The assessment of satisfaction with care in the perinatal period

Patient satisfaction is frequently used to evaluate the quality of medical care and to guide the development of health care services. Improved satisfaction is a goal recommended by the Institute of Medicine and the government of the United Kingdom for health care reform. During the perinatal period, dynamic changes in physical and psychological state impose unique challenges in the assessment of satisfaction. This article reviews the measurement of satisfaction with care, together with factors that may influence satisfaction and its measurement during the perinatal period. Recommendations are also provided for further research and development of satisfaction instruments and potential interventions to improve satisfaction with perinatal care.     

Interventions in labour and birth and satisfaction with care: The Canadian Maternity Experiences Survey Findings

Objective: To examine whether interventions in labour and birth contributed to ratings of satisfaction with these experiences, in women giving birth vaginally or attempting a vaginal birth prior to giving birth by caesarean section. Background: Ratings of satisfaction with women’s overall experience of labour and birth have long been encouraged, yet remain challenging to assess or to interpret. Methods: Data from the Canadian Maternity Experiences Survey (MES) – a nationally representative sample of women who had a singleton live birth in 2005–2006 – were analysed. Associations between the number of and type of labour and birth interventions, and women’s satisfaction with the overall labour and birth experience and six aspects of caregiver interactions, were assessed. Results: Among women having vaginal births, fewer interventions during labour was significantly associated with higher overall satisfaction with the labour and birth experience (ranging from 75% of women having no interventions to 46.4% having eight or more interventions rating their experiences as ‘very postive’). The same pattern was observed for satisfaction with women’s perceptions of caregiver’s respect, concern for dignity, compassion shown to them, the information given to them, their involvement in decision making, and caregiver’s competence. Among women having unplanned caesarean sections following attempted vaginal birth, the number of interventions was not associated with satisfaction ratings; however, satisfaction ratings were consistently lower than among women giving birth vaginally. Conclusion: These findings provide support for demedicalising vaginal labour and birth as well as for optimising the potential for a vaginal birth rather than caesarean section.     

Reported information sharing and satisfaction with maternity care providers during the COVID-19 pandemic: Associations with socioeconomic status and shifts to telehealth

Background

The COVID-19 pandemic has dramatically affected pregnant people’s prenatal care, labor, and delivery experiences. Given these rapid changes, providers have needed to be proactive in sharing information about COVID-19-related care impacts. The purpose of this study was to investigate: (a) Whether patient demographics or disrupted care (eg, canceled appointments and rapid shift to telehealth) is associated with patient-reported information sharing from the providers; and (b) Whether patient-reported provider information sharing or disruptions to care are associated with patient satisfaction with provider.

Methods

Data come from a convenience sample of 1999 pregnant people living in the United States who completed an online survey between April 16 and May 7 2020.

Results

Thirty-eight percent of participants said that their provider had not discussed how the pandemic would affect their care during pregnancy, labor, or delivery. Participants with lower education, less income, or whose appointments had been canceled or rescheduled because of the pandemic were significantly less likely to report information sharing. Provider satisfaction was significantly lower among participants who did not report information sharing, those who had appointments by way of telehealth, and those who reported that all their appointments had been rescheduled/canceled.

Discussion

At the beginning of the pandemic, there were significant socioeconomic inequities in reported information sharing by the providers, which in turn was negatively associated with provider satisfaction. Providers need to be aware of the role implicit bias may play in information sharing—both generally and during public health crises—and consider ways to reduce the impacts of disrupted care delivery on patient satisfaction. If left unaddressed, perceived poor provider communication and associated low satisfaction with providers could contribute to adverse perinatal outcomes.     

Hyperemesis gravidarum and patient satisfaction: A path model of patients' perceptions of the patient-physician relationship

Objective.?To examine the relationship between patients' perceptions of the patient-physician relationship and patients' satisfaction with the overall medical care received from their physicians in the treatment of hyperemesis gravidarum (HG).

Methods.?This study investigated patients' beliefs and their views of their physicians' beliefs about the causal explanation of HG, the seriousness of the illness, and the impact of the illness upon patients' daily lives. Also examined were the extent to which patients' beliefs were congruent with their perception of their physicians' beliefs, and patients' ratings of the humanistic characteristics of physicians they deemed important. Ninety-six respondents who had experienced at least one hospitalization from January 1993 through April 1997 responded to interview questions focusing on their HG illness experience. Using both quantitative and qualitative methodological approaches, a path model of patient perception factors associated with patient satisfaction was tested.

