Unexplored aspects: Improving maternity care through patient-reported outcomes

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Approximately one-third of women report challenges in their birth experience, along with issues related to healthcare responsiveness and shared decision-making six months postpartum. In the pursuit of comprehensive healthcare quality assessment, traditional clinical indicators often fall short of capturing the nuanced aspects of patient well-being. A retrospective cohort study, conducted by Anouk Klootwijk et al., delves into the transformative potential of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in the realm of pregnancy and childbirth care. By utilizing the International Consortium for Health Outcome Measures (ICHOM) indicator set, the study aims to transform perspectives on quality assessment in maternity care.

The study included 645 women and was conducted through an online survey between 2018 and 2019. The focus centred on the women’s experiences six months post-childbirth, capturing PROMs and PREMs at a prominent academic maternity unit in the Netherlands. Regression analysis unravelled associations between these measures, healthcare utilisation, and distinct patient subgroups.

Struggles encountered by women giving birth

Despite a low 5% dissatisfaction rate with care, the study uncovered suboptimal scores, notably in birth experience (32%) and painful sexual intercourse (42%). Subgroup analyses revealed associations with relevant quality indicators, emphasizing the multifaceted nature of maternity care. Identified subgroups associated with poor scores, such as women in deprived areas and those with a limited social network, had lower birth experience scores. Assisted vaginal delivery was associated with poorer outcomes in health-related quality of life and birth experience. Women with preterm delivery and first-time mothers  had worse scores on multiple PROMs and PREMs compared to women who gave birth at term and multiparous women. For example, preterm birth was linked to insufficient pain relief during labour. This indicates the need for additional attention in terms of pain management in this specific patient group.

In addition, about one third of women also reported poor healthcare responsiveness and shared decision-making. Pain during sexual intercourse was conveyed by almost half of all women. There may even be an underestimation in findings due to possible social desirability bias in responses to taboo topics such as incontinency or pain with intercourse.

Satisfaction paradox: Suboptimal scores, yet positive feedback

Despite these far from optimal scores, women collectively reported good satisfaction with medical care . However, satisfaction with care is more likely to reflect hospitality rather than the actual outcome . Responses are heavily influenced by external factors, including the feeling of personal control, individual expectations, and needs. This highlights the need for a more comprehensive assessment beyond satisfaction scores and indicates the value of more targeted and detailed questionnaires.

In conclusion , measuring satisfaction alone is not effective in identifying areas for improving care. PROMs and PREMs offer actionable insights for quality improvement in maternity care and provide a more comprehensive view than traditional clinical outcomes or patient satisfaction scores. The authors emphasize the need for awareness among healthcare professionals regarding persistent pain and sexual health challenges. Training patients and professionals to report, collect, and discuss PROMs and PREMs enables informed shared decision-making.


Paper available at: Patient-reported outcome and experience measures for quality improvement in pregnancy and childbirth care: a retrospective cohort study. BMJ Open Qual. 2023 Mar;12(1):e001922.

Full list of authors: Anouk Klootwijk, Pieter Bakx, Arie Franx, Hilmar Bijma, Hiske Ernst-Smelt, Marije Lamain-de Ruiter, Anke Posthumus, Bas van Rijn

DOI: 10.1136/bmjoq-2022-001922