Article Text

Download PDFPDF

Original research
Association between maternal satisfaction and other indicators of quality of care at childbirth: a cross-sectional study based on the WHO standards
  1. Marzia Lazzerini,
  2. Ilaria Mariani,
  3. Chiara Semenzato,
  4. Emanuelle Pessa Valente
  1. WHO Collaborating Center for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Friuli-Venezia Giulia, Italy
  1. Correspondence to Dr Emanuelle Pessa Valente; emanuelle.pessavalente{at}


Objectives This study aimed to explore the association between maternal satisfaction and other indicators of quality of care (QoC) at childbirth, as defined by WHO standards.

Design Cross-sectional study.

Setting Referral hospital in Northeast Italy.

Participants 1244 consecutive mothers giving birth in the hospital participated in a survey.

Data collection and analysis Univariate analyses were performed to evaluate the association between maternal satisfaction and 61 variables, including measures of ‘provision of care’, ‘experience of care’, ‘availability of resources’ and other maternal characteristics. Exploratory factor analysis was performed to create groups of correlated variables, which were used in multivariate analysis.

Results Overall, 509 (40.9%) of women were >35 years of age, about half (52.7%) were highly educated, most (95.2%) were married/living with partner and employed (79.3%) and about half (52.9%) were primiparous. Overall, 189 (15.2%) were not born in Italy and 111 (8.9%) did not have Italian citizenship. Most women (84.2%) were highly satisfied (score ≥7/10) with the care received. Among the 61 variables explored, 46 (75.4%) were significantly associated with women’s satisfaction, 33 with higher satisfaction and 13 with lower satisfaction. Multivariate analysis largely confirmed univariate findings, with six out of eight groups of correlated variables being statistically significantly associated with women’s satisfaction. Factors most strongly associated with women’s satisfaction were ‘effective communication, involvement, listening to women’s needs, respectful and timely care’ (OR 16.84, 95% CI 9.90 to 28.61, p<0.001) and ‘physical structure’ (OR 6.51, 95% CI 4.08 to 10.40, p<0.001). Additionally, ‘victim of abuse, discrimination, aggressiveness’ was inversely associated with the wish to return to the facility or to recommend it to a friend (OR 0.35, 95% CI 0.17 to 0.70, p<0.003).

Conclusion This study suggested that many variables are strongly associated with women’s satisfaction with care during childbirth and support the use of multiple measures to monitor the QoC at childbirth.

  • quality in health care
  • reproductive medicine
  • maternal medicine

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors ML conceived the paper in discussion with IM, CS and EPV. IM analysed data. ML drafted the initial manuscript and all authors reviewed/edited the manuscript for critically important intellectual content and approved the final version of the manuscript.

  • Funding This study was funded by the Institute for Maternal and Child Health IRCCS Burlo Garofolo.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Patient consent for publication Obtained.

  • Ethics approval Ethical approval was obtained from the Independent Ethical Review Board of the IRCCS Burlo (protocol number: 617/2016).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. All details of the analyses conducted are provided within the manuscript. Additional details can be provided by contacting the corresponding author on a reasonable request.