Cesarean section is one of the most commonly performed surgical procedures in obstetric practice. Anesthesia plays a vital role in ensuring maternal safety, comfort, and satisfaction during cesarean delivery. Spinal anesthesia is widely used for cesarean section because it provides rapid onset of anesthesia, effective pain relief, and allows the mother to remain conscious during childbirth. However, the patient's overall experience depends not only on the effectiveness of anesthesia but also on communication with healthcare professionals, preoperative counselling, intraoperative comfort, and the management of anesthesia-related complications [1].

Maternal satisfaction is an important indicator of the quality of healthcare services. Siddiqi and Jafri [1]

investigated maternal satisfaction following spinal anesthesia for cesarean delivery, highlighting the importance of evaluating women's experiences during anesthesia. Similarly, Dharmalingam and Zainuddin [2] examined maternal satisfaction among women receiving spinal anesthesia for cesarean section and emphasized the relevance of patients' experiences in assessing anesthetic care. These studies demonstrate the importance of understanding women's perspectives when evaluating the quality of obstetric anesthesia services.

Several factors may influence maternal satisfaction, including adequate pain relief, effective communication, the attitude of healthcare staff, and the management of unpleasant sensations or adverse effects. Demilew et al. [3] investigated maternal satisfaction and associated factors among women undergoing cesarean section under spinal anesthesia in Ethiopia. Bayable et al. [4] also assessed maternal satisfaction and associated factors among women undergoing cesarean delivery under spinal anesthesia. These studies support the need to identify patient-related and healthcare-related factors that contribute to satisfaction with anesthetic services.

Maternal satisfaction may also vary according to the availability of healthcare resources, institutional practices, and the quality of communication between patients and healthcare professionals. Idris et al. [5] examined maternal satisfaction and associated factors in hospitals in Eritrea, providing evidence from another healthcare setting. In Pakistan, Naseer et al. [6] compared neonatal Apgar scores and patient satisfaction between spinal and general anesthesia for elective cesarean sections. Such comparative research highlights the importance of considering patients' experiences alongside clinical outcomes when evaluating anesthetic techniques.

The choice of anesthesia can influence the mother's experience of childbirth, including her comfort, anxiety, awareness during surgery, and perception of care. Novakovic et al. [7] examined patient satisfaction with general anesthesia compared with spinal anesthesia for cesarean section. Ida et al. [8] investigated factors associated with anesthetic satisfaction following cesarean delivery under neuraxial anesthesia. Their research areas are relevant to understanding the determinants of patient satisfaction and identifying aspects of perioperative care that may require improvement.

In addition to the choice of anesthetic technique, patients' expectations and experiences should be considered when assessing the quality of anesthesia services. Leighton and Halpern [9] reviewed the effects of epidural analgesia on labor and maternal and neonatal outcomes, illustrating the broader importance of evaluating maternal outcomes in obstetric anesthesia. Charuluxananan et al. [10] investigated factors associated with patient satisfaction regarding spinal anesthesia, further supporting the need to assess satisfaction as an important component of anesthetic care.

Despite the widespread use of spinal anesthesia for cesarean section, patients may experience anxiety, fear of surgery, nausea, shivering, discomfort, or concerns about possible complications. Their satisfaction may also be influenced by the information provided before surgery, the behavior of healthcare staff, and the effectiveness of communication throughout the perioperative period. Understanding these factors is particularly important in public hospitals, where patient expectations, service demands, and available resources may differ between institutions.

In Mirpur, Azad Jammu and Kashmir (AJK), locally generated evidence regarding patients' perceptions and satisfaction with spinal anesthesia for cesarean section is important for evaluating the quality of obstetric anesthesia services. Therefore, the present study aims to assess patients' perceptions and satisfaction regarding spinal anesthesia for cesarean section in public hospitals of Mirpur, AJK. The findings may help identify factors associated with patient satisfaction, highlight areas requiring improvement, and support the development of patient-centered anesthesia services.

A descriptive cross-sectional study will be conducted in public hospitals of Mirpur, Azad Jammu and Kashmir (AJK), Pakistan, to assess patients’ perceptions and satisfaction regarding spinal anesthesia for cesarean section. The study population will include women who undergo cesarean delivery under spinal anesthesia during the study period.

 A sample of 200 patients will be recruited using a convenient sampling technique. Data will be collected through a structured, pretested questionnaire after obtaining informed consent from eligible participants. The questionnaire will include demographic characteristics, previous experience of cesarean delivery and anesthesia, preoperative information and counselling, anxiety before surgery, intraoperative comfort, pain perception, anesthesia-related side effects, communication with healthcare staff, overall satisfaction, and willingness to receive spinal anesthesia in future cesarean deliveries. Patient satisfaction will be assessed using predefined response categories, such as satisfied, partially satisfied, and dissatisfied. Data will be analyzed using SPSS version 26. Descriptive statistics, including frequencies, percentages, means, and standard deviations, will be used to summarize the findings. Associations between patient satisfaction and selected demographic and clinical variables will be assessed using appropriate statistical tests, including the chi-square test for categorical variables. A p-value of less than 0.05 will be considered statistically significant. Ethical approval will be obtained from the relevant institutional ethics review committee before data collection, and confidentiality and anonymity of participants will be maintained throughout the study.

A total of 200 patients were included in the illustrative analysis from Mohi-ud-Din Islamic Medical College & hospital  Mirpur, and AJK Medical College & hospital . Of these, 100 (50%) were allocated to each hospital. The largest age group was 26–30 years, comprising 76 (38%) patients, followed by 64 (32%) aged 18–25 years. Most participants were from urban areas (56%), and 33% had secondary education.

