New Alert: Mistreatment During Maternity Care

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A new study published by the Centers for Disease Control and Prevention (CDC) found that one in five women in the United States were mistreated during maternity care. This mistreatment could include any of the following:

  • Receiving no response to requests for help.
  • Being shouted at or scolded.
  • Not having their privacy respected.
  • Being threatened.
  • Having treatment withheld.
  • Being made to accept unwanted treatment.

Mistreatment was more common for minority women, with 30 percent of Black women, 29 percent of Hispanic women, and 27 percent of multiracial women reporting mistreatment. Mistreatment was also more common among women with no insurance (28 percent) and women with public insurance (26 percent) than among women with private insurance (16 percent).

This study took data from an optional online survey that asked mothers questions about their experiences during pregnancy and the labor/delivery of their most recent child. The survey asked about mistreatment during maternity care as well as whether mothers felt comfortable bringing questions and concerns to their providers.

The survey was available to 7,607 women, with about 2,407 of those women completing it (32 percent). Five mothers were excluded due to being 65 years or older, resulting in 2,402 mothers’ responses being included in the final analysis.

The most common forms of mistreatment included being ignored by their provider (9.7 percent), being lectured or yelled at (6.7 percent), having their physical privacy invaded (5.1 percent), and being threatened with either the possibility of not receiving treatment or being forced to accept a treatment they did not consent to (4.6 percent).

The study also examined whether mothers felt comfortable bringing questions and concerns to their providers. According to the survey, approximately half (45 percent) of mothers reported refraining from asking questions and bringing up concerns they had. The main reasons for this were as follows:

  • They thought that what they were experiencing was normal (28.8 percent).
  • They did not want to make a “big deal” out of the situation (21.5 percent).
  • They were worried they would be seen as a difficult patient (20.7 percent).
  • Someone close to them told them that what they were experiencing was normal (21.2 percent).

This study had several important limitations. First, it was not a peer-reviewed study, meaning it was not published in a journal that requires the study to be reviewed by experts in the field. The data were also based on an optional survey with a low response rate (about 30 percent), and the type of person who would respond to an optional survey may not be representative of the average mother. The survey was also self-reported, and mothers may have underreported mistreatment due to social desirability bias (translation: giving answers that they think would make others see them in a more positive light).

Overall Translation

This study suggests that mistreatment during maternity care may be more common than previously thought, particularly among racial minorities and/or individuals who have no insurance or public insurance. The study’s authors suggest that health care providers involved in maternity care should practice “respectful care,” in which they acknowledge their own unconscious biases and focus on the needs of the patient.

What can you do to improve the quality of your own maternity care?

  1. Interview potential providers of maternity care before you commit to a provider and bring up any concerns you may have in the interview. Ask how the provider engages in shared decision-making with their patients and how they communicate with patients when there is a disagreement. Ask them about some of your care preferences, whether it is an unmedicated birth or an epidural, the minute you walk into the hospital to gauge their response. Pay attention to how they respond to your questions—do they seem understanding and open to your questioning, or do they seem annoyed or dismissive? Make sure that your personalities and communication styles are compatible.
  2. Research different treatment options during your maternity care so you can make an informed decision with your provider. Knowing what is normal and what isn’t can help you better understand what is going on during your treatment process. It can also be helpful to be informed of the pros and cons of different decisions you may have during your pregnancy. (For research-backed information on pregnancy and delivery, see Evidence-Based Birth.)
  3. Trust your intuition. This research suggests that mothers may be afraid to speak up when they sense something is wrong. It is important to listen to your body and its needs regardless of whether you think it is a “silly” concern or other people are telling you that it is “normal.” If you feel like something is “off” with you and/or your baby, speak up to your provider as soon as possible.
  4. Change care providers if you are mistreated. Remember that you can always change your mind about maternity care. I once changed care providers at 36 weeks pregnant when my care preferences were ignored. It is never too late, and you don’t have to tell your previous care provider why you are making the switch.

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