title: Labor and Birth Care Satisfaction Associated With Medical Interventions and Accompaniment During Labor Among Chilean Women.
abstract: BACKGROUND
  Satisfaction with care during labor and birth has been associated with various obstetric variables. The purpose of this study was to determine which labor and birth procedures are significant predictors of maternal patient satisfaction in a large cross-sectional sample.
  
  
  METHODS
  An observational, cross-sectional study of 1660 women giving birth in Chilean public hospital facilities was conducted from 2012 to 2013. Data were collected from 9 different hospitals in 8 regions of Chile using 2 instruments, including the American College of Nurse-Midwives Intrapartum Care Data Set and a locally validated measure of maternal well-being. Women were eligible if they arrived at the labor and delivery unit during early labor (2-3 centimeters dilated) and spent at least 4 hours in labor at the facility. In the current analysis, odds ratios were calculated using ordinal logistic regression for association with a less optimal well-being score (possible outcome values were optimal, adequate, and minimal). Odds ratios were adjusted for age, education, single status, and parity (nulliparous vs multiparous). Stepwise regression was used to identify the procedural factors that were significantly associated with labor and birth care satisfaction.
  
  
  RESULTS
  Factors significantly associated with lower satisfaction were cesarean birth (odds ratio [OR], 1.4; 95% confidence interval [CI], 1.1-1.7), pharmacologic pain management (OR, 1.3; 95% CI, 1.02-1.7), continuous fetal heart rate monitoring (OR. 1.4; 95% CI, 1.2-1.8), and episiotomy (OR, 1.4; 95% CI, 1.1-1.7). Nulliparity was also associated with minimal maternal satisfaction (OR, 1.3; 95% CI, 1.0-1.5). Greater satisfaction was associated with accompaniment by a companion of choice during labor (OR, 0.49: 95% CI, 0.40-0.60).
  
  
  CONCLUSIONS
  This study is one of the first to provide empirical evidence that maternal patient satisfaction is negatively affected by many common obstetric procedures in the Latin American context. These findings are consistent with World Health Organization recommendations regarding judicious and necessary, rather than routine, use of obstetric interventions.
authors.forename: Fiona
authors.initials: F
authors.lastname: Weeks
authors.forename: Loreto
authors.initials: L
authors.lastname: Pantoja
authors.forename: Jovita
authors.initials: J
authors.lastname: Ortiz
authors.forename: Jennifer
authors.initials: J
authors.lastname: Foster
authors.forename: Gabriel
authors.initials: G
authors.lastname: Cavada
authors.forename: Lorena
authors.initials: L
authors.lastname: Binfa
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D002677:Chile; D003430:Cross-Sectional Studies; D036861:Delivery, Obstetric / Q000379:methods*; D004841:Episiotomy; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D016015:Logistic Models; D008880:Midwifery; D009721:Nurse Midwives; D016017:Odds Ratio; D059408:Pain Management; D036801:Parturition; D017060:Patient Satisfaction; D018743:Perinatal Care; D011247:Pregnancy; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Chile; Latin America; childbirth; intrapartum care; obstetric labor; patient satisfaction; quality of health care