Birth Satisfaction Scale-Revised Indicator

📜
Abstract

The Birth satisfaction Scale-Revised Indicator (BSS-RI) represents a critical advancement in perinatal psychometrics, offering a highly condensed, theoretically grounded measure of a mother's subjective childbirth experience. Historically, obstetric care has heavily prioritized physical morbidity and mortality metrics, often overshadowing the profound psychological dimensions of labor and delivery. However, modern healthcare frameworks increasingly recognize that a positive birth experience is foundational to both Maternal mental health and optimal infant bonding. The BSS-RI was developed to capture these essential emotional and evaluative components without burdening patients or clinicians with lengthy surveys.

Originally distilled from the longer 30-item Birth satisfaction Scale and its 10-item revised counterpart, the 6-item BSS-RI provides a rapid, user-friendly assessment tool. It measures two primary domains: the internal stress experienced by the mother and her external evaluation of the quality of care received. This specific study focuses on the cross-cultural adaptation and psychometric validation of the BSS-RI for the Chinese population. By establishing a reliable and valid Chinese version, researchers and clinicians are equipped with an efficient screening instrument that can be seamlessly integrated into high-volume Postpartum care settings to identify women who may require additional psychological support.

🏷
Keywords
Birth satisfaction
psychometrics
Postpartum care
Maternal mental health
Cross-cultural validation
Factor analysis

📊 Psychometric Scorecard

Items Count
6
Structure
Multidimensional
Cronbach's α
0.00
Fit Index (CFI)
0.989
Validation Country
📍 China

Translation Method: Expert panel review and cross-cultural adaptation

Authors

👤 Yanchi Wang

👤 Jian Gu

👤 Feng Zhang
✉ [email protected]

👤 Jianhua Deng
✉ [email protected]

Purpose

The primary purpose of the Chinese BSS-RI is to provide a rapid, universally applicable assessment of Birth satisfaction that overcomes the practical limitations of existing psychometric tools. While other instruments, such as the Childbirth Experience Questionnaire (CEQ), offer valuable insights, their length often precludes routine use in busy clinical environments. Furthermore, many existing tools are restricted to specific delivery modes, such as vaginal births, leaving a gap in evaluating the experiences of women who undergo cesarean sections.

This scale addresses a critical need in maternal healthcare by offering a concise, 6-item measure that is valid across all modes of delivery. For clinicians, it serves as an efficient screening mechanism to quickly identify mothers who may have had traumatic or unsatisfactory birth experiences, thereby facilitating early intervention. For researchers, it provides a standardized, theoretically sound metric to evaluate the impact of different obstetric interventions and care models on maternal psychological well-being.

Construct

Birth satisfaction is a complex, multidimensional psychological construct that encapsulates a woman's subjective cognitive and emotional evaluation of her labor and delivery experience. It is not merely the absence of trauma, but rather a holistic appraisal of how expectations aligned with reality, how much control the mother felt she had, and how she perceived the healthcare environment. The BSS-RI operationalizes this construct through two distinct yet interconnected dimensions: Stress Experienced (SE) and Quality of Care (QC).

The Stress Experienced dimension captures the internal, physiological, and emotional distress or coping mechanisms utilized during childbirth. It reflects the personal, psychological burden of the event. Conversely, the Quality of Care dimension focuses on the external environment, specifically the mother's perception of the support, professionalism, and empathy provided by the medical staff. Together, these subscales align with broader theoretical models of patient satisfaction, acknowledging that a positive birth experience requires both manageable internal stress and high-quality external support.

Validity

The validation framework for the Chinese BSS-RI was comprehensive, ensuring the tool accurately measures what it claims to measure. Content validity was initially established through a panel of experts who evaluated the relevance of each item, yielding strong Content Validity Index (CVI) scores. To establish convergent validity, the researchers demonstrated that total scores on the BSS-RI positively correlated with a standalone global satisfaction rating, confirming that the scale aligns with general self-reported satisfaction.

Divergent validity was successfully supported by showing no significant correlation between the scale scores and unrelated demographic variables, such as maternal age. Furthermore, the instrument demonstrated excellent known-groups discriminant validity. By utilizing an analysis of variance, the researchers found significant differences in BSS-RI scores across four distinct delivery modes, ranging from uncomplicated vaginal deliveries to emergency cesarean sections. This proves the scale's sensitivity in detecting variations in satisfaction based on the clinical reality of the birth experience.

