Wednesday, 23 April 2014

The Birth Satisfaction Scale (BSS)

Prof Caroline J. Hollins Martin PhD MPhil BSc PGCE PGCC ADM RM RGN
To obtain the BSS and marking grid email:

Measuring women’s experiences of childbirth can be achieved using a valid and reliable instrument. For this purpose a psychometric scale called the 10-item-Birth-Satisfaction-Scale-Revised (10-item-BSS-R) has been developed. Two versions of the scale are now available for use in projects intended to evaluate childbearing women’s experiences of childbirth:

(1)   The psychometrically robust, valid and reliable 10-item-BSS-R from which scores can be correlated with other validated measures (e.g., pain, depression, self-efficacy scales).

(2)   The qualitative 30-item-Birth-Satisfaction-Scale-Long-Form (30-item-BSS-LF) designed to assess individual women’s experiences for purpose of debriefing, before counselling or prior to in-depth qualitative work.

What is birth satisfaction?
Every woman constructs expectations of childbirth with variation in appreciating the concept. Literature supports that birth satisfaction includes:
          having one’s comfort considered
          being listened too
          receiving the type of pain relief requested
          coping well during labour
          feeling in control
          being well-prepared
          receiving minimal obstetric injuries
          achieving the desired style of delivery
Within the confines of safety, birth satisfaction is about attempting to provide women with what they want during labour. Three overarching themes identified in the literature are important when measuring birth satisfaction:
(1)   Quality of care provision
(2)   Personal attributes
(3)   Stress experienced during labour
These 3 themes are divided into sub-themes that underpin the questions asked on the 30-item-BSS-LF 

Scale development paper:
Hollins Martin, C.J., Fleming, V. (2011). The Birth Satisfaction Scale (BSS). International Journal of Health Care Quality Assurance. 24(2):124-135.

Qualitative validation of the themes and sub-themes that underpin the 30-item-BSS-LF was carried out using a research method called concurrent analysis.

Qualitative validation reference
Hollins Martin, C.J., Snowden, A., Martin, C.R. (2012). Concurrent analysis: validation of the domains within the Birth Satisfaction Scale. Journal of Reproductive and Infant Psychology. 30(3):247-260. 

Evaluation of key psychometric properties of the 30-item-BSS-LF
For the purpose of psychometric testing of statements on the 30-item-BSS-LF, a quantitative survey was carried out at Ayrshire Maternity Unit (AMU) in Kilmarnock (West of Scotland, UK). Participants included a convenience sample of women (n=228) <10 days post-delivery. Key psychometric properties of the 30-item-BSS-LF were evaluated using Exploratory Factor Analysis (EFA) and Structural Equation Modelling techniques (SEM).
Post psychometric analysis of the items on the 30-item-BSS-LF, the scale was reconfigured into the 10-item-BSS-R, which comprises 3 sub-scales that measure distinct but correlated domains of: (1) quality of care provision (4-items), (2) women’s personal attributes (2-items), and (3) stress experienced during labour (4-items)

Psychometric report paper
Hollins-Martin, C.J., Martin, C. (2014). Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R). Midwifery.

The validated 10-item-BSS-R is a robust questionnaire that can be used to measure birth satisfaction post birth. The BSS can be used to collect data both nationally and internationally, with results potentially correlated with other validated measures. In contrast, the 30-item-BSS-LF may be used to assess individual women’s views of their birth experience prior to counselling or in-depth qualitative work. If you would like to use either scale please contact: The first author would be interested in working with researchers who are willing to translate the scale into other languages to make it available for wider use. 

Friday, 24 January 2014

Diet and nutrition in the menstrual cycle, periconception and fertility



Hollins-Martin,C.J., van den Akker, O.B.A., Martin, C.R., Preedy, V.R. (Eds.). (2014). Handbook of diet and nutrition in the menstrual cycle, periconception and fertility. Human Health Handbooks no.7. Wageningen Academic Publishers, The Netherlands. ISBN: 978-90-8686-212-2

Published: 15th January 2014 by Human Health Handbooks - 566 pages

The reproductive cycle in women is complex and can be considered to begin with epigenetic programming and ending with menopause. Intervening steps involve a variety of processes, including the cellular development of the sex organs, menarche, episodic endocrine cycles, menstruation, ovulation and conception. These processes can be influenced by diet and nutrition and vice versa. Body composition has an impact on the menstrual cycle and periconception and these factors in turn also influence body composition. Similarly, either food deprivation, dietary excess or obesity can result in marked changes in the menstrual cycle with a concomitant effect on fertility. This handbook is the first scientific source that provides a comprehensive overview of the relationship of diet and nutrition with puberty, menarche and menstrual cycle, conception and fertility and infertility. The handbook of diet and nutrition in the menstrual cycle, conception and fertility will benefit dieticians, nutritionists, gynaecologists, endocrinologists, obstetricians, paediatricians and those concerned with women's health in general.