Journal Article

Pattern of unreported negative birth experiences in the maternity ward

Birkeland, Søren Fryd, Clausen, Mette Kring, Bogh, Søren Bie, Morsø, Lars

2025

Overview

Introduction Denmark is one of the safest places for childbirth, yet some women report dissatisfaction with their maternity care. However, some negative birth experiences may remain unreported due to thresholds for complaining. The study aimed to identify patterns of unreported negative birth experiences and to quantify the extent of these dark figures. Material and Methods A survey was distributed to 3081 women who gave birth at a Danish hospital in 2022, resulting in 1022 responses (response rate = 33.2%). The women reported their birth experiences in categories based on the Healthcare Complaints Analysis Tool (HCAT), specifying problems, harm caused, and whether they had filed a complaint or intended to. Dark figure ratios regarding problems and harm levels were calculated by comparing unreported negative experiences to formally filed complaints based on the survey responses, covering each problem type and harm level. Results Of the 1022 respondents, 336 (32.9%) women reported negative birth experiences, yet only 26 women had filed complaints. The remaining 310 unreported cases comprised 787 problems across HCAT categories. The most frequent problems were about communication and quality. The highest dark figure ratios were found within the management domain comprising institutional processes (13.0) and environment (9.9). The dark figure ratios showed an inverse relationship with harm severity, being highest for minimal (19.5) and minor (21.2) harm levels and decreasing for moderate (5.5), major (4.8) and catastrophic (0.3) harm levels. Conclusions This study demonstrates a substantial underestimation of negative birth experiences when relying solely on formal complaints, with dark figure ratios ranging from 4.8 to 13, depending on the issue. The inverse relationship between harm severity and dark figure ratios suggests a threshold for filing a complaint, as the likelihood of reporting increases with greater harm. These findings provide novel insights into unreported maternity care experiences, highlighting the need to integrate patient experiences into healthcare improvements. Patient complaints represent only a fraction of problems experienced during childbirth. Among 336 women with negative birth experiences, only 26 filed complaints, revealing a dark figure with up to 13 times more unreported issues. Integrating complaint data with dark figure estimates enables a more accurate assessment of the true scope and nature of patient‐perceived problems.

• Publisher: John Wiley & Sons, Inc,John Wiley and Sons Inc,Wiley
• Subject: Adult / Birth / birth experience / Complaints / dark figures / Delivery, Obstetric - psychology / Denmark / Female / harm / Healthcare Complaint Analysis Tool (HCAT) / hospital / Humans / Maternal child nursing / Maternal Health Services - standards / maternity ward / Original Research / Parturition - psychology / Patient Satisfaction - statistics & numerical data / Pregnancy / problem pattern / Surveys and Questionnaires / women