Midwifery · 2026
Psychometric validation of the Ukrainian Birth Satisfaction Scale-Revised (UA-BSS-R) and determinants of maternal satisfaction in a conflict-affected perinatal centre.
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Bielka Kateryna, Kuchyn Iurii, Yevstifeiev Danylo, Shevchenko Illia, Sazhyn Dmytro, Lymar Lesya, Hollins Martin Caroline J, Martin Colin R
Аннотация
BACKGROUND: The Birth Satisfaction Scale-Revised (BSS-R) is a globally recognised measure of birth experience, not previously validated in Ukraine, where ongoing armed conflict since 2022 has created a uniquely challenging perinatal environment.
OBJECTIVES: To conduct the first psychometric validation of the Ukrainian-language BSS-R (UA-BSS-R) and identify determinants of birth satisfaction at a conflict-affected reference perinatal centre.
METHODS: A cross-sectional study of 871 postpartum women was conducted at a tertiary reference perinatal centre in Kyiv (August 2024-February 2025). The UA-BSS-R was developed via four-stage translation and pilot testing. Psychometric properties were evaluated by confirmatory factor analysis, internal consistency, and validity testing; predictors of low satisfaction (BSS-R ≤ 32/40, i.e. ≤80%) were identified using Firth penalised logistic regression.
RESULTS: The hypothesised three-factor structure of the UA-BSS-R showed acceptable fit (CFI=0.930; SRMR=0.054; RMSEA=0.086, marginally above the conventional threshold), and total-scale reliability was good (α=0.817). A 17.6-percentage-point gap was found between the Quality of Care Provision (QCP; 94.6% of maximum) and Women's Personal Attributes (WPA; 77.0%) subscales, the latter being closely related to the Stress Experienced during Labour subscale at the latent level (r = 0.95). Seven independent predictors of low satisfaction were identified: vaginal birth with intervention (aOR 2.36, 95% CI 1.42-3.94), unplanned caesarean section (aOR 2.12, 95% CI 1.12-4.01), suboptimal analgesia satisfaction (aOR 4.25, 95% CI 2.69-6.71), absent labour-progress information (aOR 10.50, 95% CI 2.45-45.12; estimated from a small exposed subgroup), perceived lack of privacy (aOR 7.04, 95% CI 2.27-21.86), less than fully sufficient postpartum support (aOR 3.31, 95% CI 1.96-5.60), and primiparity (aOR 1.81, 95% CI 1.14-2.87).
CONCLUSIONS: The UA-BSS-R is psychometrically sound for Ukrainian perinatal research and service-level audit. The QCP-WPA gap indicates that high ratings of care provision can coexist with a less favourable internal experience of birth. For healthcare systems under conflict, trauma-informed communication and shared decision-making, respectful care including privacy, timely and responsive pain management, and adequate postpartum support emerge as clinical priorities that may mitigate the psychological impact of intrapartum unpredictability.
OBJECTIVES: To conduct the first psychometric validation of the Ukrainian-language BSS-R (UA-BSS-R) and identify determinants of birth satisfaction at a conflict-affected reference perinatal centre.
METHODS: A cross-sectional study of 871 postpartum women was conducted at a tertiary reference perinatal centre in Kyiv (August 2024-February 2025). The UA-BSS-R was developed via four-stage translation and pilot testing. Psychometric properties were evaluated by confirmatory factor analysis, internal consistency, and validity testing; predictors of low satisfaction (BSS-R ≤ 32/40, i.e. ≤80%) were identified using Firth penalised logistic regression.
RESULTS: The hypothesised three-factor structure of the UA-BSS-R showed acceptable fit (CFI=0.930; SRMR=0.054; RMSEA=0.086, marginally above the conventional threshold), and total-scale reliability was good (α=0.817). A 17.6-percentage-point gap was found between the Quality of Care Provision (QCP; 94.6% of maximum) and Women's Personal Attributes (WPA; 77.0%) subscales, the latter being closely related to the Stress Experienced during Labour subscale at the latent level (r = 0.95). Seven independent predictors of low satisfaction were identified: vaginal birth with intervention (aOR 2.36, 95% CI 1.42-3.94), unplanned caesarean section (aOR 2.12, 95% CI 1.12-4.01), suboptimal analgesia satisfaction (aOR 4.25, 95% CI 2.69-6.71), absent labour-progress information (aOR 10.50, 95% CI 2.45-45.12; estimated from a small exposed subgroup), perceived lack of privacy (aOR 7.04, 95% CI 2.27-21.86), less than fully sufficient postpartum support (aOR 3.31, 95% CI 1.96-5.60), and primiparity (aOR 1.81, 95% CI 1.14-2.87).
CONCLUSIONS: The UA-BSS-R is psychometrically sound for Ukrainian perinatal research and service-level audit. The QCP-WPA gap indicates that high ratings of care provision can coexist with a less favourable internal experience of birth. For healthcare systems under conflict, trauma-informed communication and shared decision-making, respectful care including privacy, timely and responsive pain management, and adequate postpartum support emerge as clinical priorities that may mitigate the psychological impact of intrapartum unpredictability.