Satisfaction with childbirth care in Brazilian maternity hospitals participating in the Stork Network program: women’s opinions

Santos, Yammê Ramos Portella; Carvalho, Thaiza Dutra Gomes de; Leal, Neide Pires; Leal, Maria do Carmo

doi:10.1590/0102-311XEN154522

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ARTICLE • Cad. Saúde Pública 39 (5) • 2023 • https://doi.org/10.1590/0102-311XEN154522 copy

Satisfaction with childbirth care in Brazilian maternity hospitals participating in the Stork Network program: women’s opinions

Satisfação com a assistência ao parto em maternidades brasileiras que participam da Rede Cegonha: opinião das mulheres

Satisfacción con la atención del parto en maternidades brasileñas que participan de la Red Cigüeña: la opinión de las mujeres

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study aimed to describe maternal satisfaction with their experience during childbirth and birth and their association with sociodemographic, clinical and obstetric, and good practice characteristics during childbirth care. The sample included 2,069 women who wanted to express their opinions at the end of the interview of the Stork Network Assessment survey. Exploratory factor analysis was performed to summarize the variables of interest, creating latent variables, for input in the multiple logistic regression model. Six factors were created and tested in the model. Respect for the puerperal women was associated with satisfaction (vaginal delivery: 1.40; cesarean section: 1.47). Regarding those who underwent a cesarean section, satisfaction was associated with living in the Central-West (1.91) and South (2.00) regions and the presence of a companion during hospitalization (1.25). However, for women who had vaginal delivery, satisfaction was inversely associated with large hospitals (0.62) and undergoing interventions during labor and delivery (0.83), but positively with multiparity (1.98), receiving good care practices for labor and delivery (1.24), and having immediate contact with the newborn (1.20). The better understanding of the factors associated with mothers’ care satisfaction for labor and delivery can improve care quality provided in public hospitals in the Brazil.

Keywords:
Patient Satisfaction; Pregnancy; Birth

Characteristics	Interest to speak (%)			Satisfaction with the care received (%)
Characteristics	Yes (n = 2,069)	No (n = 8,480)	p-value *	Satisfaction (n = 1,084)	Dissatisfaction (n = 985)	p-value *
Region
North	14.3	19.9	< 0.001	11.0	17.9	< 0.001
Northeast	21.1	20.2		19.4	22.9
Southeast	26.0	23.1		26.3	25.6
South	16.7	20.6		18.7	14.6
Central-West	22.0	16.1		24.6	19.1
Location			< 0.001
Capital or metropolitan area	82.9	77.7		82.3	83.5	0.489
Other municipalities	17.1	22.3		17.7	16.5
Hospital size (births/year)
Up to 1,499	16.5	16.7	0.080	19.3	13.3	0.001
1,500 to 2,999	29.0	31.3		28.1	30.0
≥ 3,000	54.5	52.0		52.6	56.6
Age (years)
< 20	17.1	21.6	< 0.001	18.0	16.2	0.332
20 to 34	70.2	68.1		68.8	71.8
≥ 35	12.6	10.3		13.2	12.0
Education
< Primary education	22.1	27.0	< 0.001	23.0	21.2	0.542
Complete primary education	27.0	29.5		27.2	26.8
≥ Complete high school	50.8	43.5		49.8	52.0
Race/Skin color
White	28.1	29.4	0.182	29.9	26.1	0.115
Black	13.8	12.4		12.9	14.9
Brown	58.1	58.2		57.2	59.0
Marital status
Without a partner	19.3	20.4	0.298	20.5	18.1	0.156
With a partner	80.7	79.6		79.5	81.9
Parity
Primiparous	44.3	45.2	0.767	43.6	45.0	0.274
1 previous birth	28.4	27.8		27.4	29.4
2 previous deliveries	15.9	15.3		16.4	15.4
3 or more previous deliveries	11.4	11.8		12.6	10.1
Current pregnancy was planned
No	63.2	64.1	0.657	63.2	63.2	0.990
Yes	36.8	35.9		36.8	36.8
Mode of delivery
Vaginal	56.4	55.4	0.580	59.2	53.3	0.007
Cesarean	43.6	44.6		40.8	46.7
Newborn admitted to the ICU
No	95.8	96.4	0.145	95.6	95.9	0.773
Yes	4.2	3.6		4.4	4.1
Fetal or neonatal death
No	99.0	99.1	0.718	99.1	99.0	0.832
Yes	1.0	0.9		0.9	1.0

