Maternal and Child Health Journal

, Volume 18, Issue 5, pp 1280–1290 | Cite as

Positive Childbirth Experiences in US Hospitals: A Mixed Methods Analysis

  • Laura B. Attanasio
  • Marianne E. McPherson
  • Katy B. Kozhimannil


Research on maternity care quality in the US often focuses on avoiding adverse events. Positive birth experiences receive less attention. This analysis used a mixed methods approach to identify factors associated with confidence and positive experiences during birth among a national sample of US mothers. Data are from a nationally representative survey of women who delivered a singleton baby in a US hospital in 2005 (N = 1,573). We explored the relationship between confidence, positive birth experiences and socio-demographic characteristics as well as factors related to the clinical encounter and health systems, including common obstetric procedures and interventions. Self-reported confidence during birth was the outcome in quantitative analyses. We used logistic regression analysis and qualitative analysis of open-ended survey responses. Approximately 42 % of mothers reported feeling confident during birth. Confidence going into labor was the strongest predictor of confidence during birth (adjusted odds ratio 12.88 for nulliparous women, 8.54 for parous women). Black and Hispanic race/ethnicity (compared to white) and having partner support were positively associated with confidence during birth for nulliparous women. Qualitative analyses revealed that positive experiences were related to previous birth experiences, communication between women and their clinicians, perceptions of shared decision-making, and communication among clinicians related to the timing and logistics of managing complications and coordinating care. For clinicians who care for women during pregnancy and childbirth, thoughtful, deliberate attention to factors promoting positive birth experiences may help create circumstances amenable to enhancing the quality of obstetric care and improving outcomes for mothers and infants.


Obstetrics Birth Mixed methods Patient satisfaction Patient communication 



This research was supported by a grant from the Eunice Kennedy Shriver National Institutes of Child Health and Human Development (NICHD; Grant Number R03HD070868) and the Building Interdisciplinary Research Careers in Women’s Health Grant (Grant Number K12HD055887) from NICHD, the Office of Research on Women’s Health, and the National Institute on Aging, at the National Institutes of Health, administered by the University of Minnesota Deborah E. Powell Center for Women’s Health. We also wish to thank Amy Romano, CNM, and Christina McPherson, CNM for their valuable feedback on the manuscript.


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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Laura B. Attanasio
    • 1
  • Marianne E. McPherson
    • 2
  • Katy B. Kozhimannil
    • 1
  1. 1.Division of Health Policy and ManagementUniversity of Minnesota School of Public HealthMinneapolisUSA
  2. 2.National Initiative for Children’s Healthcare QualityBostonUSA

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