^{<h3>Introduction</h3>}

^{<br/>Childbirth and the peripartum period represent critical life events with profound physical, psychological and social implications for women. The} quality of perinatal experiences strongly influences maternal satisfaction, bonding with the newborn and long-term mental health outcomes. Negative experiences during childbirth have been associated with postnatal depression, post-traumatic stress disorder and impaired breastfeeding outcomes, all of which generate substantial personal, public health, and economic costs [1, 2]. Globally, up to 30% of women report their birth as traumatic, while 10-15% develop postpartum depression, conditions that not only increase healthcare utilisation, but also affect family wellbeing and child development [2]. These risks disproportionately affect vulnerable groups, such as women with limited social support, those experiencing obstetric complications and migrants facing barriers to healthcare access.

<br/>Over the past decade, social media platforms have become a major source of health-related information, including reproductive and perinatal topics. With more than 5.24 billion active users worldwide, platforms such as Facebook, Instagram, TikTok and YouTube allow women to share experiences, seek advice, and build communities [3]. However, this digital environment is characterised by both opportunities and risks. A recent review highlighted the large amount of misleading or inaccurate content on women’s reproductive health available online, which may result in delayed care seeking and inappropriate health behaviours [4]. At the same time, evidence shows that pregnant women actively turn to the Internet as their primary source of childbirth-related knowledge, with 24.3% reporting that online content decreased their fears, but 14.8% caused increased anxiety [5].

<br/>The influence of social media is further amplified by influencers and healthcare professionals, whose content may shape pregnancy and childbirth expectations by presenting idealised birth scenarios [6, 7].

<br/>Despite growing recognition of this phenomenon, several critical knowledge gaps remain. In much of the existing literature, Internet use is broadly addressed, rather than focusing specifically on interactive social media platforms, and only a few studies, such as those mentioned above, have directly examined how these platforms influence women’s birth satisfaction or their lived perinatal experiences. Furthermore, many analyses are concentrated on body image or antenatal anxiety, leaving the impact of social media on the subjective evaluation of childbirth underexplored [8-10]. Thus, there is a need for studies investigating the interplay between social media engagement and childbirth satisfaction, especially when measured with validated instruments. In this study, we addressed this gap by examining how women’s use of social media influences their peripartum expectations and overall satisfaction with childbirth. By linking digital engagement with women’s lived experiences of birth, we offer new insights into how social media shape perceptions of care, expectations of maternity services and emotional responses to childbirth. Within social media narratives, childbirth is frequently framed in emotionally charged terms and success is often implicitly linked to specific birth outcomes, including mode of birth and immediate neonatal condition. Apgar score, although a clinical indicator, may therefore function as a symbolic marker of a “successful” or “problematic” birth within online perinatal narratives, potentially shaping women’s expectations and retrospective evaluations of childbirth. Mode of birth and the newborn’s Apgar score were selected as variables due to their proven impact on birth satisfaction [11]. Emotional responses to perinatal social media content and self-reported influence of social media on birth expectations were chosen to capture both the emotional and the cognitive pathway and to explore associations between social media use and perinatal perceptions in a complex, real-world context. The findings contribute to a better understanding of the digital determinants regarding maternal health.

<h3>Material and methods</h3>

<h4>Study design and participants</h4>

<br/>This cross-sectional study was conducted between February and July 2025 among women who had given birth within the previous 12 months. The study was approved by the Bioethics Committee at the Medical University of Gdańsk (Decision No. KB/17/2025; approval dated 31 January 2025).

<br/>Eligible participants were women aged 18 years or older, who had delivered a live-born infant within the past year, used social media during pregnancy or the postpartum period, and had sufficient cognitive ability to complete the questionnaire independently. Exclusion criteria comprised severe perinatal complications, diagnosed anxiety disorders, or inability to complete the survey due to language or technical barriers.

