed unidimensional structures of both the PCCh and the SWCh. These instruments are theoretically derived and can be used in future clinical research studies to examine patient-environment fit as a predictor of birth outcomes.

• Perceived control and childbirth satisfaction were correlated with childbirth self-efficacy, positive and negative affect about the birth and childbirth-related distress symptoms.

• Perceived control was significantly correlated with global childbirth satisfaction, explaining more variance than obstetric variables.

Appendix A

Perceived control in childbirth scale

Instructions: Each item below is a statement with which you may agree or disagree. Please respond to these items as they relate to your most recent experience of childbirth. For each item indicate the number, which represents how much you agree with it using the scale below. Please make sure that you mark ONLY ONE number per item. This is a measure of your personal experience; there are no right or wrong answers.

• 6 − Strongly agree

• 5 − Moderately agree

• 4 − Slightly agree

• 3 − Slightly disagree

• 2 − Moderately disagree

• 1 − Strongly disagree

——1.	I was able to participate in making decisions about how to manage my labor and birth.
——2.	I was given choices before procedures were decided upon.
——3.	I did not feel that I was in control of my birth environment.

During my labor and birth, when I was told about the procedures I felt…

——4.	That I could not question my medical care provider’s decisions.
——5.	That I did not have much influence over what procedures were done.
——6.	That I was in control of the situation.
——7.	That I could get all my questions answered.
——8.	That what I said or did made no difference in what occurred.

From the time I arrived at the hospital or birth center, I felt…(or, from the time my medical care providers arrived at my home, I felt…)

——9.	At a loss to know what I would be experiencing.
——10.	If I wanted to, I could change the procedures I was receiving.
——11.	I knew what the purpose and effects of the procedures were.
——12.	If I asked my medical care providers to do something differently during labor and delivery, they usually did it.

Appendix B

Satisfaction with childbirth scale

Instructions: Each item below is a statement with which you may agree or disagree. Please respond to these items as they relate to your most recent experience of childbirth. For each item indicate the number, which represents how much you agree with it using the scale below. Please make sure that you mark ONLY ONE number per item. This is a measure of your personal experience; there are no right or wrong answers.

• 7− Strongly agree

• 6− Moderately agree

• 5− Slightly agree

• 4− Neither agree nor disagree

• 3− Slightly disagree

• 2− Moderately disagree

• 1− Strongly disagree

——1.	In most ways, my childbirth experience was close to my ideal.
——2.	My baby’s birth did not go the way I wanted it to go.
——3.	The conditions of my childbirth experience were excellent.
——4.	If I could do it over, I would change some things about my childbirth experience.
——5.	I am satisfied with the experience of my baby’s birth.
——6.	I got what I wanted out of my childbirth experience.
——7.	If I could do it over, I would change almost nothing about my childbirth experience.