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Factors related to childbirth satisfaction

Article  in  Journal of Advanced Nursing · May 2004

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I S S U E S A N D IN N O V A T I O N S IN N U R S I N G P R A C T I C E

Factors related to childbirth satisfaction

Petra Goodman PhD EdM RN
Lieutenant Colonel, US Army, Fort Gordon, Georgia, USA

Marlene C. Mackey PhD RN FAAN

Associate Professor, College of Nursing, University of South Carolina, Columbia, South Carolina, USA

Abbas S. Tavakoli DrPH

Statistician, College of Nursing, University of South Carolina, Columbia, South Carolina, USA

Submitted for publication 17 February 2003

Accepted for publication 28 October 2003

Correspondence: G O O D M A N P . , M A C K E Y M . C . & T A V A K O L I A . S . ( 2 0 0 4 ) Journal of Advanced

Marlene Mackey, Nursing 46(2), 212–219
College of Nursing, Factors related to childbirth satisfaction
University of South Carolina,
Background. A woman’s satisfaction with the childbirth experience may have
Columbia,
immediate and long-term effects on her health and her relationship with her infant,
SC 29208,
USA. but there is a lack of current research in this area.
E-mail: marlene.mackey@sc.edu Aim. This paper reports a study to examine multiple factors for their association
with components of childbirth satisfaction and with the total childbirth experience.
Method. A correlational descriptive study was conducted with 60 low-risk post-
partum women, aged 18–46 years, with uneventful vaginal deliveries of healthy full-
term infants at two medical centres in the south-eastern United States. The Labor
Agentry Scale, McGill Pain Questionnaire and Mackey Childbirth Satisfaction
Rating Scale and a background questionnaire were completed by women. Obstet-
rical data were collected from the medical record.
Findings. Personal control was a statistically significant predictor of total childbirth
satisfaction (P ¼ 0Æ0045) and with the subscale components of satisfaction (self,
partner, baby, nurse, physician and overall). In addition, having expectations
for labour and delivery met was a significant predictor of satisfaction with own
performance during childbirth.
Conclusions. Personal control during childbirth was an important factor related to
the women’s satisfaction with the childbirth experience. Helping women to increase
their personal control during labour and birth may increase the women’s childbirth
satisfaction.

Keywords: childbirth satisfaction, personal control, nurse, midwife

quality of care, make decisions about the organization and

Introduction
Patient satisfaction is an important health outcome in today’s
cost conscious health care arena and is one of the most
frequently reported outcome measures for quality of care and
provision of health care services (Bowman et al. 1992,
Jackson et al. 2001). Patient satisfaction is used by health
care providers, administrators and policymakers to assess the
provision of health care services, avoid malpractice litigation
and maintain a competitive edge in the health care arena
(Brown & Lumley 1997, 1998, Dufrene 2000, Jackson et al.
2001). Therefore, understanding women’s satisfaction with
their childbirth experience is relevant to health care provid-
ers, administrators and policymakers as an indicator of the
quality of maternity care (Hodnett 2002).

212
2004 Blackwell Publishing Ltd

Issues and innovations in nursing practice
Patient satisfaction with the childbirth experience also has
implications for the health and well-being of a woman and
her newborn. A woman’s satisfaction with her childbirth
experience may have immediate and long-term effects on her
health and her relationship with her infant. A satisfactory
childbirth experience has contributed to a woman’s sense
of accomplishment and self-esteem (Simkin 1991, 1992,
Laurence 1997) and has led to expectations for future
positive childbirth experiences (Slade et al. 1993, Mackey
1995, Waldenstrom et al. 1996).
In contrast, women who experienced unsatisfactory births
‘remember the birth of their child only with pain, anger, fear,
or sadness, or they remember nothing, which is suggestive of
traumatic amnesia’ (Laurence 1997, p.832). A traumatic and
unsatisfactory birth could lead to postpartum depression or
post-traumatic stress disorder in which women relive their
labour in dreams and flashbacks that, in turn, trigger extreme
distress (Phillips & O’Hara 1991, Ballard et al. 1995). An
unsatisfactory childbirth may also result in future abortions
(Goldbeck-Wood 1996), a lack of ability to resume sexual
intercourse (Laurence 1997) or preference for a caesarean for
subsequent births (Ryding 1991, 1993).
A woman’s satisfaction with the childbirth experience is
also important for the well-being of the infant. A mother’s
positive perception of her birth experience has been linked to
positive feelings toward her infant and adaptation to the
mothering role (Simkin 1991, 1992). Conversely, traumatic
births have affected women’s ability to breast-feed and bond
with their children and have led to child neglect and abuse
(Laurence 1997).
Although many researchers have examined childbirth
satisfaction, satisfaction has typically been conceptualized
as a global/overall evaluation of childbirth. The findings have
not always been comparable across studies, suggesting that
childbirth satisfaction may be a complex phenomenon
consisting of multiple dimensions or components of satisfac-
tion. Given the significance of childbirth satisfaction, addi-
tional research is needed that examines the components of
satisfaction and addresses the contradictions surrounding
factors associated with childbirth satisfaction. Therefore, this
study was designed to examine multiple factors for their
association with components of childbirth satisfaction and
with the total childbirth experience.
Literature review
Labour pain and childbirth satisfaction
Labour pain is one factor related to satisfaction with
childbirth. Women who have experienced less labour pain