<br/>In total, 460 women participated in the study. The sample size was considered adequate for the planned statistical analyses. According to commonly accepted methodological recommendations for regression analyses, a minimum of 10-20 observations per independent variable is required to obtain stable and reliable estimates [12]. In the present study, the maximum number of predictors included in the regression models did not exceed five. Therefore, the minimum required sample size would range from 50 to 100 participants. The final sample of 460 respondents substantially exceeded these recommendations, ensuring sufficient statistical power and stability of the estimated models. The majority were aged between 26 and 35 years, had higher education and resided in urban areas. Approximately half of the sample experienced non-physiological births, including caesarean sections and instrumental deliveries. Detailed characteristics of the study group are presented in Table 1.

<h4>Data collection</h4>

<br/>Data were collected using an anonymous online survey distributed via parenting and perinatal support groups on social media platforms such as Facebook and Instagram. Potential participants were invited to take part through a study announcement that contained information about the research aims and procedures.

<br/>Participation was voluntary. After reading the study information sheet, participants provided informed consent electronically by clicking the agreement option; only those who consented were able to proceed to the questionnaire. The survey consisted of three parts: 1) sociodemographic and clinical questions; 2) items regarding social media use, emotional response to perinatal content and perceived influence on childbirth expectations; and 3) the standardised Polish version of the Birth Satisfaction Scale – Revised (BSS-R) [13]. The assessment of feelings toward childbirth-related content on social media was conducted using a single-choice question included in the questionnaire: What feelings did the perinatal content viewed on social media evoke in you? Respondents were given three possible answers: positive, neutral, or negative feelings. The perceived influence of social media on childbirth expectations was assessed using a single author-designed item with four ordinal response options ranging from “no influence” to “significant influence”.The BSS-R is a self-report instrument designed to obtain women’s subjective evaluation of childbirth experiences. It consists of 10 items rated on a five-point Likert scale (from strongly disagree to strongly agree), yielding a total score ranging from 0 to 40, with higher scores indicating greater satisfaction.

<br/>The scale is structured into three subscales:

<br/>• Stress Experienced (SE, 4 items): assesses the degree of distress, anxiety and perceived trauma during labour and birth;

<br/>• Women’s Attributes (WA, 2 items): evaluates perceived coping, control, and personal resources in managing childbirth;

<br/>• Quality of Care (QC, 4 items): measures satisfaction with communication, support, and professional care received from maternity staff.

<br/>The BSS-R is widely used in perinatal research across different settings and has demonstrated good reliability and validity. In this study, Cronbach’s a coefficients indicated acceptable to very good internal consistency for the total scale and all subscales. The Polish version of the Birth Satisfaction Scale – Revised (BSS-R) demonstrated very good internal consistency (Cronbach’s a = 0.85 for total scale; subscales a > 0.70). This confirms that the instrument provided reliable measurement of birth satisfaction in this sample.

<br/>The missing data were marginal and concerned a single observation (< 1% of the dataset). Their negligible level resulted from the configuration of the research instrument, which prevented respondents from completing the questionnaire without answering all questions. The analysis revealed no systematic patterns or associations between the occurrence of missing data and sociodemographic or clinical variables, allowing them to be classified as missing completely at random (MCAR).

<h4>Statistical analysis</h4>

<br/>All statistical analyses were performed using Statsmodels, Matplotlib, Seaborn, Scipy.stats in Python and Excel. Descriptive statistics were calculated for sociodemographic and clinical variables, including measures of central tendency (mean, median) and variability (standard deviation, range, quartiles). Normality of continuous variables was assessed using skewness and kurtosis. Categorical variables were summarised as frequencies and percentages.

<br/>Birth satisfaction, measured with the standardised Polish version of the Birth Satisfaction Scale – Revised (BSS-R), was analysed using descriptive statistics. Internal consistency of the BSS-R and its subscales was evaluated with Cronbach’s a coefficient. Associations between categorical variables were assessed via the chi-square test (c²) of independence or Fisher’s exact test when expected cell counts were low. Correlations between ordinal or non-normally distributed variables were examined with Spearman’s rank correlation coefficient (r).

