Factor that Influence on Ultra-Orthodox Jewish Mothers’ Service Satisfaction with Obstetric Care in Israeli Public Hospitals

18 The Ultra-Orthodox sector is a uniquely conservative and closed community 19 within Israeli society, which makes up 8-11% of the population of Israel. The Ultra-Orthodox live in separate neighborhoods that constitute closed cultural 21 quarters with little interaction with the non-orthodox society. Within these 22 neighborhoods, they maintain their traditional lifestyle, which adheres to strict, 23 Torah-based Jewish law. Observance of Jewish laws and customs is closely 24 monitored and access to the internet and the general media is limited, keeping 25 the exposure to undesired contents at the minimum. 26 Religious law observance includes modest dress codes, complete separation 27 between male and female that begins in early childhood, and strong family values, including marrying young and aspiring to form a big, close-knit family unified around the traditions of the community. The men in the Ultra-Orthodox confidence among UOJM and increase their loyalty to a specific hospital in future deliveries.

the mother, and the team -organization. The third parameter determining the 126 level of satisfaction included Technical factors, such as medical, anesthetic or emergency equipment used during the delivery. All three parameters are important and affect mothers' satisfaction with the service, although not to the 129 same extent. ([10]; [11]). This study's aim is to determine and rank the main The Aim of the study 135 The aim of this study is to evaluate the cultural factors that affect UOJM's 136 satisfaction level when receiving childbirth services in Israeli hospitals. These 137 factors will then be classified into dimensions, and the 138 The study area and study design 139 The study population is UOJM who had vaginal deliveries (no caesarean or other  The participating mothers had to fill in the questionnaires by themselves. The 159 students were guided to make sure the mother understood that the questionnaire 160 is for academic purposes. They gave the questionnaire to the mother and waited while she completed it. We used 5 students for each of the four cities, 20 students 162 all together. Satisfaction with one of the aspects was defined as the proportion of 163 mothers who had chosen a mark of 4 or 5 with all the variables under this aspect 164 of care.

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Data collection, data instrument 166 The journey of the study was conducted using mixed methodologies in two 167 phases as described in Table 1: The questionnaires were given to each mother after explaining the academic 188 purpose of the study and ensuring its anonymity (we also made sure she gave 189 birth within the last 12 months). The mothers signed a form of consent. The 190 questionnaires were filled out by the mother and handed back to the students.

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Dimensions of mother's satisfaction: 215 Using an explanatory study among 36 mothers we interviewed them 216 in related the main factors influence their satisfaction in the delivery 217 room.

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The mothers mentioned that interpersonal interaction as well as the    previous birth (see Table 4).  Listening and attending to the mother's wishes 2.20 1.12 The quality of the service and treatment 3.77 1.18 Kindness and attitude of the personnel to the mother as an individual To find a significant correlation between sociodemographic variables, 269 we conducted Spearman analysis (see Table 5 To find any correlation between items' dimensions and demographic 276 variables, we used a Spearman correlation (see Table 6 ). Results

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show that there is no significant correlation between the UOJMs' 278 satisfaction and demographic variables or former childbirths.   Predictors of mother's satisfaction: 290 Linear regression including service's dimensions:

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Linear multiple regression was conducted to define significant 292 dimensions predicting mother's satisfaction (see Table 7 ). The Al three aspects had high correlation to mother's average satisfaction, 296 but the interpersonal dimension had the high score (β=.57).

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In general: The high childbirth rate among UOJM in Israel (more than six 321 children per family compared to a national average of 2.9 children) and the fact 322 that more than 99% of deliveries take place in public hospitals make this an  In addition, laboring women want to take active part in the process. When they 356 are not routinely closely informed and consulted with, they feel dissatisfied with 357 the service (2.21, 2.29).

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These results are comparable to other studies ([24]; [25] ;( [26]) which emphasize 359 the mother's need to be informed and consulted during the procedure. In western 360 countries such as Australia or the Netherlands, ([8]; [27]) the personal, caregiver- The Technical dimension: although birthing women use conventional 373 medical care, they need to have access to alternative obstetric care, which is 374 highly popular in Israel ( [28]; [29]). When this is not the case, they express 375 dissatisfaction (mean satisfaction 1.22).

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The fact that UOJM do not access the internet and avoid social network  [31]; [32]; [33]), which have shown that low income and highly educated mothers 387 will be less satisfied with maternity care.