Regarding previous experience, 82 (41%) patients had undergone a previous cesarean section, while 76 (38%) had previous experience of spinal anesthesia. In terms of perception, 148 (74%) considered spinal anesthesia safe, 132 (66%) reported adequate preoperative information, and 156 (78%) reported comfort during surgery. Preoperative anxiety was reported by 86 (43%) patients, while 160 (80%) expressed a preference for spinal anesthesia in a future cesarean section.

Regarding anesthesia-related discomfort, shivering was the most frequently reported complaint (27%), followed by nausea or vomiting (19%), intraoperative pain or discomfort (14%), headache (11%), and itching (9%). Seventy-six (38%) patients reported no discomfort.

Overall, 142 (71%) patients were satisfied with spinal anesthesia, 38 (19%) were partially satisfied, and 20 (10%) were dissatisfied. These illustrative findings suggest generally favorable patient perceptions and satisfaction, although preoperative anxiety, counselling, and anesthesia-related discomfort may require further attention.

Table 1 :  Demographic characteristics of participants (n = 200)

Table 2 :  Distribution by study hospital and previous experience

 Table 3 :  Patients’ perceptions regarding spinal anesthesia

Table 4 :  Anesthesia-related discomfort and side effects

Table 5:  Overall patient satisfaction

The present study assessed patients’ perceptions and satisfaction regarding spinal anesthesia for cesarean section in public hospitals of Mirpur, AJK. In the illustrative results, 71% of patients were satisfied, 19% were partially satisfied, and 10% were dissatisfied. Patient satisfaction is an important indicator of healthcare quality and reflects the relationship between patients’ expectations and their actual experiences of care. Heidegger et al. [11] emphasized that satisfaction should be assessed through multiple aspects of anesthetic care rather than relying solely on a general satisfaction rating.

The overall satisfaction observed in this illustrative dataset was lower than the 96.8% satisfaction reported by Myles et al. [12] in a prospective survey of 10,811 surgical patients. Their study also found that intraoperative awareness, postoperative pain, severe nausea and vomiting, and other complications were associated with

dissatisfaction. These findings highlight the importance of

preventing and promptly managing unpleasant experiences during and after anesthesia.

In the present illustrative analysis, 74% of patients considered spinal anesthesia safe, while 78% reported comfort during surgery. Auquier et al. [13] demonstrated the importance of systematically measuring perioperative satisfaction using an appropriate questionnaire. Their work supports assessing specific dimensions of care, including comfort, information, and patients’ overall experiences, to identify areas requiring improvement.

Preoperative anxiety was reported by 43% of patients, while 66% reported receiving adequate information before surgery. Kestin [15] discussed the role and clinical considerations of spinal anesthesia in obstetric practice. Clear preoperative explanations may help patients understand the procedure, prepare for expected sensations, and develop realistic expectations. However, the relationship between counselling and anxiety should be evaluated using actual patient data before drawing conclusions about its effect on satisfaction.

Regarding anesthesia-related discomfort, shivering was reported by 27% of patients, nausea or vomiting by 19%, and intraoperative pain or discomfort by 14%. Juhani and Hannele [16] examined complications associated with spinal anesthesia for cesarean delivery, highlighting the clinical importance of recognizing and managing adverse events. Myles et al. [12] also identified pain and severe nausea or vomiting as factors associated with patient dissatisfaction. These findings support the need for careful monitoring and timely treatment of anesthesia-related symptoms.

Maternal safety remains an essential component of obstetric anesthesia. Hawkins et al. [17] examined anesthesia-related maternal deaths in the United States between 1979 and 1990, demonstrating the importance of anesthesia safety in obstetric care. Although the present study focuses primarily on patient perceptions and satisfaction rather than serious clinical outcomes, patients’ confidence in anesthetic care may be influenced by their understanding of safety measures and the quality of communication with healthcare professionals.

Lee [18] discussed potential approaches to improving satisfaction with spinal anesthesia. In the present illustrative dataset, 80% of patients expressed willingness to choose spinal anesthesia for a future cesarean section. This preference may reflect positive experiences with the technique, although willingness to choose it again does not necessarily correspond directly to overall satisfaction. Patient education, effective communication, adequate analgesia, and prompt management of discomfort may help improve the overall experience.

Choi et al. [19] compared combined spinal–epidural anesthesia with epidural anesthesia for cesarean section, illustrating the importance of evaluating anesthetic techniques in relation to their clinical characteristics and patient experience. However, because the present study concerns spinal anesthesia and does not directly compare anesthetic techniques, its findings should not be used to establish the superiority of one technique over another.

Finally, Oh et al. [20] examined causes of patient dissatisfaction with anesthetic care, reinforcing the importance of identifying potentially modifiable aspects of the perioperative experience. In the present illustrative analysis, 29% of patients were either partially satisfied or dissatisfied. This group represents a potential target for improvements in counselling, communication, comfort, and symptom management. Further analysis of actual data should determine whether these factors are statistically associated with satisfaction.

Overall, the illustrative findings suggest that patients may have generally favorable perceptions of spinal anesthesia for cesarean section, while anxiety, inadequate information, and anesthesia-related discomfort remain important areas for attention.

The present study indicates that patients may have generally positive perceptions and satisfaction regarding spinal anesthesia for cesarean section in hospitals of Mirpur, AJK. Most participants in the illustrative results were satisfied with the anesthetic technique and expressed willingness to choose it for future cesarean deliveries. However, preoperative anxiety, inadequate counseling, and anesthesia-related discomfort, particularly shivering and nausea, may affect the patient experience. Improving preoperative education, communication, intraoperative monitoring, and timely management of side effects may enhance patient satisfaction.

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