<br/>To identify independent predictors of fulfilled birth expectations, binary logistic regression analysis was conducted. The dependent variable was fulfilment of birth expectations (fulfilled, which included the responses “mostly fulfilled” and “fully fulfilled”, vs. not fulfilled, which included the responses “not fulfilled at all” and “mostly not fulfilled”). Predictor variables included: women’s emotional responses to perinatal social media content (negative, neutral, positive), mode of birth (for the purposes of the analysis, this variable was transformed into two categories: non-induced vaginal delivery, designated as physiological, and induced delivery, including caesarean section or operative delivery, designated as non-physiological), self-reported influence of social media on birth expectations (yes/no), and the newborn’s Apgar score. Sociodemographic and clinical variables (age, education, parity, place of residence, pregnancy and postpartum course) were included as covariates to control for potential confounding. Statistical significance was set at p < 0.05 for all analyses.

<h3>Results</h3>

<br/>A total of 460 women participated in the study. The majority were aged 26-35 years, with a median age of 30. Most participants had higher education (83%) and lived in urban areas (76%). Regarding childbirth, 44% underwent caesarean section, 31% reported a natural birth, 21% an induced vaginal birth, and 4% an instrumental birth. The median duration of pregnancy among the surveyed women was 39 weeks. In 50% of the respondents, childbirth occurred between the 38^th and 40^th weeks of pregnancy. The majority of pregnancies (82%) and postpartum periods (94%) were physiological. Nearly all participants (95%) reported using social media for perinatal content during pregnancy, with more than 80% of women viewing both Instagram and Facebook. Every third woman also used YouTube and/or TikTok, and a few mentioned the X platform as well. Detailed characteristics are presented in Table 1.

<br/>The mean total score on the BSS-R indicated a generally high level of birth satisfaction. Internal consistency was very good for the overall scale (a = 0.85) and acceptable to good across subscales. Two-thirds of participants (62%) reported that their birth expectations were mostly fulfilled, and 18% reported full fulfilment, whereas about one-fifth (21%) stated that their expectations were not met.

<br/>Spearman’s rank correlations indicated significant positive associations between fulfilment of birth expectations and birth satisfaction scores. The strongest relationship was observed for the Quality of Care subscale (r = 0.45, p < 0.001) and the total BSS-R score (r = 0.44, p < 0.001), suggesting that higher perceived support and lower stress were closely associated with fulfilment of expectations.

<br/>Chi-square tests revealed a noteworthy association. Women who reported that social media had influenced their birth expectations were significantly more likely to state that those expectations were not fulfilled (c² = 11.08, p = 0.0009).

<br/>Binary logistic regression was conducted to identify independent predictors of fulfilled birth expectations, while controlling for clinical and sociodemographic covariates (age, education, parity, place of residence, pregnancy and postpartum course). The model was statistically significant (likelihood ratio test, p < 0.001), with a Nagelkerke pseudo-R² of 0.22, indicating moderate explanatory power.

<br/>The forest plot presents odds ratios (ORs) and 95% confidence intervals obtained from a logistic regression model assessing factors associated with the fulfilment of birth expectations. Positive and neutral emotional responses to perinatal content on social media, physiological birth, and a higher Apgar score increased the likelihood of expectations being fulfilled. In contrast, reporting that social media had shaped birth expectations was associated with a significantly higher likelihood of unmet expectations. The vertical dashed line indicates the reference value of OR = 1 (no effect).

<br/>Women reporting positive emotional responses to perinatal social media content had almost five-fold higher odds of fulfilled expectations compared to those with negative responses. Neutral responses were also associated with significantly higher odds, indicating that the emotional tone of social media engagement plays an important role in shaping birth evaluations.

<br/>A natural birth course more than doubled the likelihood of fulfilled expectations, while a higher Apgar score increased the odds by approximately 33% for each additional point. Conversely, women who explicitly acknowledged that social media had shaped their expectations were much less likely to report fulfilment (OR = 0.29), suggesting a mismatch between digital narratives and lived experiences.