2004 Blackwell Publishing Ltd, Journal of Advanced Nursing, 46(2), 212–219
Factors related to childbirth satisfaction
have reported higher levels of childbirth satisfaction com-
pared with women with more labour pain (Fawcett et al.
1992, Green 1993, Slade et al. 1993, Mackey 1995, 1998,
Waldenstrom et al. 1996, Brown & Lumley 1997, 1998,
Fowles 1998, Lavender et al. 1999, Waldenstrom 1999,
Windridge & Berryman 1999). In one study, 40% of women
identified pain as the worst part of the labour and delivery
experience (Mackey 1998). However, high levels of labour
pain do not preclude a positive overall childbirth experience
(Salmon & Drew 1992, Green 1993, Russell & Reynolds
1993, Ranta et al. 1995, Hart & Foster 1997).
Personal control and childbirth satisfaction
Personal control is another factor related to satisfaction with
the childbirth experience. Higher levels of personal control
have been associated with greater childbirth satisfaction
(Simkin 1991, 1992, Bramadat & Driedger 1993, DiMatteo
et al. 1993, Fleissig 1993, Green 1993, Slade et al. 1993,
Mackey 1995, Knapp 1996, Waldenstrom et al. 1996, Hart
& Foster 1997, Campero et al. 1998, Fowles 1998, Lavender
et al. 1999). Personal control accounted for 59% of the
variance in childbirth satisfaction in one study (Bramadat &
Driedger 1993) and 46% of the variance in another study
(Knapp 1996).
Women have also determined their satisfaction with their
childbirth experience according to how well they perceived
they had managed their own performance (i.e. their ability to
maintain control). Those who managed well (i.e. stayed in
control) viewed childbirth as positive; whereas, those who
had difficulty or managed poorly (i.e. lost control) viewed
childbirth both positively and negatively (Mackey 1995,
1998). Others have also reported that women evaluated their
childbirth experience by the amount of personal control they
experienced during labour and birth (Simkin 1991, DiMatteo
et al. 1993, Fleissig 1993).
Expectations, preparation and satisfaction
Women whose expectations for labour and birth were met
have reported higher childbirth satisfaction compared with
those whose expectations were not met (Green 1993, Slade
et al. 1993, Waldenstrom et al. 1996). For example,
expectations of being in control (both self-control and
control of what was done to them) have been positively
associated with achieving control and with increased satis-
faction (Hodnett & Osborn 1989). Women with childbirth
preparation were more satisfied with their birth experience
than those without preparation (Hart & Foster 1997, Quine
et al. 1993). Others, however, have found no relationship
213
P. Goodman et al.
between childbirth preparation and childbirth satisfaction
(Slade et al. 1993).
Demographics and childbirth satisfaction
Some researchers have found a relationship between lower
educational level and childbirth satisfaction (Dannenbring
et al. 1997, Waldenstrom 1999), whereas others found no
relationship (Green et al. 1990, Mackey 1995). Satisfaction
has been related to older age and higher income by some
(Waldenstrom 1999) but not by others (Mackey 1995, Ranta
et al. 1995). In one study, multiparae had higher childbirth
satisfaction than primiparae (Waldenstrom 1999) whereas in
others, there was no difference in satisfaction between
multiparae and primiparae (Ranta et al. 1995, Waldenstrom
et al. 1996).
In summary, the review of the literature provides contra-
dictory and limited information about factors associated
with childbirth satisfaction. Some researchers have reported
an inverse relationship between pain and satisfaction, but
others have found no association between the variables.
Having expectations met and personal control has consis-
tently been associated with childbirth satisfaction. However,
sometimes researchers have used the concept of control as
an indicator of satisfaction rather than a correlate of
satisfaction. Contradictory results have also been found
with childbirth preparation and several demographic char-
acteristics.
These contradictory findings suggest that childbirth satis-
faction is a complex phenomenon differentially influenced by
multiple factors. Typically, it has been conceptualized as a
global evaluation of the experience, without consideration of
the specific components that comprise satisfaction. Women
can be satisfied with some components of an experience and
dissatisfied with others. For example, participants in the
childbirth event (self, partner, baby, physician and nurse) can
be conceptualized as components of childbirth satisfaction.
These participants may be the basis of a satisfactory or
unsatisfactory birth experience evaluation. Therefore, it is
important to examine women’s satisfaction with the partic-
ipants in the experience in addition to their satisfaction with
the overall experience. In addition, an understanding of
factors associated with both overall satisfaction and with
satisfaction with components of the experience (the partic-
ipants) is needed.
Readers should note that in the United States of America
and thus in this paper, the terms ‘nurse’ or ‘nurse-midwife’
are used, when ‘midwife’ would be used in other health care
systems.
214
2004 Blackwell Publishing Ltd, Journal of Advanced Nursing, 46(2), 212–219
The study
Aim
The aim of this study was to examine the association of
selected variables with childbirth satisfaction and its compo-
nents in order to have a more comprehensive description of
factors related to satisfaction with the childbirth experience.
Sample
A convenience sample of 60 low-risk postpartum women,
who had uneventful vaginal deliveries of healthy full-term
infants at two medical centres in the south-eastern United
States, participated in the study prior to hospital discharge.
The sample size was based on a significance level of 0Æ05, an
effect size of 0Æ34 and power of 0Æ80 (Burns & Grove 2001).
Questionnaires
Major instruments are described below. In addition, a
background form measured the extent to which labour
expectations were met, childbirth preparation and demo-
graphic characteristics.
The McGill Pain Questionnaire provides a pain rating
index which is a summated score (0–78) based on the rank
order of words chosen by respondents in each of 20 groups of
verbal descriptors (Melzack et al. 1984). A high score reflects
a high level of pain. Widely used in the clinical study of pain,
high construct validity (Mongini & Italiano 2001) and
reliability coefficients of 0Æ75–0Æ97 (Thomas et al. 1998,
Zakrzewska et al. 1999) have been reported.
The Labor Agentry Scale is a 29-item summated rating
scale that measures personal control during childbirth
(Hodnett & Simmons-Tropea 1987). Participants indicate
the degree of agreement or disagreement with each item (e.g.
I felt confident, I felt defeated) on a 7-point Likert scale.
Previous studies have demonstrated construct validity and
reported Cronbach’s alpha reliability coefficients of 0Æ91–
0Æ98 (Hodnett & Simmons-Tropea 1987, Hodnett 1989,
Hodnett & Osborn 1989). The reliability of the scale in the
present study was 0Æ93.
The Mackey Childbirth Satisfaction Rating Scale is a
34-item scale measuring childbirth satisfaction. It contains
five subscales (self, nine items; partner, two items; baby, three
items; nurse, nine items; physician, eight items) representing
the behaviours of the major participants in the event and
one subscale for global overall labour and delivery evalua-
tion (three items). Respondents indicate their degree of
Issues and innovations in nursing practice Factors related to childbirth satisfaction