Results.?Perceived shared beliefs about the etiology of HG for a particular patient's illness were more important direct contributing factors of satisfaction than were the specific causal explanations. The length of the patient-physician relationship provided important indirect effects on patient satisfaction; three key mediating variables were patients' perceptions about physician humanism and perceived agreement about the cause and impact of HG. Pertinent qualitative findings are provided as additional sources of information to supplement the quantitative results.

Conclusion.?Knowledge of the patient-physician relationship factors that influence HG women's satisfaction can be used to enhance service delivery and may ultimately improve perinatal outcomes.     

Postpartum care: evaluation and experience among care providers and care receivers

Introduction: There have been substantial alterations in the structure of postpartum care over the last several decades. Our aim was to investigate the perceived quality of, and satisfaction with, postpartum care among caregivers and care receivers in the maternity ward of a community hospital in Norway with about 2600 births per year. Methods: We conducted a cohort study of women giving birth and the caregiving staff in the maternity ward during a 7‐month period. A questionnaire, with a Cronbach α coefficient above 0.8, was filled in anonymously, both by the staff in the ward and by the women. The questionnaire explored the respondents’ evaluations of the information offered by the staff; the teaching of skills in child care and establishment of breastfeeding; assistance with practical tasks like making beds, serving meals, and keeping order in the room; visiting rules; level of noise in the ward; whether the pediatric service was adequate; length of the stay; and to what extent caregivers were able to respond to the individual needs of the mothers. Finally, the questionnaire explored the degree of kindliness communicated by the staff. Five extra questions in the women's questionnaire explored their personal experiences in the ward. Results: The care receivers’ evaluations of the maternity ward did not differ significantly from that of the caregivers in questions related to overall care and service. However, the mothers rated the importance of assistance with child care during the night significantly higher than did the staff. Responses to questions addressing noise in the ward demonstrated a higher tolerance among the mothers compared with the staff. In addition, mothers tended (but not a statistically significant result) to rate the quality of the teaching of child‐care skills lower, compared with the staff's ratings. Discussion: By exploring both the caregivers’ and care receivers’ evaluations and expectations of the actual services in the maternity ward, areas for enhancement of the quality of the ward and its services can be detected and carried out. The present study revealed 2 areas needing further focus: assistance with child care during the night and teaching of child‐care skills during the stay. We believe that investigations that collect data from both caregivers and care receivers, by using adapted and validated questionnaires to gather information on quality and satisfaction with the maternity ward, are mandatory for improvement and continuous adaptation of health services.     

Severe maternal morbidity among immigrant women in the Netherlands: patients' perspectives

This 2006 study investigated ethnicity-related factors contributing to sub-standard maternity care and the effects on severe maternal morbidity among immigrant women in the Netherlands. In-depth interviews were carried out with 40 immigrant and 10 native Dutch women. The immigrant women reported that health care providers often paid insufficient attention to their pregnancy-related complaints, especially in cases of pre-eclampsia. They also reported delays in receiving information about diagnosis and treatment. Obstetricians who reviewed 20 of these cases judged sub-standard care to have played a role in the development of complications in 16 of them. The women themselves had problems identifying medically significant complications, presenting their complaints to health care providers effectively, and taking an active role as patients. Even highly educated migrant women showed low health literacy skills in their interaction with doctors. Patients' perspectives are valuable as one of the tools to evaluate the quality of maternity care. Communication by maternal health professionals can be improved through more sensitivity to social factors that affect immigrant women's health problems. Women with limited health literacy should be empowered through education about danger signs in pregnancy and information about preferences and policies in obstetrics in the Netherlands. They should also be invited to participate in medical decision-making.     

Perinatal Behavioral Health,the COVID-19 Pandemic,and a Social Determinants of Health Framework

The United States has greater prevalence of mental illness and substance use disorders than other developed countries, and pregnant women are disproportionately affected. The current global COVID-19 pandemic, through the exacerbation of psychological distress, unevenly affects the vulnerable population of pregnant women. Social distancing measures and widespread closures of businesses secondary to COVID-19 are likely to continue for the foreseeable future and to further magnify psychosocial risk factors. We propose the use of a social determinants of health framework to integrate behavioral health considerations into prenatal care and to guide the implementation of universal and comprehensive psychosocial assessment in pregnancy. As the most numerous and well-trusted health care professionals, nurses are ideally positioned to influence program and policy decisions at the community and regional levels and to advocate for the full integration of psychosocial screening and behavioral health into prenatal and postpartum care as core components.