<br/>Importantly, these effects remained significant even after controlling for potential confounders, including maternal age, education, parity, place of residence as well as pregnancy and postpartum course, none of which emerged as independent predictors.

<h3>Discussion</h3>

<br/>The study showed a clear distinction between neutral and positive emotional responses to perinatal social media content. Positive reactions were strongly associated with fulfilled expectations, increasing the odds of satisfaction nearly fivefold compared to negative reactions. This suggests that when content evokes strong positive emotions, it can meaningfully shape women’s perceptions and interpretations of their childbirth experience. In contrast, neutral reactions, which might reflect interest or mild engagement without strong emotional investment, also increased the likelihood of fulfilment, though to a lesser degree. This indicates that even when women are not emotionally highly stimulated by social media content, merely encountering narratives that are not negative can still support more realistic and satisfying expectations. One possible explanation is that neutral emotional responses may reflect a more critical or selective engagement with social media content, allowing women to process information without strong affective amplification. In contrast, strongly positive emotional reactions may enhance emotional identification with online narratives, increasing their influence on expectations and retrospective evaluations of childbirth. This suggests that not only the emotional valence, but also the intensity of emotional engagement with social media content plays a key role in shaping perinatal perceptions. Furthermore, a physiological birth course more than doubled the likelihood of fulfilment, while higher Apgar scores – reflecting better immediate neonatal condition – were also significantly associated with positive evaluations. Conversely, women who explicitly reported that social media shaped their expectations were substantially less likely to experience fulfilment, indicating a potential discrepancy between digital narratives and lived childbirth experiences.

<br/>These findings are consistent with previous research showing that women’s expectations may be influenced long before pregnancy and that negative birth stories can contribute to the fear of childbirth and increased likelihood of caesarean section [14]. The observed association between physiological birth and greater satisfaction underscores the alignment between uncomplicated deliveries and women’s expectations, a finding that stands in contrast to reports of rising global rates of caesarean sections, often requested for non-medical reasons [15-17]. Similarly, the association between higher Apgar scores and fulfilled expectations reflects evidence linking favourable neonatal outcomes to maternal satisfaction, including lower risk of neonatal intensive care admission [11, 18]. The paradoxical finding that women who acknowledged social media as shaping their expectations were less likely to report fulfilment suggests that online portrayals may generate rigid or idealised expectations, difficult to reconcile with clinical realities. This pattern is reinforced by studies in which portrayals of birth are compared across different media formats, where dramatization or over-medicalisation can create mismatched expectations [19-22]. It is also important to consider the role of social media algorithms in shaping perinatal expectations. Algorithm-driven content personalisation may increase repeated exposure to similar narratives, reinforcing previously held beliefs and emotional responses. As a result, women engaging with idealised or emotionally salient perinatal content may be increasingly exposed to comparable portrayals, potentially amplifying unrealistic expectations and limiting contact with more diverse or balanced perspectives. Although algorithmic exposure was not directly assessed in this study, it represents an important contextual factor in understanding how social media narratives may influence childbirth perceptions. In this study, respondents were not asked to differentiate between specific types of perinatal social media content they consumed, which limits more nuanced interpretation of the findings. However, different content types may plausibly influence expectations through distinct mechanisms. Evidence-based content produced by healthcare professionals may promote realistic expectations and informed decision-making, whereas commercial content may emphasise idealised outcomes or selectively highlight benefits of paid services. Peer-to-peer narratives, while offering emotional support and identification, may disproportionately amplify extreme or emotionally salient experiences. The absence of content differentiation should therefore be considered an important limitation, and future studies combining exposure assessment with content-specific analyses are needed to better understand these pathways.

