Open Access Open Access  Restricted Access Subscription or Fee Access

A survey of women’s birth experiences in Scotland using the Birth Satisfaction Scale (BSS)

Caroline Hollins Martin, Colin Martin


Background: ‘Birth satisfaction’ is important since experience of labour can influence women’s post-natal adjustment.

Objective: To explore: (1) childbearing women’s experiences of ‘birth satisfaction’ and (2) identify contexts in which it is more appropriate to use the 30-item Birth Satisfaction Scale (BSS) or the 10-item BSS-Revised (BSS-R).

Study design: A quantitative survey was conducted using the 30-item BSS. As a function of completing the 30-item BSS, participants also completed the short-form 10-item BSS-R.

Participants: A convenience sample of post-natal women (n=228) attending for National Health Service (NHS) care at the Ayrshire Maternity Unit in the West of Scotland (UK) participated. Participants were within their first 10 post-natal days.

Results: The 30-item BSS mean scores = 115.84 (SD 14.05). The thematically determined subscale mean scores of quality of care provision (BSS-QC; 8-items), women’s personal attributes (BSS-WA; 8-items) and stress experienced during labour (BSS-SL;14-items) subscales, were 32.2 (4.09), 31.9 (4.16) and 51.73 (8.04) respectively. Women experienced greater ‘birth satisfaction’ when they had a Spontaneous Vertex Delivery compared with a complicated delivery. Primigravidas were generally less ‘birth satisfied’ than multiparous women.

Key conclusions: Overall assessment of care was complimentary, with global levels of ‘birth satisfaction’ generally high. In response to psychometric tests, the 30-item BSS has been trimmed down to a statistically robust, valid and reliable 10-item BSS-R.

Implications for practice: Now that a valid and reliable 10-item BSS has been developed to measure women’s experiences of childbirth, it can be used to assess differences between variables such as home and hospital birth, or to establish correlates with other valid measures. We advance our study as an important contribution to person-centered maternal healthcare.


Assessment, Birth Satisfaction Scale (BSS), Birth satisfaction, Maternity care, Midwives, Obstetrics

Full Text:



Department of Health (DoH). (2004). The National Service Framework for Children, Young People and Maternity Services. London: DoH.

Department of Health (DH). (2006). Our health, our care, our say. London: DoH.

Department of Health (DoH). (2007). Maternity matters: choice, access and the continuity of care in a safe service. London: DoH.

Department of Health (DoH). (2007). Improving the quality and outcomes for maternity service users through effective commissioning. London: DoH.

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

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.

Hollins-Martin, C.J. & Martin, C. (2014). Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R). Midwifery 30 (6) 610-619.

Quinne, L., Rutter, D.R. & Gowan, S. (1993). Women’s satisfaction with the quality of the birth experience: a prospective study of social and psychological predictors. Journal of Reproductive and Infant Psychology 11, 107-113.

Melzack, R., Taenzer, P., Feldman, P. & Kinch, R. (1984). Labor is still painful after prepared childbirth. Canadian Medical Journal 125, 357-363.

Sorenson, D.S. & Tschetter, L. (2010). Prevalence of negative birth perception, disaffirmation, perinatal trauma symptoms, and depression among postpartum women. Perspectives in Psychiatric Care 46 (1) 14-25.

Geissbuehler, V. & Eberhard, J. (2002). Fear of childbirth during pregnancy: a study of more than 8000 pregnant women. Journal of Psychosomatic Obstetrics & Gynaecology 23, 229-235.

Beck, C.T. (2009). Birth trauma and its sequelae. Journal of Trauma & Dissociation 10 (2) 189-203.

McKenzie-McHarg, K. (2004). Traumatic birth: understanding predictors, triggers, and counseling process is essential to treatment. Birth 31 (3) 219-221.

Gamble, J. & Creedy, D. (2005). Psychological trauma symptoms of operative birth. British Journal of Midwifery 13 (4) 218-224.

Jacoby, A. (1987). Women’s preferences for and satisfaction with current procedures in childbirth: findings from a national study. Midwifery 3, 117-124.

Eriksson, C., Westman, M.D. & Hamberg, M.D. (2006). Content of childbirth related fear in Swedish women and men: analysis of an open ended questionnaire. American College of Nurse-Midwives 51, 112-118.

Morgan, B.M., Bulpitt, C.J., Clifton, P. & Lewis, P.J. (1982). Analgesia and satisfaction in childbirth (the Queen Charlotte’s 1000 mother survey). Lancet 2 (8302) 808-811.

Lowe, N.K. (1991). Maternal confidence in coping with labour. Journal of Obstetric, Gynecologic and Neonatal Nursing 20 (6) 457-463.

Stockman, A. & Altmaier, E. (2001). Relation of self-efficacy to reported pain and pain medication usage during labour. Journal of Clinical Psychology in Medical Settings 8, 161-166.