Characteristics	Satisfaction with the care received (%)
Characteristics	Satisfaction (n = 1,084)	Dissatisfaction (n = 985)	Total (n = 2.069)	p-value *
As soon as you arrived at the maternity hospital, how long did you wait to register at reception?
Up to 10 minutes	84.1	79.0	81.6	0.006
More than 10 minutes	15.9	21.0	18.4
Did they allow you stay out of bed and walk during labor?
No	25.6	31.4	28.3	0.017
Yes	74.4	68.6	71.7
Did the staff offer liquids, water, juices, soups, or any food during your labor?
No	49.5	57.2	53.1	0.003
Yes	50.5	42.8	46.9
Did you use any non-pharmacological methods to relieve pain during labor?
No	34.1	44.3	38.9	< 0.001
Yes	65.9	55.7	61.1
Did you receive pain relief medication during labor?
No	79.1	79.0	79	0.252
Yes	20.9	21.0	21
When you were in labor, was IV in the vein?
No	38.9	33.0	36.2	0.018
Yes	61.1	67.0	63.8
At delivery, did someone squeeze/climb on your belly to help the baby out?
No	85.9	81.6	84	0.051
Yes	14.1	18.4	16
Did you cut your perineum (vagina) at delivery?
No	69.6	64.3	67.3	0.06
Yes	30.4	35.7	32.7
After birth, did you breastfeed at the birthplace?
No	65.5	74.3	69.7	< 0.001
Yes	34.5	25.7	30.3
Immediately after birth, still at the birthplace, was your baby in skin-to-skin contact with you?
No	45.4	53.9	49.5	< 0.001
Yes	54.6	46.1	50.5
Did you receive information about your right to choose a companion during your stay?
No	27.8	38.6	33	< 0.001
Yes	72.2	61.4	67
Did they allow you to have a companion during your stay?
No	3.7	9.3	6.4	< 0.001
Yes	96.3	90.7	93.6
How many health professionals came forward, informing their name and function?
None or minority	35.3	52.5	43.5	< 0.001
Majority or all	64.7	47.5	56.5
How many health professionals are calling you by name?
None or minority	15.4	25.6	20.2	< 0.001
Majority or all	84.6	74.4	79.8
How often did you feel comfortable talking about your doubts, complaints, fear, and expectations?
Never or few times	22.7	33.5	27.9	< 0.001
Always or often	77.3	66.5	72.1
How often did you feel welcome, well treated and respected during your stay in this maternity hospital?
Never or few times	5.3	19.6	12.1	< 0.001
Always or often	94.7	80.4	87.9
Did you feel offended or treated badly by any professional in this maternity hospital?
No	93.5	88.0	90.8	< 0.001
Yes	6.5	12.0	9.2
How often do you feel that the health team at this maternity hospital seeks to provide answers and resolve your doubts and / or requests?
Never or few times	11.4	28.2	19.4	< 0.001
Always or often	88.6	71.8	80.6

Variables	Respect for the puerperal woman	Companion presence	Service delay	Communalities (h²)
How long did you wait to register at reception?	0.00	-0.01	0.97	0.94
How many health professionals introduced themselves, informing their name and function?	0.60	0.22	0.07	0.52
How many health professionals called you by your name at the maternity hospital?	0.54	0.07	0.02	0.33
How often did you feel comfortable talking about your doubts, complaints, fears and expectations?	0.70	0.07	-0.04	0.56
How often did you feel welcomed, well treated and respected during your stay in the maternity hospital?	0.90	-0.06	0.00	0.75
How often did you feel that the health team at the maternity hospital sought to provide answers and resolve your doubts and requests?	0.89	-0.03	-0.02	0.77
Did you feel offended or mistreated by any professional of the maternity?	-0.52	0.02	0.00	0.26
Did you receive information about your right to choose a companion during your stay?	-0.02	0.82	-0.02	0.66
Did they allow you to have a companion during your stay?	0.09	0.51	-0.02	0.32
Eigenvalue	3.12	1.27	0.95
Explained variance (%)	31.16	12.67	9.50
Accumulated variance (%)	31.16	43.83	53.33

Variables	Good practices	Interventions	Contact with the baby	Communalities (h²)
Episiotomy	-0.04	0.60	-0.07	0.63
Serum in vein	0.09	0.53	-0.04	0.71
Kristeler	-0.02	0.47	-0.27	0.70
Analgesia	0.08	0.62	0.11	0.60
Ambulation	0.59	0.00	0.14	0.64
Food supply	0.55	0.09	0.29	0.60
Use of a non-pharmacological method	0.90	0.06	0.01	0.81
Breastfeeding	0.15	-0.09	0.47	0.75
Skin-to-skin	0.13	-0.02	0.82	0.31
Eigenvalue	1.51	1.27	1.09
Explained variance (%)	16.82	14.15	12.11
Accumulated variance (%)	16.82	30.97	43.08

Characteristics	Vaginal delivery		Cesarean section
Characteristics	OR	95%CI	OR	95%CI
Region
Central-West	-	-	1.91	1.12-.326
North	-	-	1.00	1.00-1.00
Northeast	-	-	1.45	0.85-2.47
Southeast	-	-	1.47	0.88-2.45
South	-	-	2.00	1.14-3.51
Hospital size (births/year)
< 1,499	1.00	1.00-1.00	-	-
1,500 to 2,999	0.78	0.48-1.27	-	-
≥ 3,000	0.62	0.40-0.96	-	-
Parity
Primiparous	1.00	1.00-1.00	-	-
1 previous delivery	0.95	0.66-1.37	-	-
2 previous deliveries	1.47	0.91-2.37	-	-
3 or more previous deliveries	1.98	1.19-3.29	-	-
Respect for the puerperal woman	1.40	1.21-1.61	1.47	1.22-1.77
Companion presence	-	-	1.25	1.02-1.53
Good practices	1.24	1.06-1.45	-	-
Interventions	0.83	0.70-0.98	-	-
Contact with the baby	1.20	1.01-1.42	-	-

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[1] Correspondence
T. D. G. Carvalho Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz. Rua Leopoldo Bulhões 1480, Rio de Janeiro, RJ 21041-210, Brasil. thaizagomes@hotmail.com