Boosting all mums’ birth satisfaction - Caroline Hollins-Martin

In my experience as a midwife, the most rewarding relationships with women have involved creating a connection through building a trusting relationship.

Caroline Hollins-Martin, Professor in Maternal Health at Edinburgh Napier University

Research evidence backs this up, with women who receive continuity of care from a known midwife reporting greater satisfaction with their birth experience.

In this respect, ‘birth satisfaction’ means more to women than straightforwardly delivering a healthy baby. Together, giving birth can be one of the most challenging experiences, and also one of the most exhilarating.

It is not just about being handed the end-product of a healthy baby. It is also about creating memories about the event that women relay in subsequent stories that are told and retold. The role of the midwife is to optimise crafting of the best possible story.

In my current job as an academic midwife, I have pursued the opportunity to find out what is important to women and their views of what has affected their personal levels of birth satisfaction.

With the support of another interested professor, we have developed an evidence-based 10-item questionnaire called the Birth Satisfaction Scale-Revised (BSS-R).

This is available free of charge to midwives, obstetricians, academics and others who want to gather evaluations of birth satisfaction in an effort to improve experience at https://www.bss-r.co.uk/

Since developing the BSS-R©, we have worked with a multitude of teams around the world to evaluate birth satisfaction in a variety of contexts, and the BSS-R© is now recommended as the key clinical measure globally by the International Consortium for Health Outcomes Measurement.

Birth satisfaction is influenced by the woman’s personality, quality of care provided, and the amount of stress experienced during labour and delivery. Personality is not something midwives have the power to change, but the latter two factors are within their control.

I recognised early in my career that it is important for midwives to optimise the conditions of every woman’s birth journey. The experience is affected by relationships with their midwife and the level of support provided during the variety of events that occur.

Any midwife who declares their profession at a social gathering will inevitably be regaled with women’s birth stories. The standing joke is, if you do not want a busman’s holiday, tell them you are a hairdresser.

What research has told us is that women’s experiences of labour are affected by physical trauma, having an excessively long labour, being provided with the opportunity to make decisions, levels of personal anxiety, quality of communication with maternity care professionals, support provided by midwives, feelings of being in control, perceptions of cleanliness and comfort of the surrounding environment, and the amount of distress caused by all of these factors in combination.

While the BSS-R© is now recognised globally as the key clinical measure of birth satisfaction, it is also important to mention that birth satisfaction is also important for men, which is an area of developing research.

What we do know is that birth satisfaction for dads is an entirely different ‘kettle of fish’. For example, aide-de-camp factors that constitute ‘birth satisfaction’ for fathers include feeling equipped with skills to help their partner cope during labour. This in part involves teaching them strategies to help provide support for self and partner.

In the current climate, where the importance of birth satisfaction is acknowledged, the government has requested changes to the way midwifery services are organised in Scotland.

These changes are captured in the document ‘The best start: five-year plan for maternity and neonatal care’, first published in 2017, which acknowledges the importance of satisfaction with events that unfold during pregnancy, childbirth and post-delivery.

Caroline Hollins-Martin, Professor in Maternal Health at Edinburgh Napier University