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Am J Obstet Gynecol. 2018 Nov 4. pii: S0002-9378(18)31020-2. doi: 10.1016/j.ajog.2018.10.093. [Epub ahead of print]

Childbirth-Specific Patient-Reported Outcomes as Predictors of Hospital Satisfaction.

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Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA; Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA; Department of Community Health Sciences, Fielding School of Public Health at UCLA, Los Angeles, CA. Electronic address:
Childbirth Research Associates, North Hollywood, CA.
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Burns Allen Research Institute, Los Angeles, CA.
BirthSwell, Ithaca, NY.
Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA.
AMF Consulting, Los Angeles, CA.



Under value-based payment programs, patient-reported experiences and outcomes (PROs) can impact hospital and physician revenue. To enable obstetrical providers to improve the childbirth experience, a framework for understanding what women expect and desire during childbirth is needed.


To identify key predictors of childbirth hospital satisfaction using the Childbirth Experiences Survey (CBEX).


This study builds on a larger effort that used Patient-Reported Outcomes Management Information System (PROMISĀ®) methodology to develop a childbirth-specific preliminary PRO item bank. These efforts led to the development of an antepartum and postpartum survey (CBEX Parts 1 and 2). All phases of the study were conducted with the participation of a community-based research team. We conducted a prospective observational study using national survey response panels organized through Nielsen to identify women's antepartum values and preferences (V&P) for childbirth (CBEX Part 1). Eligible participants were US pregnant women (English or Spanish speaking) >18 years old, and > 20 weeks pregnant. Women were re-contacted and invited to participate in a postpartum follow-up survey to collect information about their childbirth PROs, including childbirth satisfaction (CBEX Part 2). In bivariate analyses, we tested whether predisposing conditions (e.g., patient characteristics or previous experiences), V&P, PROs, and the "gaps" between V&P and PROs were predictors of women's satisfaction with hospital childbirth services. Multivariable logistic regression models were fitted to examine the simultaneous effect of predictors on hospital satisfaction, adjusted for key predisposing conditions.


Of 500 women who anticipated a vaginal delivery at the time of the antepartum survey, who labored prior to delivery, and who answered the postpartum survey, key findings included: 1) the strongest predictors of women's satisfaction with hospital childbirth services were items in the domains of staff communication, compassion, empathy, and respect; and 2) 23 childbirth-specific PROs were identified. Examples of these PROs, such as being told about progress in labor and being involved in decisions regarding labor pain management, appeared especially relevant to women experiencing childbirth. A final model predicting women's satisfaction with hospital childbirth services included a total of eight items that could be optimized by doctors, midwives, and hospitals. These included the patient's report of how well she coped with labor pain, whether the hospital provided adequate space and food for their support person, and whether she received practical support for feeding the newborn.


This study identified 23 childbirth-specific PROs that were predictors of childbirth hospital satisfaction. The implementation of CBEX Parts 1 and 2 in a multi-hospital setting may lead to the development of childbirth hospital performance measures and strategies for improvement of the childbirth experience.


birth expectations; birth satisfaction; childbirth experience; hospital satisfaction; patient-reported outcomes


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