The impacts of the COVID-19 pandemic on birth satisfaction in a prospective cohort of 2,341 U.S. women.

Abstract Problem Birth satisfaction is an important health outcome that is related to postpartum mood, infant caretaking, and future pregnancy intention. Background The COVID-19 pandemic profoundly affected antenatal care and intrapartum practices that may reduce birth satisfaction. Aim To investigate the extent to which pandemic-related factors predicted lower birth satisfaction. Methods 2,341 women who were recruited prenatally in April-May 2020 and reported a live birth between April-October 2020 were included in the current analysis. Hierarchical linear regression to predict birth satisfaction from well-established predictors of birth satisfaction (step 1) and from pandemic-related factors (step 2) was conducted. Additionally, the indirect associations of pandemic-related stress with birth satisfaction were investigated. Findings The first step of the regression explained 35% of variance in birth satisfaction. In the second step, pandemic-related factors explained an additional 3% of variance in birth satisfaction. Maternal stress about feeling unprepared for birth due to the pandemic and restrictions on companions during birth independently predicted lower birth satisfaction beyond the non-pandemic variables. Pandemic-related unpreparedness stress was associated with more medicalized birth and greater incongruence with birth preference, thus also indirectly influencing birth satisfaction through a mediation process. Discussion Well-established contributors to birth satisfaction remained potent during the pandemic. In addition, maternal stress and restriction on accompaniment to birth were associated with a small but significant reduction in birth satisfaction. Conclusion Study findings suggest that helping women set flexible and reasonable expectations for birth and allowing at least one intrapartum support person can improve birth satisfaction.