Childbirth Satisfaction: Between Expectancy and Experience

Background purpose: Women's satisfaction with childbirth has personal, familial and societal implications for maternal mental health, family size, and even legal actions. Childbirth is a pivotal event for many women and evidence suggests that women possess strong expectations regarding this experience. The actual place and mode of birth could be different from what was initially planned, due to medical circumstances or a change of mind. The actual delivery and its congruence with the preferred birth could elicit different feeling and perceptions.  However, few studies have simultaneously and distinctly investigated the medical, cognitive, and emotional factors that contribute to birth satisfaction. In the current study, we evaluated how these factors contribute to birth satisfaction and assessed its underlying mechanism. We hypothesized that (1) A more medicalized birth and greater incongruence with plan would lead to lower birth satisfaction; (2) perceptions of control would mediate the association between the predictors and birth satisfaction; and (3) emotions experienced while giving birth and perceptions of intrapartum care would mediate the association between perceptions of control and birth satisfaction.

Methods: Participants in this longitudinal observational study were 330 first-time Israeli mothers. Their mean age was 30.0 and they were mostly Jewish (98.5%) and married or cohabiting (95.2%). They were recruited during pregnancy at women’s health centers and natural birth online communities. All women completed questionnaires during pregnancy, including their planned mode and place of birth. Two months postpartum, they completed a questionnaire assessing actual place and mode of birth, two distinct perceptions of self-control, five separate emotional experiences, perceived intrapartum care, and global birth satisfaction. A model of birth satisfaction based on relevant theory and prior empirical work was tested using structural equation modeling.

Results: Model testing affirmed our hypotheses and indicated that the negative association between a more medicalized birth and birth satisfaction was partially mediated by perceived control. In turn, specific emotions mediated the association between perceptions of control and birth satisfaction. Perceived control over the birth environment predicted positive emotions, less fear, and better perceived care, while greater perceived control over the birth process predicted more positive emotions, less fear, and less guilt. Greater incongruence between planned and actual birth predicted lower birth satisfaction, mediated by perceived care and feelings of guilt. The full model predicted 64% of the variance in birth satisfaction.

Conclusions and implications: The current investigation provided a fine-tuned portrait of women's lived birth experience. The experience and the way it differs from expectations trigger a series of perceptions which are manifested in distinct emotions and subsequently influence satisfaction. The findings underscore the value of helping women achieve satisfying births by discussing with them their expectations, providing them with experiences that meet their needs and supporting those with a gap between expectations and experience. Further research is needed to test the current model in different cultures and explore the long-term consequences of birth satisfaction on adjustment to motherhood. Conserving individual preferences while lowering blame is likely to improve women's health and well-being.