Influence of mode of delivery on satisfaction with hospitalization for childbirth in the study Birth in Brazil

Controversial results have been reported on the association between mode of delivery and patient satisfaction. This study investigates which mode of delivery leads to greater satisfaction with hospital admission for childbirth. A cohort study was conducted with data from the Birth in Brazil study, which began in 2011. A total of 23,046 postpartum women were included from a random sample of hospitals, selected by conglomerates with a three level stratification. At the first follow-up, 15,582 women were re-interviewed. Mode of delivery, dichotomized into vaginal or cesarean section, and confounders were collected before hospital discharge. The outcome maternal satisfaction, investigated as a 10-item unidimensional construct, was measured by the Hospital Birth Satisfaction Scale up to six months after discharge. We used a directed acyclic graph to define minimal adjustment variables for confounding. The effect of mode of delivery on satisfaction was estimated using a structural equation model with weighting by the inverse of the probability of selection, considering the complex sampling design. The weight was estimated considering the different sample selection probabilities, the losses to follow-up, and the propensity score, which was estimated in a logistic regression model. The analysis revealed no significant difference in satisfaction with hospitalization for childbirth between respondents who had vaginal delivery and cesarean section in the adjusted analysis (standardized coefficient = 0.089; p-value = 0.056). Therefore, women who had vaginal delivery and cesarean section were equally satisfied with their hospitalization for childbirth.

分娩方式与患者满意度之间的关联已有诸多颇具争议的研究结果报道。本研究旨在探究何种分娩方式可使分娩住院产妇获得更高的满意度。本研究依托2011年启动的巴西分娩研究（Birth in Brazil Study）数据开展队列研究。研究通过三级分层集群抽样法选取医院随机样本，最终纳入23046名产后妇女。在首次随访阶段，共有15582名妇女接受了再次访谈。本研究将分娩方式二分类为阴道分娩与剖宫产，混杂因素数据于产妇出院前完成采集。本研究的结局指标为产妇满意度，该指标被界定为单维度10条目构念，采用医院分娩满意度量表（Hospital Birth Satisfaction Scale）在产妇出院后6个月内完成测评。我们借助有向无环图（Directed Acyclic Graph）确定了用于校正混杂的最小调整变量集合。考虑到研究采用复杂抽样设计，我们采用以选择概率倒数作为权重的结构方程模型（Structural Equation Model），对分娩方式对满意度的影响效应进行估计。权重估算综合考量了不同的样本选择概率、随访失访情况，以及通过逻辑回归模型计算得到的倾向得分（Propensity Score）。校正分析结果显示，阴道分娩与剖宫产产妇的分娩住院满意度无显著统计学差异（标准化系数=0.089；P值=0.056）。由此可见，阴道分娩与剖宫产产妇对其分娩住院体验的满意度并无显著差异。