Measurement properties of the German version of the birth satisfaction scale-revised (BSS-R) in women with pre-existing medical conditions and high-risk pregnancy

Jost, Elena; Merz, Waltraut M.; Kosian, Philipp; Hartmann, Claudia; Schmid, Matthias; Hollins Martin, Caroline J.; Martin, Colin R.

Abstract

Background: The Birth Satisfaction Scale-Revised (BSS-R) is a validated questionnaire for assessment of childbirth experience which has been translated into many languages. It is the instrument of choice in the International Consortium for Health Outcomes Measurement (ICHOM) standard set for ‘Pregnancy and Childbirth’. Translation of the key outcome measures from English into German language was previously performed, but its validation is pending. Aim and Objectives: To analyze the key psychometric properties of the German version of the BSS-R (Ger-BSS-R), and to evaluate its application in women with chronic conditions. Methods: 248 women with pre-existing medical conditions were provided with the Ger-BSS-R during hospital inpatient stay for childbirth. The 10-item measurement contains three sub-scales for assessing quality of care provision (QC), women’s personal attributes (WA), and stress experienced during labor (SE). Results: Complete data was available in N = 224 cases. After removal of four multivariate outliers, N = 220 were available for psychometric evaluation. The cesarean section rate was 50.5%, prematurity occurred in 14.5% of deliveries and induction of labor was performed in 49.7% of cases with planned vaginal delivery. Mean total BSS-R score was 25.7 (SD 5.94). In the confirmatory factor analysis, the tri-dimensional measurement model was found to offer a good fit to Ger-BSS-R data. For internal consistency, the total, SE and QC sub-scale Cronbach’s alphas were significantly lower than those of the founder version. Conclusions: The Ger-BSS-R is a robust instrument for assessing birth satisfaction. This is the first study to apply the BSS-R in women with pre-existing medical conditions. Compared to the founder UK version, differences in total BSS-R scores and sub-scales for experience of stress and quality of care are present, requiring further investigations.

Citation

Jost, E., Merz, W. M., Kosian, P., Hartmann, C., Schmid, M., Hollins Martin, C. J., & Martin, C. R. (2025). Measurement properties of the German version of the birth satisfaction scale-revised (BSS-R) in women with pre-existing medical conditions and high-risk pregnancy. BMC Pregnancy and Childbirth, 25(1), Article 488. https://doi.org/10.1186/s12884-025-07571-7

• Journal Article Type: Article
• Acceptance Date: Apr 7, 2025
• Online Publication Date: Apr 24, 2025
• Publication Date: 2025
• Deposit Date: Apr 28, 2025
• Publicly Available Date: Apr 28, 2025
• Journal: BMC Pregnancy and Childbirth
• Print ISSN: 1471-2393
• Publisher: BMC
• Peer Reviewed: Peer Reviewed
• Volume: 25
• Issue: 1
• Article Number: 488
• DOI: https://doi.org/10.1186/s12884-025-07571-7
• Keywords: Obstetric medicine, Quality of intrapartum care, Pre-existing condition, Birth experience, Psychometrics, Patient-reported outcome, Birth satisfaction, High-risk pregnancy
• Public URL: http://researchrepository.napier.ac.uk/Output/4246118