Psychometric properties of a Saudi Arabian version of the Birth Satisfaction Scale-Revised (BSS-R)


Saudi women
birth satisfaction
factor analysis
cross-sectional study

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D’Sa, J. L., Jahlan, I. O., Alsatari, E. S., Zamzam, S., & Martin, C. R. (2024). Psychometric properties of a Saudi Arabian version of the Birth Satisfaction Scale-Revised (BSS-R). Belitung Nursing Journal, 10(1), 105–113.
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Accepted for publication: 2024-01-22
Peer reviewed: Yes

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Background: Maternal outcomes are closely associated with birth satisfaction, and the Birth Satisfaction Scale-Revised (BSS-R), a concise, multidimensional self-report measure, has undergone translation and validation internationally. However, research on birth satisfaction in Saudi Arabia is scarce. The absence of valid Arabic-language tools for the Saudi population may impede critical research on this topic, necessitating the translation and use of psychometrically sound instruments for measuring birth satisfaction in Saudi women.

Objective: This study aimed to translate and evaluate the psychometric properties of the Saudi Arabian version of the BSS-R (SA-BSS-R).

Methods: A total of 218 Saudi women participated in the study, and psychometric analysis of the translated SA-BSS-R involved confirmatory factor analysis, divergent validity analysis, and known-group discriminant validity assessment within a cross-sectional study design.

Results: The three-factor BSS-R measurement model displayed poor fit, and internal consistency fell below the threshold value. Additionally, it was observed that women undergoing an episiotomy had significantly lower overall SA-BSS-R scores.

Conclusion: The SA-BSS-R manifested atypical measurement properties in this population. Despite insightful observations related to episiotomy, the identified measurement shortcomings highlight the need for a more robust and culturally sensitive translation to enhance measurement characteristics.


Copyright (c) 2024 Juliana Linnette D'Sa, Ibtesam Omar Jahlan, Eman S. Alsatari, Sahar Zamzam, Colin R. Martin

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Declaration of Conflicting Interest

There are no conflicts of interest to declare.


The authors acknowledge the Nursing Research Affairs, King Saud University Medical City, Riyadh, for permission to collect the data and the Prince Naif Health Research Center, Investigator Support Unit for the language editing service provided.

Authors’ Contributions

All authors contributed to the study’s conception and design and approved the manuscript's final version. JLD and IOJ were involved in translating the instrument, ESA collected data, SZ performed data entry, and CRM analyzed the data and interpreted findings. JLD and CRM drafted the manuscript and reviewed the final version critically.

Data Availability

The data generated in this study are available from the corresponding author upon reasonable request. The BSS-R can be freely used for clinical and research purposes with permission from Professor Caroline J Hollins Martin at [email protected]. More information regarding the BSS-R can be found on the website

Declaration of Use of AI in Scientific Writing

There is nothing to declare.


Al Nadabi, W., & Mohammed, M. A. (2019). Arabic language surveys measuring mothers’ satisfaction during childbirth: A review. Global Journal of Health Science, 11(6), 169.

Al-Zabidi, F. Z. M., Elsirafi, M. S., Muqresh, M. A., Ali, M. A., & Billah, S. M. B. (2021). Situation analysis of episiotomy in the gulf: A scoping review. International Journal of Human and Health Sciences, 5(3), 286-291.

Almalki, H. H. (2021). Assessment of women’s birth satisfaction [Unpublished master’s thesis, King Saud University]. Riyadh, Saudi Arabia.

Ayers, S., Bond, R., Bertullies, S., & Wijma, K. (2016). The aetiology of post-traumatic stress following childbirth: A meta-analysis and theoretical framework. Psychological Medicine, 46(6), 1121-1134.

Barbosa-Leiker, C., Fleming, S., Hollins Martin, C. J., & Martin, C. R. (2015). Psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R) for US mothers. Journal of Reproductive and Infant Psychology, 33(5), 504-511.

Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine, 25(24), 3186-3191.

Bell, A. F., & Andersson, E. (2016). The birth experience and women's postnatal depression: A systematic review. Midwifery, 39, 112-123.

Bell, A. F., Andersson, E., Goding, K., & Vonderheid, S. C. (2018). The birth experience and maternal caregiving attitudes and behavior: A systematic review. Sexual & Reproductive Healthcare, 16, 67-77.

Bentler, P. M. (1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238-246.

