Exploring Maternal Autonomy, Respect, and Satisfaction During Childbirth: Insights From Home Birth Experiences

Background Maternal autonomy, respect, and satisfaction during childbirth are crucial aspects of maternity care. While hospital births are standard in many healthcare systems, home births are increasingly preferred by women seeking more personalized and autonomous experiences. This study evaluates maternal experiences of respect, autonomy, and satisfaction in home and hospital birth settings using validated assessment tools. Methods A retrospective study was conducted among 162 Greek women with at least one home birth experience. Data were collected via an online survey (2010-2023) using validated scales, including the Mother's Autonomy in Decision Making (MADM) scale, Mothers on Respect Index (MORi), Birth Satisfaction Scale-Revised (BSS-R), and Mistreatment in Childbirth Scale (MIST). Statistical analyses included the Kolmogorov-Smirnov test, the Mann-Whitney test, Spearman correlation, and multivariate regression to identify factors associated with satisfaction, autonomy, and experiences of mistreatment. Results Women reported significantly higher levels of respectful care during home births, as reflected in the MORi scores (mean: 74.4, SD = 8.8), compared to hospital births (mean: 56.4, SD = 13.7; p < 0.001). Measures of autonomy (MADM mean: 37.0, SD = 5.5) and birth satisfaction (BSS-R mean: 31.8, SD = 6.5) were also significantly higher among those who gave birth at home. Notably, the vast majority of participants (107, 88.4%) did not report any form of mistreatment, indicating generally positive childbirth experiences. Among the 14 (11.6%) who did report mistreatment, verbal abuse was most frequently mentioned (9, 7.4%), followed by privacy violations (2, 1.6%). Regression analysis highlighted two key factors that significantly contributed to greater birth satisfaction: the ability to choose one's birth position (p = 0.010) and receiving adequate information from midwives (p < 0.001). Conclusions Home births are associated with higher maternal autonomy, respect, and satisfaction compared to hospital settings. Maternity care policies should integrate respectful and autonomy-supportive practices to enhance maternal experiences in all birth environments.