Quality of intrapartum midwifery care in Austria: Implications for birth satisfaction and maternal mental health

PROBLEM: A substantial proportion of people who give birth experience childbirth as negative or traumatic, which may adversely affect postpartum mental health. BACKGROUND: Respectful, supportive and woman-centred intrapartum care is a recognised determinant of positive birth experiences, yet evidence linking perceived midwifery care quality with birth satisfaction and trauma-related outcomes in Austria remains limited. AIM: To examine the associations between perceived quality of intrapartum midwifery care, birth satisfaction and birth-related post-traumatic stress disorders (PTSD). METHODS: A national cross-sectional online survey was conducted among women who gave birth between 2020 and 2025. Participants completed validated instruments assessing perceived midwifery care quality, birth satisfaction and PTSD. Multiple linear regression examined associations between care quality and outcomes; receiver operating characteristic (ROC) analysis explored the association between quality of care and PTSD. FINDINGS: A total of 1973 participants were included. Higher perceived quality of care was strongly associated with greater birth satisfaction, and lower perceived quality with higher post-traumatic stress symptom (PTSS) scores. Personal control during labour and trust in care providers emerged as key predictors of both outcomes. Instrumental and caesarean births were also associated with higher PTSS scores. The exploratory ROC analysis linked lower MMAYbirth scores to clinically relevant PTSD (sensitivity .86, specificity .74), but few affected cases limit its use as a stand-alone screening tool. CONCLUSION: Improving the quality of intrapartum midwifery care, particularly by strengthening communication, emotional support and women's sense of control, may contribute to more positive birth experiences and lower levels of postpartum trauma symptoms.