The Birth Satisfaction Scale – Revised (BSS-R): should the subscale scores or the total score be used?

ABSTRACT

Objective and background: The 10-item Birth Satisfaction Scale – Revised (BSS-R) is increasingly being used internationally as the instrument of choice for the assessment of birth satisfaction. There remains conjecture over the most appropriate way to score the instrument; subscale scores overall total score, or both approaches. The current study sought to clarify this issue by examining the measurement characteristics of the United States version of the BSS-R from a large data set.

Methods: Secondary analysis of a data matrix from a large sample US BSS-R validation study (N = 2116) using structural equation modelling.

Results: A bi-factor model revealed an excellent fit to data (χ²_(df = 25) = 208.21, p < 0.001, CFI = 0.98, RMSEA = 0.06, SRMR = 0.04), demonstrating relative independence of the BSS-R quality of care subscale, while in contrast the women’s attributes and stress experienced during childbearing subscales could be explained more plausibly by a general factor of experience of childbirth.

Conclusion: Consistent with the recommendations of the original BSS-R validation study, the current investigation found robust empirical evidence to support the use of both the subscale scoring system and the total score. Researchers and clinicians can therefore select either approach (or both) with confidence.

KEYWORDS:

• Birth Satisfaction Scale – Revised (BSS-R)
• scoring
• validation
• maternity care
• outcomes
• midwives
• obstetricians

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1. As would be anticipated, model-fit of the three-factor correlated model is identical to that reported by Martin et al. (2017), the trivial fractional variation in χ² (256.82 vs. 255.15) explained by rounding to two decimal points in the correlation matrix and individual BSS-R item standard deviations.