Brown, S. & Lumley, J. (1994). Satisfaction with care in labour and birth: a survey of 790 Australian women. Birth 21 (1) 4-13.

Dannenbring, D., Stevens, M.J. & House, A.E. (1997). Predictors of childbirth pain and maternal satisfaction. Journal of Behavioural Medicine 20 (2) 127-142.

Bandura, A. (1982). Self efficacy mechanism in humans. American Psychologist 37 (2) 122-147.

Handfield, B. & Bell, R. (1996). Do childbirth preparation classes influence decision making about labour and postpartum issues? Birth 22 (3) 153-160.

Ford, E. & Ayers, S. (2009). Stressful events and support during birth: the effect on anxiety, mood and perceived control. Journal of Anxiety Disorders 23 (2) 260-268.

Goodman, P., Mackay, M.C. & Tavakoli, A.S. (2004). Factors related to childbirth Satisfaction, Journal of Advanced Nursing 46, 212-219.

Green, J.M., Baston, H.A., Easton, S.C. & McCormick, F. (2003). Greater expectations. The inter-relationship between women’s expectations and experience of decision-making, continuity, choice and control in labor, and psychological outcomes. Leeds: Mother and Infant Research Unit, University of Leeds. Leeds, UK.

Knapp, L. (1996). Childbirth satisfaction: the effects of internality and perceived control. Journal of Perinatal Education 5, 7-16.

Gibbens, J. & Thomson, A. (2001). Women’s expectations and experiences of childbirth. Midwifery 17, 302-313.

Hall, S.M. & Holloway, I.M. (1998). Staying in control: women’s experiences of labour in water. Midwifery 14, 30-36.

Halldorsdottir, S. & Karlsdottir, S.I. (1996). Journeying through labour and delivery: perceptions of women who have given birth. Midwifery 12, 48-61.

Proctor, S. (1998). What determines quality in maternity care: comparing the perceptions of childbearing women and midwives. Birth 25 (2) 85-93.

Waldenstrom, U. & Nilsson, C.A. (1993). Women’s satisfaction with birth centre care: a Randomised controlled study. Birth 21 (1) 3-13.

Hodnett, E.D., Gates, S., Hofmeyr, G.J., Sakala, C. (2012). Continuous support for women during childbirth. Cochrane Database of Systematic Reviews. Issue 10. Art. No.: CD003766. DOI: 10.1002/14651858.CD003766.pub4.

Chen, C., Wang, S. & Chang, M. (2001). Women’s perceptions of helpful and unhelpful nursing behaviours during labour: a study of Taiwan. Birth 28 (3) 180-185.

Stadlmayr, W., Amsler, F., Lemola, S., Stein, S., Alt, M., Bürgin, D., Surbek, D. & Bitzer, J. (2006). Memory of childbirth in the second year: the long term effect of a negative birth experience and its modulation by the perceived intranatal relationship with caregivers. Journal of Psychosomatic Obstetrics & Gynecology 27 (4) 211-224.

Bedell, S.E., Graboys, T.B., Bedell, E. & Lown, B. (2004). Words that harm, words that heal. Archives of Internal Medicine 164 (13) 1365-1368.

Kirkpatrick, J.N., Nash, K. & Duffy, T.P. (2005). Well rounded. Archives of Internal Medicine 165 (6) 613-616.

Ryding, E.L., Wijma, B., Wijma, K. & Rydstrom, H. (1998). Fear of childbirth during pregnancy may increase the risk for emergency section. Acta Obstetrica et Gynecologia Scandinavica 77, 542-547.

Wax, J., Cartin, A., Pinette, M. & Blackstone, J. (2004). Patient choice caesarean: an evidence based view. Obstetrical & Gynecological Survey 59, 601-616.

Hannah, P., Adams, D., Lee, A. & Glover, V. (1992). Links between early post-partum mood and post-natal depression. British Journal of Psychiatry 160, 777-780.

Reynolds, J.L. (1997). Post-traumatic stress disorder after childbirth: the phenomenon of traumatic birth. Canadian Medical Association Journal 156, 831-835.

National Institute of Clinical Excellence (NICE). (2011). Guideline 132 issued in November 2011 (UK). Available at:

Allport, G.W. (1964). Pattern and growth in personality. New York: Holt.

Dweck, C.S. (1999). Self-theories: their role in motivation, personality and development. Philadelphia: Taylor and Francis/Psychology Press.

Kaur, J. & Kaur, K. (2012). Obstetric complications: Primiparity versus multiparity. European Journal of Experimental Biology 2 (5) 1462-1468.

Fretts, R.C., Schmittdiel, M.A., McLean, F.H., Usher, R.H. & Goldman, M.B. (1995). Increased maternal age and the risk of fetal death. New England Journal of Medicine 333, 953-957



  • There are currently no refbacks.