Client satisfaction and transfers across care levels of women with uncomplicated pregnancies at the onset of labor

•Women with uncomplicated pregnancies were highly satisfied with the care they received during childbirth.•Transfers across care levels during childbirth are associated with lower client satisfaction.•Several factors in three categories of determinants influenced client satisfaction negatively.•Transferred women perceived more health problems and medical interventions.•Well-executed expectation management could help to prepare women.

Objectiveto compare the client satisfaction of women with uncomplicated pregnancies at the onset of labor who were transferred across care levels during childbirth and women who were not transferred across care levels in the Dutch perinatal healthcare system, and-if there are differences-to identify the variables that may explain them.Methodsthe research entailed a population-based study of women with uncomplicated pregnancies at the onset of labor living in the catchment area of a Dutch Neonatal Intensive Care Unit (NICU) in the eastern part of the Netherlands who gave birth between April 2014 and September 2014. Respondents completed a validated questionnaire (n = 842; mean age 30.7 years). Client satisfaction, measured on a 10-point scale, was assessed within 12 weeks after childbirth.Findingsof the 842 respondents, 277 women experienced a transfer of care during childbirth, and 565 women were not transferred. The client satisfaction of women who were transferred across care levels (mean 8.04; SD 1.4) was significantly lower (p<0.001) than that of women who were not transferred across care levels (mean 8.78; SD 0.9). Seven variables together explained 93.2% of the difference in client satisfaction. Explanatory pregnancy and childbirth variables were perceived health problems for the mother and medical interventions during childbirth. Explanatory clients' experiences with the care process variables were respect, prompt attention, quality of basic amenities, social consideration, and choice and continuity.Conclusionwomen were highly satisfied with the care they received, although transfers across care levels during childbirth were associated with substantially lower client satisfaction. The differences in client satisfaction between transferred and non-transferred women can largely be explained by pregnancy and childbirth characteristics, and by clients' experiences with the care process.