Bossano, C. M., Townsend, K. M., Walton, A. C., Blomquist, J. L., & Handa, V. L. (2017). The maternal childbirth experience more than a decade after delivery. American Journal of Obstetrics and Gynecology, 217(3), 342.e341-342.e348.

Brown, T. (2015). Confirmatory factor analysis for applied research (2nd ed.). New York: Guilford Press.

Burduli, E., Barbosa-Leiker, C., Fleming, S., Hollins Martin, C. J., & Martin, C. R. (2017). Cross-cultural invariance of the Birth Satisfaction Scale-Revised (BSS-R): Comparing UK and US samples. Journal of Reproductive and Infant Psychology, 35(3), 248-260.

Calik, K. Y., Karabulutlu, Ö., & Yavuz, C. (2018). First do no harm-interventions during labor and maternal satisfaction: A descriptive cross-sectional study. BMC Pregnancy and Childbirth, 18, 415.

Clark, L. A., & Watson, D. (1995). Constructing validity: Basic issues in objective scale development. Psychological Assessment, 7(3), 309–319.

Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297-334.

Davis, A. M. B., & Sclafani, V. (2022). Birth experiences, breastfeeding, and the mother-child relationship: Evidence from a large sample of mothers. Canadian Journal of Nursing Research, 54(4), 08445621221089475.

Diedenhofen, B., & Musch, J. (2015). Cocor: A comprehensive solution for the statistical comparison of correlations. PloS One, 10(4), e0121945.

Diedenhofen, B., & Musch, J. (2016). Cocron: A web interface and R package for the statistical comparison of cronbach's alpha coefficients. International Journal of Internet Science, 11(1), 51-60.

Emmens, B., Hollins Martin, C. J., & Martin, C. R. (2023). Translation and validation of the Dutch version of the Birth Satisfaction Scale-Revised (BSS-R). Journal of Reproductive and Infant Psychology, 41(2), 213-227.

Fair, C. D., & Morrison, T. E. (2012). The relationship between prenatal control, expectations, experienced control, and birth satisfaction among primiparous women. Midwifery, 28(1), 39-44.

Fenwick, J., Staff, L., Gamble, J., Creedy, D. K., & Bayes, S. (2010). Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery, 26(4), 394-400.

He, S., Jiang, H., Qian, X., & Garner, P. (2020). Women’s experience of episiotomy: A qualitative study from China. BMJ Open, 10(7), e033354.

Hildingsson, I., Johansson, M., Karlström, A., & Fenwick, J. (2013). Factors associated with a positive birth experience: An exploration of Swedish women’s experiences. International Journal of Childbirth, 3(3), 153-164.

Hollins Martin, C. J., & Martin, C. R. (2014). Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R). Midwifery, 30(6), 610-619.

Hollins Martin, C. J., & Martin, C. R. (2024). The Birth Satisfaction Scale-Revised (BSS-R).

Hosseini Tabaghdehi, M., Keramat, A., Kolahdozan, S., Shahhosseini, Z., Moosazadeh, M., & Motaghi, Z. (2020). Positive childbirth experience: A qualitative study. Nursing Open, 7(4), 1233-1238.

Hu, L. t., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1-55.

Jahlan, I., Plummer, V., McIntyre, M., & Moawed, S. (2016). What women have to say about giving birth in Saudi Arabia. Middle East Journal of Nursing, 10(1), 1-9.

Jorgensen, T. D., Pornprasertmanit, S., Schoemann, A. M., & Rosseel, Y. (2022). semTools: Useful tools for structural equation modeling.

Kline, P. (2000). A psychometric primer. London: Free Association Books.

Kline, R. B. (2011). Principles and practice of structural equation modeling (3rd ed.). London: Guilford Press.

Martin, C. R., Hollins Martin, C. J., Burduli, E., Barbosa-Leiker, C., Donovan-Batson, C., & Fleming, S. E. (2018). The Birth Satisfaction Scale–Revised (BSS-R): should the subscale scores or the total score be used? Journal of Reproductive and Infant Psychology, 36(5), 530-535.

Ministry of Health. (2021). Saudi home birth standards

Mohammad, K. I., Alafi, K. K., Mohammad, A. I., Gamble, J., & Creedy, D. (2014a). Jordanian women's dissatisfaction with childbirth care. International Nursing Review, 61(2), 278-284.

Mohammad, K. I., Shaban, I. A., Homer, C. S., & Creedy, D. (2014b). Women's satisfaction with hospital-based intrapartum care: A Jordanian study. International Journal of Nursing and Midwifery, 6(3), 32-39.

