Validation of the questionnaire for assessing the childbirth experience [QACE] in a Polish population
This study confirms that the Polish version of the Questionnaire of Assessment of Childbirth Experience (QACE) is a reliable and valid psychometrically sound instrument for evaluating childbirth experiences among Polish women, demonstrating strong construct validity, internal consistency, and cross-language agreement with the original English version.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
For decades, the success of childbirth was measured almost exclusively by the physical safety of the mother and the baby. Did the delivery happen without medical crisis? Was the infant born healthy? These questions remain vital, but they tell only half the story. A growing body of medical understanding now recognizes that the emotional journey of labor and delivery is just as critical to a woman's long-term well-being. How a woman feels during the process—whether she felt heard by her doctors, whether she felt safe, and how she connected with her newborn in the first moments after birth—can shape her mental health, her relationship with her child, and even her decisions about having more children in the future. To understand these feelings, researchers need a way to measure them accurately, much like a thermometer measures temperature. Without a reliable tool, it is difficult to know if a hospital is truly providing good care or if a specific type of delivery changes a woman's emotional experience.
In Poland, until recently, there was no standardized way to ask women about their birth experiences in their own language. While other countries had developed detailed questionnaires to capture these complex feelings, Polish doctors and researchers had to rely on tools that were either not translated or not tested for use with Polish women. To fill this gap, a team of researchers from universities and hospitals in Kraków set out to adapt and test a specific international tool called the Questionnaire for Assessing the Childbirth Experience, known as QACE. Their goal was not just to translate the words, but to prove that the questions worked the same way for Polish women as they did for women in other countries, ensuring that the answers reflected true feelings rather than confusion over language or cultural differences.
The researchers recruited nearly 400 women who had recently given birth at a major university hospital in Kraków. These women represented a wide mix of backgrounds and birth experiences, including those who gave birth naturally and those who required a cesarean section. To ensure the translation was accurate, the team used a rigorous process where the questionnaire was translated from English to Polish and then back to English by different experts to catch any errors. They then asked the women to fill out the questionnaire in both languages. This allowed the team to compare the answers directly, checking if a woman's response in Polish matched her response in English. They also asked the women to rate how well the Polish version captured their thoughts, which served as a direct check on the quality of the translation.
The results showed that the Polish version of the questionnaire works exceptionally well. The tool successfully identified four distinct areas of the birth experience: the woman's emotional state during labor, her relationship with the medical staff, the first moments of bonding with her baby, and her feelings about the birth one month later. The study confirmed that these four areas are separate but connected parts of the whole experience. When the researchers analyzed the answers, they found that the questions consistently grouped together in the way the original designers intended. For example, questions about feeling supported by nurses and doctors reliably formed one clear category, while questions about seeing and holding the baby formed another. This structure held true whether the woman had a vaginal birth or a cesarean section, meaning the tool can be used to compare different groups of women fairly.
The study also revealed specific patterns in how Polish women experienced their births. Women who had cesarean sections reported more difficulty with the first moments of bonding with their newborns compared to those who gave birth vaginally. This difference was significant and aligns with the reality that cesarean deliveries often involve a delay in immediate skin-to-skin contact. However, when asked to give a single overall rating of their satisfaction with the birth, the two groups gave similar scores. This finding highlights the value of the questionnaire: it can detect specific differences in experience that a simple overall score might miss. The tool proved sensitive enough to show that while a woman might be generally satisfied with her care, she might still feel a distinct lack of connection in the immediate post-birth period if the delivery was surgical.
Reliability was another key success. The women who answered the questionnaire in both Polish and English gave nearly identical responses, confirming that the translation was accurate and that the meaning of the questions did not get lost in the language switch. The internal consistency of the answers was also high, meaning that women who felt a certain way about one aspect of their care tended to feel similarly about related aspects. The researchers noted that many women gave the most positive possible answers regarding how well the staff treated them, which suggests that the women in this study generally felt very well cared for. While this makes it harder to detect small improvements in already-positive experiences, it confirms that the tool is working as intended in a population that feels satisfied.
This work provides Polish healthcare providers and researchers with a validated, reliable instrument to measure the subjective side of childbirth. By having a tool that accurately captures emotional experiences, hospitals can better understand what matters most to their patients and identify areas where care can be improved. The study confirms that the core elements of a birth experience—feeling safe, feeling supported by staff, and connecting with the baby—are universal, even across different languages and healthcare systems. With this new Polish version of the questionnaire, the conversation about the quality of maternity care can now include the woman's voice in a precise and meaningful way, ensuring that the emotional health of mothers is given the same attention as their physical health.
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