Convergent & Discriminant Validation Correlations

Reference Instrument Correlation Coefficient (r)
Single-item global satisfaction question (1-5 scale) Positive correlation

Reliability

The Chinese version of the BSS-RI demonstrated robust reliability metrics, confirming its stability and consistency as a measurement tool. Internal consistency was evaluated using Cronbach's alpha, with the scale yielding values exceeding the widely accepted 0.70 threshold. This indicates that the items within the questionnaire are highly cohesive and reliably measure the underlying constructs of Birth satisfaction without unnecessary redundancy.

In addition to internal consistency, the researchers rigorously tested the instrument's temporal stability. A subsample of participants completed the scale again after a two-week interval, a timeframe strategically chosen to minimize recall bias while assuming the core perception of the birth experience remains stable. The resulting Intraclass Correlation Coefficients (ICC) were strong, exceeding the 0.70 benchmark. This test-retest reliability confirms that the BSS-RI captures an enduring psychological appraisal of childbirth rather than transient mood fluctuations.

Factor Analysis

To investigate and confirm the underlying structural integrity of the translated scale, the researchers employed a rigorous split-half cross-validation strategy. The dataset was randomly divided, allowing the team to conduct an Exploratory Factor analysis (EFA) on one half to uncover the latent structure, followed by a Confirmatory Factor analysis (CFA) on the second half to verify that structure. This approach prevents overfitting and ensures the model's robustness.

The CFA results provided excellent empirical support for the theoretical two-factor model comprising Stress Experienced and Quality of Care. The goodness-of-fit indices were highly favorable and easily met stringent psychometric standards. Specifically, the model demonstrated a comparative fit index (CFI) of 0.989 and a Tucker-Lewis index (TLI) of 0.979, both well above the 0.90 threshold for good fit. Additionally, the root mean square error of approximation (RMSEA) was remarkably low at 0.035, and the Chi-square to degrees of freedom ratio was 1.511. These metrics collectively confirm that the 6-item structure perfectly maps onto its intended psychological dimensions in the Chinese cultural context.

Subscales

Subscale Items Description
Stress Experienced during Childbirth (SE) Measures the internal psychological and physiological distress, as well as the coping mechanisms experienced by the mother during labor and delivery.
Quality of Care (QC) Evaluates the mother's external perception of the support, empathy, and medical attention provided by healthcare professionals during the birth.

Instrument

Test Type Self-report questionnaire
Format 6 items, Likert scale
Scoring Yields a total score and two subscale scores
Language Chinese
Population Adults, Parents
Age Group 18 years and older
Administration Self-administered
Completion Time 10-15 minutes for the entire survey battery

Sample

The study included 824 postpartum Chinese women (mean age = 29.91 years, SD = 3.66) who were assessed six weeks after delivery. Participants were recruited via convenience sampling from three tertiary hospitals in Nantong City, China. The majority (75.4%) were primiparous mothers with an education level of a bachelor's degree or higher.

📄
Cite This Paper

Yanchi Wang, Jian Gu, Feng Zhang, Jianhua Deng (2025). Birth satisfaction Scale-Revised Indicator. Scientific reports. https://doi.org/10.1038/s41598-025-17614-w