Mortazavi, F., Mehrabadi, M., Hollins Martin, C. J., & Martin, C. R. (2021). Psychometric properties of the birth satisfaction scale-revised (BSS-R) in a sample of postpartum Iranian women. Health Care for Women International, 42(4-6), 836-851.

Nahaee, J., Mohammad-Alizadeh-Charandabi, S., Abbas-Alizadeh, F., Martin, C. R., Hollins Martin, C. J., Mirghafourvand, M., & Hassankhani, H. (2020). Pre-and during-labour predictors of low birth satisfaction among Iranian women: A prospective analytical study. BMC Pregnancy and Childbirth, 20, 408.

Nakic Rados, S., Matijas, M., Brekalo, M., Hollins Martin, C. J., & Martin, C. R. (2023). Further validation of the birth satisfaction scale-revised: Factor structure, validity, and reliability. Current Psychology, 42(16), 13693-13702.

Nilver, H., Begley, C., & Berg, M. (2017). Measuring women’s childbirth experiences: A systematic review for identification and analysis of validated instruments. BMC Pregnancy and Childbirth, 17(1), 1-19.

R Core Team. (2022). R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing.

Ratislavová, K., Hendrych Lorenzová, E., Hollins Martin, C. J., & Martin, C. R. (2024). Translation and validation of the Czech Republic version of the Birth Satisfaction Scale-Revised (BSS-R). Journal of Reproductive and Infant Psychology, 42(1), 78-94.

Romero-Gonzalez, B., Peralta-Ramirez, M. I., Caparros-Gonzalez, R. A., Cambil-Ledesma, A., Martin, C. J. H., & Martin, C. R. (2019). Spanish validation and factor structure of the Birth Satisfaction Scale-Revised (BSS-R). Midwifery, 70, 31-37.

Rosseel, Y. (2012). Lavaan: An R package for structural equation modeling. Journal of Statistical Software, 48, 1-36.

Saudi Vision. (2023). Kingdom of Saudi Arabia: vision 2030.

Sawyer, A., Ayers, S., Abbott, J., Gyte, G., Rabe, H., & Duley, L. (2013). Measures of satisfaction with care during labour and birth: A comparative review. BMC Pregnancy and Childbirth, 13(1), 108.

Scamell, M., Altaweli, R., & McCourt, C. (2017). Sarah's birth. How the medicalisation of childbirth may be shaped in different settings: Vignette from a study of routine intervention in Jeddah, Saudi Arabia. Women and Birth, 30(1), e39-e45.

Shorey, S., Yang, Y. Y., & Ang, E. (2018). The impact of negative childbirth experience on future reproductive decisions: A quantitative systematic review. Journal of Advanced Nursing, 74(6), 1236-1244.

Skvirsky, V., Taubman–Ben-Ari, O., Hollins Martin, C. J., & Martin, C. R. (2020). Validation of the Hebrew Birth Satisfaction Scale–Revised (BSS-R) and its relationship to perceived traumatic labour. Journal of Reproductive and Infant Psychology, 38(2), 214-220.

Steiger, J. H., & Lind, J. (1980, 1980). Statistically based tests for the number of common factors. Annual Spring Meeting of the Psychometric Society, Iowa City, USA.

Størksen, H. T., Garthus‐Niegel, S., Vangen, S., & Eberhard‐Gran, M. (2013). The impact of previous birth experiences on maternal fear of childbirth. Acta Obstetricia et Gynecologica Scandinavica, 92(3), 318-324.

The International Consortium for Health Outcome Measurement. (2017). Pregnancy and childbirth standard set and reference guide, version 1.0.3.

Tiwari, S. K., Murry, L., Joshi, P., Tallanao, T., Zined, R., Hollins Martin, C. J., & Martin, C. R. (2023). Translation and validation of the Hindi‐Indian version of the Birth Satisfaction Scale‐Revised. Journal of Obstetrics and Gynaecology Research, 49(3), 938-945.

Viirman, F., Hesselman, S., Wikström, A.-K., Svanberg, A. S., Skalkidou, A., Poromaa, I. S., & Wikman, A. (2022). Negative childbirth experience–what matters most? a register-based study of risk factors in three time periods during pregnancy. Sexual & Reproductive Healthcare, 34, 100779.

World Health Organization. (2018). WHO recommendations: intrapartum care for a positive childbirth experience.

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