satisfaction or dissatisfaction with each item on a 5-point
Likert scale. Face and construct validity and reliability have
been established. Internal consistency reliability coefficients
for this study (total scale, 0Æ94; self, 0Æ90; partner, 0Æ97; baby,
0Æ70; nurse 0Æ97; physician 0Æ83 and overall, 0Æ93) were
similar to those previously established (0Æ90, 0Æ80, 0Æ75, 0Æ61,
0Æ92, 0Æ87 and 0Æ57, respectively).
Ethical considerations
Human ethics approval was granted from the relevant
hospitals and the university. P.G. screened postpartum
women to confirm that they met inclusion criteria and then
explained the study to them. They were informed that their
participation was voluntary and their responses confidential.
Written informed consent was then obtained and data
collection was completed.
Data analysis
Initial data analysis consisted of descriptive statistics and
correlations among the study variables. In order to perform
t-tests for differences between mean satisfactions scores,
subgroups were created based on whether or not labour
expectations were met, employment status, childbirth pre-
paration and education. Stepwise multiple regression analysis
was performed to identify the best predictors of the seven
satisfaction subscales and of total childbirth satisfaction.
Results
Participants ranged in age from 18 to 46 years with a mean
age of 27Æ15 (SD ¼ 6Æ64) were White people (56Æ7%) and
African–American (43Æ3%). Over one-half (55%) had more
than a high school education. The majority was married
(58Æ3%) and an additional 8Æ3% were single and living with a
partner. Over half (58Æ4%) were employed and 40% had
attended childbirth preparation classes. Household incomes
ranged from below $12 000 to over $72 000 per year; 41Æ7%
were below $18 000. Their history ranged from one to eight
pregnancies, with a mean of 2Æ33 (SD ¼ 1Æ41). Their parity
ranged from one to seven with a mean parity of 1Æ93
(SD ¼ 1Æ26). Twenty-nine (48Æ3%) were pregnant with their
first child. The majority received analgesia (66Æ7%) and
anaesthesia (85%) during labour and birth. There were no
differences in demographic characteristics or responses on the
study variables by race, parity or study hospital.
The women experienced high total childbirth satisfaction,
high personal control during labour and moderate labour
pain (Table 1). Significant associations were found between
personal control and the satisfaction subscales and between
personal control and total childbirth satisfaction. Significant
associations were also found between labour pain and the
satisfaction with self subscale and between pain and total
childbirth satisfaction (see Table 1).
In order to identify other potential associations with
childbirth satisfaction, subgroups were created using varia-
bles from the demographic questionnaire and then t-tests
were used to examine the difference in satisfaction between
subgroups of women. Only two variables were significant.
Women who had their expectations for labour met and
women who were employed had higher total childbirth
satisfaction (Table 2). Stepwise multiple regressions were
then performed to find the best predictor of childbirth
satisfaction. The four variables (i.e. pain, personal control,
expectations and employment) that were entered into the
equation explained 35% of the variance in childbirth
satisfaction (Table 3). However, personal control was the
only statistically significant variable explaining the variance
in childbirth satisfaction (t ¼ 2Æ97, P ¼ 0Æ005).

