Determinants of birth satisfaction in Australian public maternity care: a cross-sectional survey using the birth satisfaction scale-revised (BSS-R)

Background: Birth satisfaction is an important indicator of maternity care quality and is associated with emotional wellbeing, care engagement, and future health-seeking behaviour. Although models of maternity care influence outcomes and experiences, most Australian studies using the Birth Satisfaction Scale–Revised (BSS-R) have focused on continuity-based or student-led cohorts, limiting generalisability to routine public services. Aim: To examine birth satisfaction among women receiving standard public maternity care in Australia and identify demographic, clinical, and psychosocial predictors. Methods: A cross-sectional survey of 396 women was conducted across three public hospitals in New South Wales, Queensland, and South Australia between 2022 and 2023. Birth satisfaction was measured using the UK version of the BSS-R and categorised as low (<20), moderate (20–25), or high (≥26). Differences across antenatal care models (hospital-based midwifery care, GP shared care, and public obstetric care) were examined using Kruskal–Wallis tests. Multinomial logistic regression identified independent predictors of satisfaction. Free-text responses were reviewed descriptively to provide contextual insight. Results: The mean BSS-R score was 23.2 (SD 5.17), lower than scores reported in previous Australian studies involving continuity-based models. Satisfaction did not differ significantly across models of care. Independent predictors of low versus high satisfaction included higher EPDS scores (per-point OR 1.14, 95% CI 1.07–1.22), emergency caesarean (OR 4.8) or elective caesarean birth (OR 2.6), ongoing maternal complications (OR 3.8), parity of one prior birth (OR 3.4), and absence of a birth companion. Free-text responses highlighted the importance of respectful, emotionally supportive care and feeling listened to were, even within fragmented care pathways. Conclusion: This study provides new reference data on birth satisfaction among women receiving routine public maternity care in Australia. Satisfaction appeared more strongly associated with clinical events, psychosocial wellbeing, and relational aspects of care than with model-of-care labels alone, while free-text responses highlighted the importance of respectful and emotionally supportive care. Strengthening respectful, emotionally attuned care across maternity services may improve women's birth experiences.