📄 Download Full-Text PDF

📚
References
39 references
  1. Vallely, L. H. et al. Intrapartum care measures and indicators for monitoring the implementation of WHO recommendations for a positive childbirth experience: A scoping review. BMJ Open 13, e069081. https://doi.org/10.1136/bmjopen-2022-069081 (2023). 🔗 https://doi.org/10.1136/bmjopen-2022-069081
  2. Wojcieszek, A. M. et al. WHO recommendations on maternal and newborn care for a positive postnatal experience: Strengthening the maternal and newborn care continuum. BMJ Glob Health https://doi.org/10.1136/bmjgh-2022-010992 (2023). 🔗 https://doi.org/10.1136/bmjgh-2022-010992
  3. Walsh, D. J. Childbirth embodiment: Problematic aspects of current understandings. Sociol. Health Illn. 32, 486–501. https://doi.org/10.1111/j.1467-9566.2009.01207.x (2010). 🔗 https://doi.org/10.1111/j.1467-9566.2009.01207.x
  4. Karlstrom, A., Nystedt, A. & Hildingsson, I. The meaning of a very positive birth experience: Focus groups discussions with women. BMC Pregnancy Childbirth 15, 251. https://doi.org/10.1186/s12884-015-0683-0 (2015). 🔗 https://doi.org/10.1186/s12884-015-0683-0
  5. Goodman, P., Mackey, M. C. & Tavakoli, A. S. Factors related to childbirth satisfaction. J. Adv. Nurs. 46, 212–219. https://doi.org/10.1111/j.1365-2648.2003.02981.x (2004). 🔗 https://doi.org/10.1111/j.1365-2648.2003.02981.x
  6. Jackson, J. L., Chamberlin, J. & Kroenke, K. Predictors of patient satisfaction. Soc. Sci. Med. 52, 609–620. https://doi.org/10.1016/s0277-9536(00)00164-7 (2001). 🔗 https://doi.org/10.1016/s0277-9536(00)00164-7
  7. Sawyer, A. et al. Measures of satisfaction with care during labour and birth: A comparative review. BMC Pregnancy Childbirth 13, 108. https://doi.org/10.1186/1471-2393-13-108 (2013). 🔗 https://doi.org/10.1186/1471-2393-13-108
  8. Critchlow, E. et al. Experiences of new mothers during the coronavirus disease 2019 (COVID-19) pandemic. Obstet. Gynecol. 139, 244–253. https://doi.org/10.1097/AOG.0000000000004660 (2022). 🔗 https://doi.org/10.1097/AOG.0000000000004660
  9. Hodnett, E. D. & Simmons-Tropea, D. A. The labour agentry scale: Psychometric properties of an instrument measuring control during childbirth. Res. Nurs. Health 10, 301–310. https://doi.org/10.1002/nur.4770100503 (1987). 🔗 https://doi.org/10.1002/nur.4770100503
  10. Srivastava, A., Avan, B. I., Rajbangshi, P. & Bhattacharyya, S. Determinants of women’s satisfaction with maternal health care: a review of literature from developing countries. BMC Pregnancy Childbirth 15, 97. https://doi.org/10.1186/s12884-015-0525-0 (2015). 🔗 https://doi.org/10.1186/s12884-015-0525-0
  11. Zhu, X., Wang, Y., Zhou, H., Qiu, L. & Pang, R. Adaptation of the childbirth experience questionnaire (CEQ) in China: A multisite cross-sectional study. PLoS ONE 14, e0215373. https://doi.org/10.1371/journal.pone.0215373 (2019). 🔗 https://doi.org/10.1371/journal.pone.0215373
  12. Wu, J. et al. Cross-cultural adaptation and psychometric evaluation of the Chinese version of childbirth experience questionnaire. Front Psychiatry 16, 1488966. https://doi.org/10.3389/fpsyt.2025.1488966 (2025). 🔗 https://doi.org/10.3389/fpsyt.2025.1488966
  13. Cheng, Y., Bai, R., Shan, S., Zhao, X. & Xia, C. Childbirth experience assessment tools based on COSMIN guidelines: A systematic review. Int. J. Nurs. Sci. 12, 89–95. https://doi.org/10.1016/j.ijnss.2024.12.001 (2025). 🔗 https://doi.org/10.1016/j.ijnss.2024.12.001
  14. Martin, C. H. & Fleming, V. The Birth satisfaction scale. Int. J. Health Care Qual. Assur. 24, 124–135. https://doi.org/10.1108/09526861111105086 (2011). 🔗 https://doi.org/10.1108/09526861111105086
  15. Hollins Martin, C. J. & Martin, C. R. Development and psychometric properties of the Birth satisfaction Scale-Revised (BSS-R). Midwifery 30, 610–619. https://doi.org/10.1016/j.midw.2013.10.006 (2014). 🔗 https://doi.org/10.1016/j.midw.2013.10.006
  16. Martin, C. R., Hollins Martin, C. & Redshaw, M. The Birth satisfaction Scale-Revised Indicator (BSS-RI). BMC Pregnancy Childbirth 17, 277. https://doi.org/10.1186/s12884-017-1459-5 (2017). 🔗 https://doi.org/10.1186/s12884-017-1459-5
  17. Omani-Samani, R. et al. The Birth satisfaction Scale-Revised Indicator (BSS-RI): A validation study in Iranian mothers. J. Matern. Fetal Neonatal. Med. 34, 1827–1831. https://doi.org/10.1080/14767058.2019.1651265 (2021). 🔗 https://doi.org/10.1080/14767058.2019.1651265
  18. In WHO recommendations on maternal and newborn care for a positive postnatal experience WHO Guidelines Approved by the Guidelines Review Committee (2022).
  19. Dol, J. et al. Timing of maternal mortality and severe morbidity during the postpartum period: A systematic review. JBI Evid. Synth. 20, 2119–2194. https://doi.org/10.11124/JBIES-20-00578 (2022). 🔗 https://doi.org/10.11124/JBIES-20-00578
  20. Terwee, C. B. et al. Quality criteria were proposed for measurement properties of health status questionnaires. J. Clin. Epidemiol. 60, 34–42. https://doi.org/10.1016/j.jclinepi.2006.03.012 (2007). 🔗 https://doi.org/10.1016/j.jclinepi.2006.03.012