Table 1 Descriptive and intercorrelations among labour pain, personal control, childbirth satisfaction and subscales of childbirth satisfaction
(n ¼ 60)

Labour pain Personal control Childbirth satisfaction Mean 95% CI Range

Labour pain – 0Æ24 0Æ29* 28Æ78 2Æ4–55Æ18 5–63

Personal control – – 0Æ59** 155Æ48 102Æ16–208Æ80 82–195
Childbirth satisfaction – – – 142Æ28 104Æ40–180Æ16 75–170
Overall global satisfaction 0Æ21 0Æ62** 0Æ77** 12Æ63 7Æ35–17Æ91 3–15
Satisfaction with self 0Æ42** 0Æ69** 0Æ78** 34Æ28 19Æ08–49Æ48 15–45
Satisfaction with partner 0Æ13 0Æ38* 0Æ57** 8Æ49 4Æ07–12Æ91 2–10
Satisfaction with baby 0Æ11 0Æ30* 0Æ59** 12Æ28 7Æ32–17Æ24 4–15
Satisfaction with nurse 0Æ19 0Æ27* 0Æ78** 40Æ35 8Æ23–16Æ93 16–45
Satisfaction with doctor 0Æ14 0Æ38* 0Æ82** 35Æ23 27Æ13–43Æ33 22–40

*P-value < 0Æ05, **P-value < 0Æ001.

