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: C.J.Hollins-Martin@salford.ac.uk

Introduction

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. http://dx.doi.org/10.1016/j.midw.2013.10.006

Conclusion

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: c.j.hollins-martin@salford.ac.uk. 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.