Association between preferred and documented mode of birth and birth experiences in low- and middle-income countries: a multisite cross-sectional study.

RATIONALE AND OBJECTIVES: Unmet birth expectations can affect birth experiences and satisfaction with care (BES). In low- and middle-income countries (LMICs), rising caesarean section (CS) rates may widen mode of birth (MOB) preferences and clinical decisions gaps. We describe matches between MOB preferences and the MOB documented in medical records, and assess whether such matches were associated with BES. METHODS: We pooled data from two cross-sectional surveys in 32 hospitals in Argentina, Burkina Faso, Thailand, and Viet Nam (QUALI-DEC project). Postpartum women retrospectively reported the MOB they had preferred during late pregnancy. We assessed separately whether women's preferred MOB matched the initiated and actual MOB documented in medical records. We measured BES using the QUALI-DEC Birth Experience and Satisfaction scale, and computed overall and dimension-specific BES scores. Associations between preferred-documented MOB matches and BES scores were estimated using multilevel multivariable linear regression, adjusted for confounders, clustering, and selection bias. FINDINGS: Of 3228 women with a MOB preference, preferred-documented MOB match rates were high for both initiated (92.0%) and actual (78.0%) MOB. Women preferring vaginal birth (VB) more often had an initiated (98.0%) and actual (81.0%) VB; those preferring CS less often had a matching prelabour CS (33.0%) or actual CS (57.0%). Matches were modestly associated with higher overall and dimension-specific BES scores, regardless of preference for VB or CS. CONCLUSIONS: Findings suggest matches between women's preferences and documented MOB may be relevant to understanding variation in BES. Additional research is needed to further clarify these associations in LMICs.