2004 Blackwell Publishing Ltd, Journal of Advanced Nursing, 46(2), 212–219 215
P. Goodman et al.

Table 2 Univariate comparisons between selected variables and total 3Æ34, P ¼ 0Æ002) and expectations (t ¼ 3Æ13, P ¼ 0Æ003)
childbirth satisfaction, overall childbirth satisfaction, satisfaction were the significant variables explaining the variance in
with self and satisfaction with partner
satisfaction with self.
Comparison groups n Mean 95% CI P-value In addition to personal control, one additional factor was
significantly related to the partner satisfaction subscale.
Total childbirth satisfaction
Labour expectations 0Æ0073 Women who had childbirth preparation had higher satisfac-
Met 31 149Æ23 144Æ90–153Æ55 tion with their partner’s participation during childbirth than
Partially or not met 27 135Æ44 126Æ45–144Æ44 women who did not have childbirth preparation (Table 2).
Employment status 0Æ0140 The two factors explained 24% of the variance in satisfaction
Employed 35 147Æ83 142Æ44–153Æ22
with partner (Table 3). Both personal control (t ¼ 2Æ48, P ¼
Unemployed 24 136Æ46 128Æ60–144Æ31
0Æ017) and childbirth preparation (t ¼ 2Æ46, P ¼ 0Æ017)
Overall childbirth satisfaction
were statistically significant variables explaining the variance
Childbirth preparation 0Æ0103
Yes 24 13Æ58 12Æ93–14Æ24 in satisfaction with partner.
No 36 12Æ00 10Æ98–13Æ02 Only one factor was significantly related to the remaining
Labour expectations 0Æ0216 subscales. Personal control was significantly associated with
Met 31 13Æ55 13Æ05–14Æ04 satisfaction with baby, satisfaction with nurses’ participation
Partially or not met 27 12Æ11 10Æ98–13Æ28
and satisfaction with physicians’ participation (Table 1).
Education 0Æ0080
£High school 27 11Æ56 10Æ21–12Æ90
‡College 33 13Æ52 13Æ05–13Æ98
Discussion
Employment status 0Æ0055
Employed 35 13Æ60 13Æ13–14Æ06 As in previous research, which identified pain as a variable
Unemployed 24 11Æ46 10Æ06–12Æ85 affecting childbirth satisfaction (Fawcett et al. 1992, Green
Satisfaction with self 1993, Slade et al. 1993, Mackey 1995, 1998, Waldenstrom
Labour expectations 0Æ0001
et al. 1996, Brown & Lumley 1997, 1998, Fowles 1998,
Met 31 38Æ19 36Æ36–40Æ02
Partially or not met 27 30Æ59 27Æ64–33Æ54
Lavender et al. 1999, Waldenstrom 1999, Windridge &
Employment status 0Æ0141 Berryman 1999), women in this study with low labour pain
Employed 35 36Æ43 34Æ19–38Æ66 had higher total childbirth satisfaction and higher satisfaction
Unemployed 24 31Æ58 28Æ14–35Æ03 with self than those with high labour pain. However, pain
Satisfaction with partner was more highly correlated with satisfaction with self
Childbirth preparation 0Æ0025 (r ¼ 0Æ42) than with the total experience (r ¼ 0Æ29). This
Yes 24 9Æ43 9Æ05–9Æ82
finding suggests that the amount of labour pain may be a
No 36 7Æ77 6Æ79–8Æ75
more important correlate of satisfaction with self than with
satisfaction with the total experience. If women are able to
In addition to personal control, four additional factors successfully manage their childbirth pain, they may evaluate
were significantly related to the global overall satisfaction themselves more satisfactorily than they evaluate the total
subscale. Women who had childbirth preparation, expecta- experience. Therefore, measuring only total childbirth satis-
tions for labour met, a higher level of education and faction may give an incomplete reflection of women’s
employment had higher global satisfaction with the child- satisfaction with the childbirth experience.
birth experience (Table 2). The five factors explained 34% of The finding that women in this study with high personal
the variance in overall global childbirth satisfaction (Table 3). control reported more total satisfaction with childbirth than
However, personal control was the only statistically signifi- women with low personal control is similar to previous
cant variable explaining the variance in global childbirth research (Simkin 1991, 1992, Bramadat & Driedger 1993,
satisfaction (t ¼ 2Æ83, P ¼ 0Æ007). DiMatteo et al. 1993, Fleissig 1993, Green 1993, Slade et al.
In addition to personal control and labour pain, two 1993, Mackey 1995, Knapp 1996, Waldenstrom et al. 1996,
additional factors were significantly related to the satisfaction Hart & Foster 1997, Campero et al. 1998, Fowles 1998,
with self subscale. Women who had their expectations for Lavender et al. 1999). These findings suggest that women
labour met and were employed had higher satisfaction with evaluate childbirth satisfaction based on the amount of
self during childbirth (Table 2). The four factors explained personal control they experience during labour and delivery
57% of the variance in satisfaction with self (Table 3). (Simkin 1991, 1992, Fleissig 1993, Mackey 1995, Walker
Personal control (t ¼ 3Æ81, P < 0Æ001), labour pain (t ¼ et al. 1995).