  21. Mokkink, L. B. et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: An international Delphi study. Qual. Life Res. 19, 539–549. https://doi.org/10.1007/s11136-010-9606-8 (2010). 🔗 https://doi.org/10.1007/s11136-010-9606-8
  22. Prinsen, C. A. C. et al. COSMIN guideline for systematic reviews of patient-reported outcome measures. Qual. Life Res. 27, 1147–1157. https://doi.org/10.1007/s11136-018-1798-3 (2018). 🔗 https://doi.org/10.1007/s11136-018-1798-3
  23. Bonett, D. G. Sample size requirements for estimating intraclass correlations with desired precision. Stat. Med. 21, 1331–1335. https://doi.org/10.1002/sim.1108 (2002). 🔗 https://doi.org/10.1002/sim.1108
  24. Zhu, Y. et al. The development and psychometric validation of a Chinese empathy motivation scale. J. Clin. Nurs. 28, 2599–2612. https://doi.org/10.1111/jocn.14846 (2019). 🔗 https://doi.org/10.1111/jocn.14846
  25. McDonald, R. P. & Ho, M. H. Principles and practice in reporting structural equation analyses. Psychol. Methods 7, 64–82. https://doi.org/10.1037/1082-989x.7.1.64 (2002). 🔗 https://doi.org/10.1037/1082-989x.7.1.64
  26. Wang, Y., Gao, Q., Liu, J., Zhang, F. & Xu, X. Translation and validation of the Chinese version of the maternal postpartum stress scale. BMC Pregnancy Childbirth 23, 685. https://doi.org/10.1186/s12884-023-05990-y (2023). 🔗 https://doi.org/10.1186/s12884-023-05990-y
  27. Lau, Y., Wang, Y., Yin, L., Chan, K. S. & Guo, X. Validation of the mainland Chinese version of the Edinburgh postnatal depression scale in Chengdu mothers. Int. J. Nurs. Stud. 47, 1139–1151. https://doi.org/10.1016/j.ijnurstu.2010.02.005 (2010). 🔗 https://doi.org/10.1016/j.ijnurstu.2010.02.005
  28. Jiang, L. C. et al. The depression anxiety stress scale-21 in Chinese hospital workers: Reliability, latent structure, and measurement invariance across genders. Front Psychol. 11, 247. https://doi.org/10.3389/fpsyg.2020.00247 (2020). 🔗 https://doi.org/10.3389/fpsyg.2020.00247
  29. Wang, Y., Li, S., Zou, X., Xu, L. & Ni, Y. Cross-cultural adaptation and validation of the Chinese version of the loneliness scale for older Adults. Geriatr. Nurs. 48, 190–196. https://doi.org/10.1016/j.gerinurse.2022.10.004 (2022). 🔗 https://doi.org/10.1016/j.gerinurse.2022.10.004
  30. Sousa, V. D. & Rojjanasrirat, W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: A clear and user-friendly guideline. J. Eval. Clin. Pract. 17, 268–274. https://doi.org/10.1111/j.1365-2753.2010.01434.x (2011). 🔗 https://doi.org/10.1111/j.1365-2753.2010.01434.x
  31. Guillemin, F., Bombardier, C. & Beaton, D. Cross-cultural adaptation of health-related quality of life measures: Literature review and proposed guidelines. J. Clin. Epidemiol. 46, 1417–1432. https://doi.org/10.1016/0895-4356(93)90142-n (1993). 🔗 https://doi.org/10.1016/0895-4356(93)90142-n
  32. Wang, L., Liang, C., Yu, H., Zhang, H. & Yan, X. Reliability and validity evaluation of the appropriate antibiotic use self-efficacy scale for Chinese Adults. BMC Public Health 22, 1344. https://doi.org/10.1186/s12889-022-13729-1 (2022). 🔗 https://doi.org/10.1186/s12889-022-13729-1
  33. Qiu, H. et al. Reliability and validity of the healthy fitness measurement scale version 1.0 (HFMS V1.0) in Chinese people. BMJ Open 11, e048269. https://doi.org/10.1136/bmjopen-2020-048269 (2021). 🔗 https://doi.org/10.1136/bmjopen-2020-048269
  34. Khademi, K. & Kaveh, M. H. Social support as a coping resource for psychosocial conditions in postpartum period: A systematic review and logic framework. BMC Psychol. 12, 301. https://doi.org/10.1186/s40359-024-01814-6 (2024). 🔗 https://doi.org/10.1186/s40359-024-01814-6
  35. Hanach, N., Saqan, R., Radwan, H., Baniissa, W. & de Vries, N. Perceived experiences and needs of digital resources among postpartum women in the United Arab Emirates: Qualitative focus group study. J. Med. Internet Res. 26, e53720. https://doi.org/10.2196/53720 (2024). 🔗 https://doi.org/10.2196/53720
  36. Coates, D., Thirukumar, P. & Henry, A. Women’s experiences and satisfaction with having a cesarean birth: An integrative review. Birth 47, 169–182. https://doi.org/10.1111/birt.12478 (2020). 🔗 https://doi.org/10.1111/birt.12478
  37. Kenyon, S. L., Johns, N., Duggal, S., Hewston, R. & Gale, N. Improving the care pathway for women who request Caesarean section: An experience-based co-design study. BMC Pregnancy Childbirth 16, 348. https://doi.org/10.1186/s12884-016-1134-2 (2016). 🔗 https://doi.org/10.1186/s12884-016-1134-2
  38. Tomsis, Y. et al. Postpartum post-traumatic stress symptoms following cesarean section–The mediating effect of sense of control. Psychiatr. Q. 92, 1839–1853. https://doi.org/10.1007/s11126-021-09949-0 (2021). 🔗 https://doi.org/10.1007/s11126-021-09949-0
  39. Ratislavova, K., Hendrych Lorenzova, E., Hollins Martin, C. J. & Martin, C. R. Translation and validation of the Czech Republic version of the Birth satisfaction Scale-Revised (BSS-R). J. Reprod. Infant Psychol. 42, 78–94. https://doi.org/10.1080/02646838.2022.2067837 (2024). 🔗 https://doi.org/10.1080/02646838.2022.2067837

