RESEARCH PAPER
 
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Women in Poland, despite having access to publicly-funded medical care during pregnancy, childbirth and the postpartum period, frequently use private care. Women's experience and satisfaction with childbirth have been considered one of the key indicators of the quality of care. In this study we explore whether and how paying for private childbirth services affects women’s experiences and satisfaction with care. The qualitative portion seeks to understand how individual women construct meaning around their childbirth experiences, including their relationships with healthcare personnel, medical interventions, birth environment, and professionalism.

Methods:
This mixed-methods study is based on data from 951 online questionnaires completed by women who gave birth between June 2017 and June 2022, in Poland. This study is part of the international Babies Born Better Survey project. The project used simultaneous quantitative and qualitative data collection, it was exploratory with equivalent status of qualitative and quantitative data. Quantitative data were analyzed descriptively and chi-squared tests were conducted to compare women who used private and public care. Qualitative data were analyzed using inductive thematic analysis. The quantitative and qualitative results were integrated, in accordance with the chosen mixed-methods design.

Results:
There were no major differences in sociodemographic characteristics (except living standards), health status and satisfaction with labor between women who paid for private services during childbirth and those who used only publicly-funded care. For both groups of women, healthcare personnel and their behavior were the most frequently mentioned aspect shaping childbirth experiences. Other important aspects were: medical interventions, birth environment, and staff professionalism.

Conclusions:
Although accessing private perinatal services care did not provide women with care consistent with their expectations, women put a lot of trust into private services as a means to receive more attentive care. Further research investigating the interplay between private and public services is needed to explore the question how private services may impact the care women receive and why women put so much trust in these services.

ACKNOWLEDGEMENTS
The work of all those who contributed to developing and running the Babies Born Better Survey is acknowledged. Details of the project, the Steering Group, and the Country Coordinators can be found at: http://www.babiesbornbetter.org/about/.
CONFLICTS OF INTEREST
The authors have completed and submitted the ICMJE Form for disclosure of Potential Conflicts of Interest and none was reported.
FUNDING
This study was derived from the Babies Born Better project, developed and supported as part of two EU COST Actions (European Cooperation in Science and Technology Programme as part of European Horizon 2020): 1) COST-Action IS0907: Childbirth Cultures, Concerns, and Consequences: Creating a dynamic European Union framework for optimal maternity care; and 2) COST-Action IS1405: Building Intrapartum Research Through Health – an interdisciplinary whole system approach to understanding and contextualizing physiological labor and birth (BIRTH).
ETHICAL APPROVAL AND INFORMED CONSENT
Ethical approval was obtained from the Ethics Committee of the University of Central Lancashire (Approval number: STEMH 449; Date: June 2020). Participants provided informed consent.
DATA AVAILABILITY
The data supporting this research are available from the authors on reasonable request.
PROVENANCE AND PEER REVIEW
Not commissioned; externally peer reviewed.
 
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