216
2004 Blackwell Publishing Ltd, Journal of Advanced Nursing, 46(2), 212–219
Issues and innovations in nursing practice Factors related to childbirth satisfaction

Table 3 Multiple regression for selected

Variable b SE 95% CI
variables predicting total childbirth
satisfaction, overall childbirth satisfaction, Total childbirth satisfaction F[4, 52] ¼ 6Æ90, P ¼ 0Æ0002
satisfaction with self and satisfaction with Intercept 119Æ66 21Æ54 76Æ44–162Æ87
partner Labour pain 0Æ23 0Æ15 0Æ53–0Æ08
Personal control 0Æ28 0Æ09 0Æ09–0Æ46
Labour expectations 5Æ15 4Æ39 13Æ96–3Æ66
Employment status 4Æ39 4Æ24 12Æ89–4Æ12
Overall childbirth satisfaction F[5, 51] ¼ 5Æ22, P ¼ 0Æ0006
Intercept 10Æ48 2Æ87 4Æ73–16Æ24
Personal control 0Æ03 0Æ01 0Æ01–0Æ06
Childbirth preparation 0Æ69 0Æ52 1Æ73–0Æ34
Labour expectations 0Æ39 0Æ55 1Æ49–0Æ70
Education 0Æ09 0Æ60 1Æ11–1Æ29
Employment status 0Æ89 0Æ58 2Æ06–0Æ28
Satisfaction with self F[4, 52] ¼ 17Æ37, P ¼ 0Æ0001
Intercept 28Æ55 7Æ15 14Æ20–42Æ90
Labour pain 0Æ17 0Æ05 0Æ27–0Æ07
Personal control 0Æ12 0Æ03 0Æ06–0Æ18
Labour expectations 4Æ56 1Æ46 7Æ49–1Æ63
Employment status 0Æ76 1Æ41 3Æ59–2Æ06
Satisfaction with partner F[2, 50] ¼ 7Æ77, P ¼ 0Æ0012
Intercept 6Æ68 1Æ99 2Æ68–10Æ69
Personal control 0Æ03 0Æ01 0Æ00–0Æ05
Childbirth preparation 1Æ37 0Æ56 2Æ49–0Æ25

