Cross-cultural adaptation and validation of the German version of the Birth Satisfaction Scale-Revised (BSS-R)

Up to one third of women are dissatisfied with their birth experience. A negative birth experience can have detrimental outcomes, making an early detection of dissatisfaction with the birth experience very important. The Birth Satisfaction Scale-Revised (BSS-R) is a multi-dimensional measure of birth satisfaction, which has been translated into several languages. The current study aimed to translate and validate a German version of the BSS-R (DE-BSS-R). A total of 3747 German women, who were participating in the cross-sectional study INVITE, completed the DE-BSS-R 3–4 months postpartum. The factor structure of the DE-BSS-R was tested using confirmatory factor analysis. Moreover, internal consistency as well as known-groups discriminant, divergent, convergent, and predictive validity were evaluated. Both the tri-dimensional and the bi-factor measurement model of the original BSS-R showed excellent fit to the data. Internal consistency was acceptable for the total score and the subscale Women’s personal attributes, but just below the recommended cut-off for the subscales Stress experienced during labour and Quality of care. However, Cronbach’s alpha did not differ significantly from the acceptable alpha values of the original BSS-R. Women with a non-instrumental vaginal birth had significantly higher birth satisfaction than women with an instrumental birth (instrumental vaginal, caesarean section). The DE-BSS-R showed good divergent, convergent, and predictive validity. Overall, the German cross-cultural adaptation of the BSS-R showed excellent psychometric properties. Both the total score and the three subscale scores are valid to quickly measure German women’s satisfaction with birth in research and clinical practice.