# The Childbirth Experience Survey (CBEX): An Analysis of Qualitative Survey data

## TL;DR

This study analyzed qualitative feedback from a childbirth experience survey to confirm its effectiveness and identify areas for improving hospital care.

## Contribution

The study validated the survey's domains and revealed nuanced issues in labor and postpartum care that contribute to maternal dissatisfaction.

## Key findings

- Qualitative responses confirmed the content validity of the 18 CBEX domains.
- Subtle issues were identified in labor management, pain management, empathy, and newborn feeding.
- Hospitals are using the data to improve childbirth-specific care quality.

## Abstract

In collaboration with community research partners, a national cross-sectional online Childbirth Experience Survey (CBEX) of pregnant and postpartum birthing people was administered in 2016. The linked antepartum-postpartum survey included items across 18 domains (e.g., labor management, pain management, newborn care and feeding), and identified 23 childbirth-specific postpartum patient-reported outcomes (PROs) that were associated with hospital satisfaction. CBEX was implemented in 16 California hospitals to identify hospital-specific opportunities for improvement in care. We analyzed postpartum qualitative survey responses (1) to evaluate the content validity to test the representativeness of existing CBEX domains, (2) to assess for any potential new domains or topics of interest within existing domains, and (3) to use these data to provide hospitals with actionable information for practice improvement.

This was an analysis of qualitative survey data based on the following CBEX item: “Is there anything else you would like to share about your birth experience?” Patients could provide multiple comments. Using Atlas.ti Version 8, we mapped participant responses to the 18 existing CBEX domains.

Of 525 surveys completed between Oct 2018 and Sept 2020, 172 patients responded to the qualitative item. A total of 235 comments were analyzed and all were able to be mapped to the 18 domains. Qualitative responses highlighted subtleties within several CBEX domains: (1) labor management: pressure from the care team to have a labor induction; (2) pain management: epidural effectiveness, timing, dosage, and education; (3) empathy and respect: issues related to students and residents; and (4) newborn feeding: rough physical handling of patients by nurses, specifically during lactation consults.

CBEX survey data is currently being utilized in hospitals to inform childbirth-specific quality improvement initiatives. By capturing detailed voluntary participant responses, CBEX provides the opportunity to document and explore nuanced aspects of the childbirth experience and subtleties that may be contributing to maternal dissatisfaction.

What is Already Known on this Subject?

What this Study Adds?

Patient-reported outcome and experience (PRO) data have become a critical component of health services quality measurement. The Childbirth Experience Survey (CBEX) was developed to assist hospitals with identifying childbirth-specific quality improvement priorities and targets.

The study confirmed content validity of the existing 18 CBEX domains. CBEX qualitative data identified subtle and specific experiences and interactions within the domains of labor management, pain management, empathy and respect, and newborn feeding. By capturing detailed voluntary participant responses, CBEX provided the opportunity to document nuanced aspects of the childbirth experience and subtleties that may be contributing to maternal dissatisfaction.