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BACKGROUND: The aim of this study was to investigate satisfaction with intrapartum and postpartum care, and the risk of not being satisfied in relation to 1) a woman's sociodemographic background, 2) physical and emotional well-being in early pregnancy, 3) labor outcomes, 4) care organization, and 5) a woman's subjective assessment of aspects of care.

METHODS: All Swedish-speaking women booked for antenatal care during 3 weeks spread over 1 year (1999-2000) were invited to participate in the study, and 2,686 (82% of those who consented to participate and 58% of those who were eligible) completed questionnaires in early pregnancy and 2 months postpartum. Women who were satisfied with overall intrapartum and postpartum care respectively were compared with those who were not regarding possible risk factors, and associations were tested by logistic regression analysis.

RESULTS: Ten percent of women were not satisfied with intrapartum care (ip) and 26% with postpartum care (pp). The following risk factors for not being satisfied were found: 1) age <25 years (ip), only elementary school (ip + pp), single status (pp), inconvenient timing of pregnancy (ip), lack of support from partner (ip); 2) suffering from many physical symptoms (ip + pp); 3) newborn transfer to neonatal clinic (ip + pp); 4) length of stay <1 day and > or =5 days (ip + pp), no "debriefing" after birth (ip), large hospital (pp); 5) lack of support by midwife (ip), little involvement in decision making (ip), dissatisfaction with birth environment (ip), insufficient time for breastfeeding support, encouragement and personal questions (pp).

AIM: This paper is a report of a study to investigate women's satisfaction with intrapartum care along three distinct dimensions simultaneously (interpersonal care, information and involvement in decision-making and physical birth environment) and to describe the characteristics of women with different patterns of satisfaction.

BACKGROUND: Patient satisfaction is an important outcome in the evaluation and development of healthcare services. Studies of satisfaction have often used single global ratings but such ratings may not capture the multidimensionality of care during childbirth.

METHOD: A cluster analytic technique was used to establish a finite set of response patterns. Data were obtained from a longitudinal population-based Swedish survey including 2605 women who completed questionnaires in early pregnancy, and 2 months and 1 year after the birth. Data collection commenced in March 1999 and was completed in April 2002.

RESULTS: Nine different clusters, or patterns of satisfaction/dissatisfaction, were found. Nearly half of the women (47%) were in clusters that were satisfied or very satisfied with at least one dimension of care, 20% in clusters that were fairly satisfied (average), and 33% in less than satisfied clusters. Fifteen per cent were mainly dissatisfied with the physical environment, 8% mainly with interpersonal care, 7% only with information and decision-making and 3% with all dimensions. Women in the different clusters differed statistically significantly in psychological health in early pregnancy, emotional reactions during labour and in labour outcomes, but not in background characteristics.

CONCLUSION: Looking at different dimensions of care instead of a single global measure gave a richer, more diverse, and also a more negative picture of women's experiences of intrapartum care.

OBJECTIVES: to investigate women's experiences of postnatal hospital care in relation to four different aspects: (1) interpersonal care; (2) time spent on physical check-ups; (3) time spent on information and support; and (4) time spent on assistance with breast feeding. More specifically, we aimed to establish whether typical clusters of women could be identified, and if so, whether these clusters could be related to specific outcomes of care, to the way in which care is organised, and to the individual's psychological health and socio-demographic background.

DESIGN: longitudinal population-based survey, including three questionnaires completed in early pregnancy, at 2 months and 1 year after birth.

SETTING: all postnatal wards in Sweden.

PARTICIPANTS: women (n=2338) recruited at their first booking visit at 593 antenatal clinics, who responded to questions relating to postnatal hospital care 2 months after birth.

FINDINGS: eight cluster profiles defined by the four aspects of postnatal care were identified. About half of the women were found in clusters that were satisfied with most aspects of care, and half in clusters that were dissatisfied with one aspect or more. Only 32% were very satisfied with all four dimensions. Specific groups of women, such as first-time mothers, migrants, young mothers and those with a short length of stay, were dissatisfied with different assessments of postnatal care. Psychological health in early pregnancy was associated with high ratings of all aspects of care, whereas emergency caesarean section and instrumental vaginal delivery was associated with dissatisfaction with breast feeding support and time spent on health check-ups.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: women's individual appraisal of specific aspects of hospital postnatal care could be grouped into response patterns that were shared by smaller or larger groups. These patterns were related to maternal characteristics, labour outcomes and the way in which care was organised. The multi-faceted approach used in this study provided details about who was dissatisfied with what, and showed that women are not necessarily either satisfied or dissatisfied with care in a general sense. In order to provide individualised care, the carer needs to be aware of these differences.

BACKGROUND: Women's evaluation of hospital postpartum care has consistently been more negative than their assessment of other types of maternity care. The need to further explore what is wrong with postpartum care, in order to stimulate changes and improvements, has been stressed. The principal aim of this study was to describe women's negative experiences of hospital postpartum care, expressed in their own words. Characteristics of the women who spontaneously gave negative comments about postpartum care were compared with those who did not.

METHODS: Data were taken from a population-based prospective longitudinal study of 2783 Swedish-speaking women surveyed at three time points: in early pregnancy, at two months, and at one year postpartum. At the end of the two follow-up questionnaires, women were asked to add any comment they wished. Content analysis of their statements was performed.

RESULTS: Altogether 150 women gave negative comments about postpartum care, and this sample was largely representative of the total population-based cohort. The women gave a diverse and detailed description of their experiences, for instance about lack of opportunity to rest and recover, difficulty in getting individualised information and breastfeeding support, and appropriate symptom management. The different statements were summarised in six categories: organisation and environment, staff attitudes and behaviour, breastfeeding support, information, the role of the father and attention to the mother.

CONCLUSION: The findings of this study underline the need to further discuss and specify the aims of postpartum care. The challenge of providing high-quality follow-up after childbirth is discussed in the light of a development characterised by a continuous reduction in the length of hospital stay, in combination with increasing public demands for information and individualised care.