Birth Satisfaction Scale-Revised Indicator Items

✉ Items are not yet available

The scale author has been contacted to obtain permission to share the items. This section will be updated once the items are provided.

Cite this article

(2026). Birth Satisfaction Scale-Revised Indicator. PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/chinese-version-of-the-birth-satisfaction-scale-revised-indicator/

. "Birth Satisfaction Scale-Revised Indicator." PSYCHOLOGICAL SCALES, 12 Aug. 2026, https://scales.arabpsychology.com/s/chinese-version-of-the-birth-satisfaction-scale-revised-indicator/.

. "Birth Satisfaction Scale-Revised Indicator." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/chinese-version-of-the-birth-satisfaction-scale-revised-indicator/.

(2026) 'Birth Satisfaction Scale-Revised Indicator', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/chinese-version-of-the-birth-satisfaction-scale-revised-indicator/.

[1] , "Birth Satisfaction Scale-Revised Indicator," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, August, 2026.

. Birth Satisfaction Scale-Revised Indicator. PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.

Related terms:

  1. Birth satisfaction scale (BSS)
  2. Personality Type Indicator (PTI)
  3. Riso-Hudson Enneagram Type Indicator (RHETI) version 2.5
  4. HSE Management Indicator Tool
  5. Pressure Management Indicator Questionnaire (PMI)
  6. Coping Strategy Indicator (CSI)
  7. Students` Life Satisfaction Scale
  8. Overall Job Satisfaction scale
  9. Employee Satisfaction With Influence and Ownership scale
  10. Satisfaction with Life Scale (SWLS)
× Figure
PDF
Scroll to Top