In the present study, 1196 women were examined to find out their satisfaction with the communication of physicians and midwives during their labor and delivery and its relation with their overall satisfaction with received related care. The results show that the majority of women who were satisfied with their care were also satisfied with the communication of their health care providers. Only 14.6% and 27.3% of women were completely satisfied with all verbal and nonverbal communication items measured, respectively. Satisfaction with this communication was greater among women who were multigravida and grand multipara. As the women’s education level increased, their satisfaction with the communication decreased which may due to this fact that educated women have a better understanding of the kind care possible given by health care providers. Age was not a significant factor in the satisfaction of women with communication.
The results of the present study regarding the association of satisfaction with sociodemographic characteristics of the women are in agreement with the results of many other studies. For instance, the results of a study done on 790 Australian women shows that parity, level of school-based education and place of residence were associated with differences in women’s overall ratings of care; however, age was not associated with ratings of care [19]. In a 2016 study, labor observations and 2672 surveys in Ghana, Guinea, Myanmar, and Nigeria, age was predominantly the single factor associated with different types of mistreatment. Younger women (15–19 years) were more likely to experience any physical abuse, verbal abuse, or stigma or discrimination, after adjusting for country, education, marital status, and parity. Younger women with no education and younger women with some education were more likely to experience verbal abuse, compared with older women (≥30 years)[14]. In a cross-sectional study by Okafor et al. in Enugu State in Nigeria, 20% of women reported discrimination on the basis of ethnicity, low social class, young age and HIV seropositive status, however, in four cross-sectional studies, women of low socioeconomic status and with no formal education reported experiences of unfriendly and harsh attitudes of staff in higher proportions [ 12].
Women in labor have a need for companionship, empathy and help, and descriptive studies of women’s childbirth experiences have suggested four dimensions to the support that they want during labor: emotional support, informational support, physical support and advocacy [20]. Both the emotional and informational support depend on the communication skills of physicians and midwives.
The results of the present study are similar to results of other studies done in different countries which also show the importance of women’s satisfaction with communication as an important factor in the general satisfaction of women’s birth care[20,21,22]. In a descriptive study from Iran, 50 midwives were evaluated by parturient women. The majority of them evaluated midwives’ communicative behaviors at an acceptable level [1].
In an institution-based cross-sectional descriptive study from Ethiopia, a total of 423 postpartum women were interviewed to assess their satisfaction in a maternal health care setting. The results show that the proportion of mothers who were completely satisfied with the health care they received ranged between 2.4 to 21%. The provider's communication with their clients yielded complete client satisfaction rates ranging between 0.7 to 26% [16].
Not being satisfied with provider communication was a reason for being dissatisfied with overall care among 400 women who delivered in a hospital in Egypt [23].
Results of a cross-sectional survey on 1004 women in India indicated that improving interpersonal interaction with nurse-midwives, and ensuring privacy during childbirth and the hospital stay are recommended first steps to improve women’s childbirth satisfaction [15].
In a qualitative study from Nigeria, the quality of communication of health care providers in a delivery room was recognized as an important factor in improving women’s experience of childbirth [24].
However, an increasing body of work over the last 20 years has demonstrated the relationship between
doctors’ non-verbal communication (in the form of eye-contact, head nods and gestures, position and tone of voice) with the following outcomes: patient satisfaction, patient understanding, physician detection of emotional distress, and physician malpractice claim history. Although more work needs to be done, there is now significant evidence that doctors need to pay considerable attention to their own non-verbal behavior. [25]. Conversely, nonverbal dominance, in the form of long physician speaking time or a dominant tone of voice, for instance, has a negative impact on satisfaction [26]. Also, it has been shown that a physician’s nonverbal behavior that expresses concern, for instance, through frequent eye contact, a concerned facial expression, or close interpersonal distance, leads to more patient trust than a physician’s behavior that conveys more distance. Regarding patient adherence, it has been shown that physician touching of the patient increases patient adherence with their medication [26].
In a qualitative study on 16 mothers in Iran, results show that outcomes of a positive midwife-mother
relationship in the delivery room can lead to facilitation of childbirth, a positive birth experience, mental health promotion and improvement in the mother’s quality of life. An effective midwife-mother relationship can lead to positive childbirth outcomes and promotion of maternal and neonatal health [21].
In a mixed-methods systematic review, a lack of evidence on the impact of interventions to support effective communication between maternity care staff and healthy women during labor and birth were identified. . [27]. A study from Syria reported that a communication skills training intervention for resident doctors were not associated with higher satisfaction reported by women. In the context of a highly crowded and stressful environment where middle-class and low-class Syrian women deliver, a specially-designed training package in interpersonal and communication skills for residents did not achieve an overall improvement in women’s satisfaction with the doctor– woman relationship in labor and delivery rooms. However, certain items in the doctors’ behavior have improved. It would be worth investigating whether the package would improve women’s satisfaction in less stressful settings, but also it is worth looking at other possible interventions in maternity care practice such as doctor–midwife collaboration or attendance of birth companions in such settings. Despite the lack of evidence from these studies, the need to improve interpersonal skills of medical doctors and obstetricians specifically should be reinforced, as good communication is central to quality healthcare [28].
Verbal and nonverbal communication of health care providers in the delivery room have a significant impact on women’s satisfaction with care, but we have to consider others factors, too. WHO recommends effective communication between maternity care providers and women in labor, however during the guideline development process, the Guideline Development Group (GDG) identified important knowledge gaps that need to be addressed through primary research regarding the effects of communication skills training on women’s and providers’ experiences, level, type and other characteristics of communication and optimal skilled birth attendant to-woman ratio for delivery of effective communication. [8]. Further studies are needed to more precisely identify the role of communication in women’s satisfaction during labor and delivery by considering all aspects of care.
Strengths and limitations
This study included a large sample size. Additionally, studying verbal and non-verbal communication was a strength of the present study, whereas the convenient sampling approach and limiting our sample to include only the experiences of births in public hospitals were limitations.