The Birth Satisfaction Scale - Revised (BSS-R): should the subscale scores or the total score be used?

OBJECTIVE AND BACKGROUND: The 10-item Birth Satisfaction Scale - Revised (BSS-R) is increasingly being used internationally as the instrument of choice for the assessment of birth satisfaction. There remains conjecture over the most appropriate way to score the instrument; subscale scores overall total score, or both approaches. The current study sought to clarify this issue by examining the measurement characteristics of the United States version of the BSS-R from a large data set. METHODS: Secondary analysis of a data matrix from a large sample US BSS-R validation study (N = 2116) using structural equation modelling. RESULTS: A bi-factor model revealed an excellent fit to data (χ2(df = 25) = 208.21, p < 0.001, CFI = 0.98, RMSEA = 0.06, SRMR = 0.04), demonstrating relative independence of the BSS-R quality of care subscale, while in contrast the women's attributes and stress experienced during childbearing subscales could be explained more plausibly by a general factor of experience of childbirth. CONCLUSION: Consistent with the recommendations of the original BSS-R validation study, the current investigation found robust empirical evidence to support the use of both the subscale scoring system and the total score. Researchers and clinicians can therefore select either approach (or both) with confidence.

Washington State Childbearing Women's Experiences of Planned Home Births: A Heideggerian Phenomenological Investigation.

The purpose of this interpretive study was to investigate planned home births that occurred in Washington State and to provide meaning. A Heideggerian phenomenological approach was chosen to investigate and interview a purposive sample of 9 childbearing women who experienced at least 1 home birth between 2010 and 2014 in Washington State. The results of this study suggest that childbirth education is an essential and valued aspect of birthing. Childbirth educators can use the findings from this investigation as a means to increase their awareness of birthing in the home. This interpretive investigation can give "voice" to the compelling evidence accumulating that is investigating planned home births as a sanctuary to allow physiological and low-intervention births to transpire.

Measurement and structural invariance of the US version of the Birth Satisfaction Scale-Revised (BSS-R) in a large sample.

BACKGROUND: The 10-item Birth Satisfaction Scale-Revised (BSS-R) is being increasingly used internationally. The use of the measure and the concept has gathered traction in the United States following the development of a US version of the tool. A limitation of previous studies of the measurement characteristics of the BSS-R is modest sample size. Unplanned pregnancy is recognised as being associated with a range of negative birth outcomes, but the relationship to birth satisfaction has received little attention, despite the importance of birth satisfaction to a range of postnatal outcomes. AIM: The current investigation sought to evaluate the measurement characteristics of the BSS-R in a large postpartum sample. METHODS: Multiple Groups Confirmatory Factor Analysis (MGCFA) was used to evaluate a series of measurement and structural models of the BSS-R to evaluate fundamental invariance characteristics using planned/unplanned pregnancy status to differentiate groups. FINDINGS: Complete data from N=2116 women revealed that the US version of the BSS-R offers an excellent fit to data and demonstrates full measurement and structural invariance. Little difference was observed between women on the basis of planned/unplanned pregnancy stratification on measures of birth satisfaction. DISCUSSION: The established relationship between unplanned pregnancy and negative perinatal outcomes was not found to extend to birth satisfaction in the current study. The BSS-R demonstrated exemplary measurement and structural invariance characteristics. CONCLUSION: The current study strongly supports the use of the US version of the BSS-R to compare birth satisfaction across different groups of women with theoretical and measurement confidence.

Birth Satisfaction Scale/Birth Satisfaction Scale-Revised (BSS/BSS-R): A large scale United States planned home birth and birth centre survey.

OBJECTIVE: to explore the prevalence of birth satisfaction for childbearing women planning to birth in their home or birth centers in the United States. Examining differences in birth satisfaction of the home and birth centers; and those who birthed in a hospital using the 30-item Birth Satisfaction Scale (BSS) and the 10-item Birth Satisfaction Scale-Revised (BSS-R). STUDY DESIGN: a quantitative survey using the BSS and BSS-R were employed. Additional demographic data were collected using electronic linkages (Qualtrics™). PARTICIPANTS: a convenience sample of childbearing women (n=2229) who had planned to birth in their home or birth center from the US (United States) participated. Participants were recruited via professional and personal contacts, primarily their midwives. RESULTS: the total 30-item BSS score mean was 128.98 (SD 16.92) and the 10-item BSS-R mean score was 31.94 (SD 6.75). Sub-scale mean scores quantified the quality of care provision, women's personal attributes, and stress experienced during labour. Satisfaction was higher for women with vaginal births compared with caesareans deliveries. In addition, satisfaction was higher for women who had both planned to deliver in a home or a birth centre, and who had actually delivered in a home or a birth center. KEY CONCLUSIONS: total and subscale birth satisfaction scores were positive and high for the overall sample IMPLICATIONS FOR PRACTICE: the BSS and the BSS-R provide a robust tool to quantify women's experiences of childbirth between variables such as birth types, birth settings and providers.