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Women admitted in the latent phase were more likely to experience intrapartum interventions, which increase the probability of caesarean section. Maternity services should be organized around women and families needs, providing early labour support, to enable women to feel reassured facilitating their admission in labour to avoid the cascade of intrapartum interventions which increases the risk of caesarean section.

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Aim To evaluate mothers’ satisfaction with childbirth experience in a cohort of women who delivered during COVID pandemia and to compare them to a pre‐COVID cohort. Design We performed a cross‐sectional study in a low‐risk Maternity Unit. Methods Women who delivered during COVID‐19 pandemic were compared to a pre‐COVID cohort recruited in 2018 in the same setting. Italian version of the Birth Satisfaction Scale‐Revised (I‐BSS‐R) was used. Results Three hundred and seventy‐seven women were included (277 pre‐COVID and 100 during COVID pandemic). No differences in terms of satisfaction at birth were reported (I‐BSS‐R mean 27.0, SD 5.3 versus mean 27.6, SD 6.1, p 0.34), despite an increased rate of active intrapartum interventions. Intrapartum variables that significantly reduced satisfaction were the same in the two groups: epidural analgesia ( p < .0001 in both groups), prolonged active phases ( p < .0001 in both), oxytocin administration ( p < .0001 in both) and operative delivery (p 0.0009 versus p 0.0019).

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Background Evidence on the safety and appropriateness of vaginal birth after caesarean (VBAC) appears clear, but knowledge about women's choice towards this mode of birth is limited. Aims To identify variables related to women's decision-making about whether to try for VBAC. Method and findings Cross-sectional study was conducted. Feelings of body failure towards the previous birth and the desire to have a vaginal birth were associated with maternal choice of VBAC. Women who perceived a repeated section as being dangerous for them opted for a VBAC (p=0.030). Opinion of women with the same experience and information found online were implicated into maternal decision-making. Conclusion This is the first Italian study to confirm that maternal choice is complex and involves many factors. Midwives and obstetricians should strive to provide an evidence-based midwifery care, in order to offer a VBAC as a safe birth option.

Objective. To explore first-time mothers' experiences of early labour within Italian maternity care services in the event that women are admitted to hospital or advised to return home after maternity triage assessment. Setting. One second-level Maternity Hospital in northern Italy with an obstetric unit for both low and high-risk women. Participants. Fifteen first-time mothers in good general health with spontaneous labour at term of a low-risk pregnancy that accessed the maternity triage during the latent phase of labour, and were either admitted at the hospital or advised to return home. Design. Qualitative interpretive phenomenological study. One face-to-face recorded semistructured interview was conducted with each participant 48-72 hours after birth. Findings. Four key themes emerged from the interviews: a) recognising early labour signs; b) coping with pain at home; c) seeking reassurance from healthcare professionals; d) being admitted to hospital versus returning home. Uncertainty about the labour progress and the need for reassurance was referred by women as the main reasons for going to hospital in early labour. An ambivalent feeling was reported by the participants when being admitted to hospital in early labour. In fact, while in the first instance the women felt reassured, some felt dissatisfied later on due to the absence of one-to-one dedicated care during the latent phase of labour. When advised to go back home, a number of women manifested feelings of disappointment, anger, fear, discouragement and anxiety for not having been admitted to hospital; however, some participants reported a subsequent feeling of comfort with being at their own home and putting in place the suggestions provided by the midwives at the moment of maternity triage assessment. The guidance provided by midwives during triage assessment seemed to be the key factor influencing women's satisfaction when advised either to return home or to stay at the hospital during the latent phase of labour. Conclusions and implications for practice. During antenatal classes and clinics, midwives should provide clear information and advice on early labour to increase women's confidence, self-efficacy and decrease their anxiety and fear. During early labour, appropriate maternity care services should be offered according to individual needs. When home visits are not provided by midwives, a telephone triage run by midwives should be considered as a routine service for the first point of contact with women during the latent phase of labour.

Objective: To validate the Italian-language version of the Birth Satisfaction Scale-Revised (BSS-R) and report key measurement properties of the tool. To evaluate the impact of antenatal class attendance on BSS-R assessed birth satisfaction.Background: Maternal satisfaction is one of the standards of care defined by the World Health Organization (WHO) to improve the quality of services. The BSS-R is a multi-dimensional self-report measure of the experience of labour and birth.Methods: Cross-sectional instrument evaluation design examining factor structure and key aspects of validity and reliability. Embedded between-subjects design to examine known-group discriminant validity and the impact of antenatal class attendance on BSS-R sub-scale and total scores as dependent variables. After giving birth, 297 women provided data for analysis . Results:The Italian version of the BSS-R (I-BSS-R) was the key study measure. The established three-factor and bi-factor models of the BSS-R were found to offer an excellent fit to the data. Comparison of the tri-dimensional measurement model and the bi-factor model of the BSS-R found no significant differences between models. Women who attended antenatal classes had significantly lower stress experienced during childbearing sub-scale scores (I-BSS-R SE), compared to those who did not. Good convergent, divergent validity and known-groups discriminant validity was established for the I-BSS-R. Internal consistency observations were found to be sub-optimal in this population.Conclusions: On all key psychometric indices, with the exception of internal consistency that requires further investigation, the I-BSS-R was found to be a valid translation of the original BSS-R. The impact of antenatal classes on birth satisfaction warrants further research.