<br/>These findings suggest that antenatal education programmes may benefit from systematically incorporating guidance on social media use and interpretation into standard prenatal curricula. Based on these findings, midwives can play an important role in antenatal education by addressing how social media influences women’s expectations and experiences of childbirth. Antenatal classes can include discussions on the often idealized and emotionally framed nature of perinatal social media content, helping women understand that digital narratives may not reflect the full range of normal childbirth experiences. Midwives can encourage women to reflect on their emotional responses to online content and to engage more mindfully with sources that promote reassurance rather than anxiety. Education can also focus on fostering flexible expectations and preparing women for different birth scenarios, emphasizing that fulfilment is not solely dependent on a physiological birth but on feeling informed, supported and empowered. Additionally, midwives can support women in critically evaluating commercial perinatal services frequently promoted on social media, distinguishing evidence-based care from marketing influences. Overall, promoting balanced, evidence-based information alongside digital literacy may help women develop more realistic expectations and support more positive subjective evaluations of childbirth. Prior evidence demonstrates that midwife-led prenatal education improves preparedness and supports physiological birth, thereby enhancing maternal satisfaction [23-25].

<h3>Limitations</h3>

<br/>Several limitations of this study should be acknowledged. First, the cross-sectional, self-reported design and recruitment exclusively through social media platforms limit causal inference and may have introduced selection bias, as participation was restricted to women who were active social media users. While the online questionnaire limited opportunities to clarify ambiguous responses, it enabled efficient recruitment of women from across the country and reduced logistical challenges. Another limitation is the overrepresentation of women with higher education (83% of the sample), a common pattern in open online recruitment that tends to attract individuals with greater digital literacy, higher health awareness, and active engagement in parenting communities [26]. Consequently, mothers with limited internet access or lower health literacy may be underrepresented. Future studies should aim to include more socio-demographically diverse populations to better reflect the educational and digital diversity of mothers aged 35 and older. Reliance on retrospective self-assessment introduces the potential for recall bias and social desirability effects. Additionally, parity in the sample was relatively low, raising questions about whether social media exerts similar influence on multiparous women. Finally, types of social media content were not differentiated (e.g. professional educational material versus peer narratives), limiting the ability to identify which exposures were most influential. Future longitudinal research, combined with content-specific analyses, would provide greater insight into these dynamics.

<h3>Conclusions</h3>

<br/>This study demonstrated that both clinical factors and digital experiences contribute to whether women’s expectations of childbirth are fulfilled. Positive or neutral emotional responses to perinatal social media content, physiological birth and higher Apgar scores were associated with greater satisfaction.

<br/>From an interpretative perspective, while physiological birth and favourable neonatal outcomes remain closely aligned with fulfilled expectations and greater maternal satisfaction, the findings highlight a disconnect between idealized or dramatized portrayals of birth and clinical realities. The lower fulfilment reported by women who recognized social media as shaping their expectations suggests that such content may foster rigid or unrealistic anticipations, potentially undermining satisfaction even in the presence of positive clinical outcomes.

<br/>Based on the findings, antenatal education programmes should explicitly incorporate structured guidance on social media use, including discussion of idealised online narratives, emotional engagement with digital content, critical appraisal of commercial messages, and promotion of flexible, evidence-based expectations regarding childbirth. Midwives can use antenatal classes to educate women about the influence of social media on childbirth expectations, highlighting that online perinatal content is often idealised and may not reflect the full range of normal experiences. Encouraging mindful engagement with social media, flexible expectations, and an understanding of clinical outcomes can help women interpret their birth experiences more positively. Promoting critical evaluation of commercially driven content and prioritising evidence-based information may further support realistic expectations and fulfilment.

<h3>Acknowledgements</h3>

<br/>The authors would like to thank the women who participated in this study and generously devoted their time to providing their views and perceptions.

<h3>Disclosures</h3>

<br/>This research received no external funding.

<br/>This study was conducted in accordance with the principles of the 1964 Declaration of Helsinki. Ethical approval was obtained from the Bioethics Committee at the Medical University of Gdańsk (Decision No. KB/17/2025; approval dated 31 January 2025). All participants provided informed consent electronically prior to completing the questionnaire.

<br/>The authors declare no conflict of interest.

<h3>References</h3>