Furthermore, the women in this study with high personal
control reported more satisfaction with self, significant
others, health care providers and the overall global labour
and delivery experience than women with low personal
control. This suggests that personal control may be related to
self-control, external control and to relationships with
significant others and caregivers who facilitate the woman’s
control over her environment. Thus, a woman’s personal
control and the facilitation of her control by others may
influence how satisfied she is with childbirth in general and
with the participants in the event.
Women in this study who had their labour expectations met
were more satisfied with the total and overall global childbirth
experience and with themselves than women whose expecta-
tions were not met. These findings support other studies that
found that positive expectations were related to childbirth
satisfaction (Green 1993, Slade et al. 1993, Waldenstrom et al.
1996). Apparently, congruency between expectations and the
actual experience of childbirth leads to satisfaction with the
experience. Women may evaluate satisfaction with self in
terms of achievement of expectations. Therefore, in order to
understand fully women’s satisfaction with childbirth, it is
important to evaluate components of the childbirth experience
in addition to a summated total childbirth satisfaction score.
Women in this study who had childbirth preparation were
more satisfied with the overall global childbirth experience
and their partners’ participation than those who did not have
childbirth preparation. These findings support other reports
that childbirth preparation was related to childbirth satisfac-
tion (Quine et al. 1993, Hart & Foster 1997). Childbirth
preparation may influence satisfaction in several ways. First,
preparation may help the woman and her partner have
realistic expectations for the experience. Secondly, prepara-
tion teaches the woman techniques to maintain control during
labour. Thirdly, preparation also teaches the woman and her
partner to receive and give support during labour. If her
partner provides helpful support, she would more likely be
satisfied with his participation during childbirth. Examining
the partner subscale of the satisfaction scale provides more
comprehensive understanding of satisfaction with childbirth.
Only personal control was a statistically significant
predictor of total childbirth satisfaction as well as satisfaction
with the component subscales (self, partner, nurse and
physician) of childbirth satisfaction. This finding provides
empirical evidence of the importance of personal control and
met expectations in contributing to women’s satisfaction
with the childbirth experience whether conceptualized as a
global measure of satisfaction or as satisfaction with the
participation of others.
These results suggest that childbirth satisfaction is a
multidimensional construct consisting of different contextual
components of the birth experience. Childbirth satisfaction

2004 Blackwell Publishing Ltd, Journal of Advanced Nursing, 46(2), 212–219 217
P. Goodman et al.
What is already known about this topic
• Childbirth satisfaction is conceptualized as overall sat-
isfaction without identifying its components.
• Pain, control and met expectations may predict total
childbirth satisfaction.
What this paper adds
• Personal control predicts total childbirth satisfaction
and also sub-components (self, partner, baby, nurse and
physician).
• Met expectations predict satisfaction with own per-
formance during childbirth.
• Pain does not predict total satisfaction or components of
satisfaction.
• Facilitating women’s achievement of personal control
and expectations during childbirth should be the focus
of nursing interventions.
may be an evaluative response resulting from self-reflection as
well as from interaction of the woman with people in her
environment. Therefore, childbirth satisfaction may reflect
satisfaction with self and others in the environment. Child-
birth evaluated globally as highly satisfactory does not
preclude being dissatisfied with the participation of self and
others. In this study, the mean pain scores were moderate
(M ¼ 28Æ78). Therefore, most women felt some degree of
pain but yet were globally satisfied with the childbirth
experience. Thus, negative feelings can coexist with positive
feelings indicating that the evaluation of the birth experience
is multidimensional.
Although childbirth satisfaction is a multidimensional
concept, the most significant predictors of all aspects of
satisfaction were personal control and having expectations
for labour and delivery met. Therefore, nurses and other
health care providers should focus their supportive inter-
ventions, both prenatally and during labour and delivery, on
facilitating women’s achievement of personal control and
meeting expectations. In order to assist women in meeting
their expectations, assessment and discussion of their wishes
and expectations should be done throughout pregnancy,
resulting in a birth plan for the actual labour and delivery.
Nurses in labour and delivery should help the woman
organize and control herself and her environment in order
to meet her expectations and to maintain personal control.
If some of the woman’s expectations are not met, it is
important for the nurse to counsel the woman about this
and to assist her to understand the circumstances, not to
218
2004 Blackwell Publishing Ltd, Journal of Advanced Nursing, 46(2), 212–219
blame herself and to accept the situation that was not able
to be controlled.
Facilitating women’s expectations and personal control
during labour and delivery can increase their satisfaction with
the birth experience. This, in turn, may help them gain
confidence to be strong parents who will provide nurturing
care to their infants, thereby potentially creating stronger
families.
Conclusions
Conclusions of this study must be considered in the light of its
limitations. The sample size was relatively small and non-
randomly selected, thus restricting the statistical inference of
the results, so that the findings are not generalizable to all
postpartum women. Extraneous variables in the two hospi-
tals (such as different activities and routines) may have
influenced internal validity.
In spite of the limitations, this study demonstrates that
childbirth satisfaction is multidimensional with different
factors predicting the various dimensions of satisfaction.
Further research should include a larger sample and incor-
porate other potential predictors of childbirth satisfaction.
Additionally, research that examines the association of
various components of satisfaction with birth outcomes and
subsequent mothering activities would provide useful infor-
mation for care providers.
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