title: Client satisfaction and transfers across care levels of women with uncomplicated pregnancies at the onset of labor.
abstract: OBJECTIVE
  to compare the client satisfaction of women with uncomplicated pregnancies at the onset of labor who were transferred across care levels during childbirth and women who were not transferred across care levels in the Dutch perinatal healthcare system, and-if there are differences-to identify the variables that may explain them.
  
  
  METHODS
  the research entailed a population-based study of women with uncomplicated pregnancies at the onset of labor living in the catchment area of a Dutch Neonatal Intensive Care Unit (NICU) in the eastern part of the Netherlands who gave birth between April 2014 and September 2014. Respondents completed a validated questionnaire (n = 842; mean age 30.7 years). Client satisfaction, measured on a 10-point scale, was assessed within 12 weeks after childbirth.
  
  
  RESULTS
  of the 842 respondents, 277 women experienced a transfer of care during childbirth, and 565 women were not transferred. The client satisfaction of women who were transferred across care levels (mean 8.04; SD 1.4) was significantly lower (p<0.001) than that of women who were not transferred across care levels (mean 8.78; SD 0.9). Seven variables together explained 93.2% of the difference in client satisfaction. Explanatory pregnancy and childbirth variables were perceived health problems for the mother and medical interventions during childbirth. Explanatory clients' experiences with the care process variables were respect, prompt attention, quality of basic amenities, social consideration, and choice and continuity.
  
  
  CONCLUSIONS
  women were highly satisfied with the care they received, although transfers across care levels during childbirth were associated with substantially lower client satisfaction. The differences in client satisfaction between transferred and non-transferred women can largely be explained by pregnancy and childbirth characteristics, and by clients' experiences with the care process.
authors.affiliation: Institute for Innovation and Governance Studies, Departments of Public Administration, and Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands. Electronic address: c.m.v.vanstenus@utwente.nl.
authors.forename: Cherelle M V
authors.initials: CM
authors.lastname: van Stenus
authors.affiliation: Institute for Innovation and Governance Studies, Department of Health Technology and Services Research, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands. Electronic address: m.m.boere-boonekamp@utwente.nl.
authors.forename: Magda M
authors.initials: MM
authors.lastname: Boere-Boonekamp
authors.affiliation: Het Verloskundig Huys, Overtoom 57, 8043 LZ Zwolle, The Netherlands. Electronic address: kerkhof@home.nl.
authors.forename: Erna F G M
authors.initials: EF
authors.lastname: Kerkhof
authors.affiliation: Institute for Innovation and Governance Studies, Department of Public Administration, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands. Electronic address: a.need@utwente.nl.
authors.forename: Ariana
authors.initials: A
authors.lastname: Need
mesh_terms: D000328:Adult; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007743:Labor, Obstetric; D008880:Midwifery; D009426:Netherlands / Q000453:epidemiology; D010348:Patient Care Team; D017060:Patient Satisfaction; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Childbirth; Client satisfaction; Perinatal healthcare; Transfer