Background No Canadian studies to date have examined the experiences of people who decline aspects of care during pregnancy and birth. The current analysis bridges this gap by describing comments from 1123 people in British Columbia (BC) who declined a test or procedure that their care provider recommended. Methods In the Changing Childbirth in BC study, childbearing people designed a mixed-methods study, including a cross-sectional survey on experiences of provider-patient interactions over the course of maternity care. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations. Results More than half of all study participants (n = 2100) declined care at some point during pregnancy, birth, or the postpartum period (53.5%), making this a common phenomenon. Participants most commonly declined genetic or gestational diabetes testing, ultrasounds, induction of labour, pharmaceutical pain management during labour, and eye prophylaxis for the newborn. Some people reported that care providers accepted or supported their decision, and others described pressure and coercion from providers. These negative interactions resulted in childbearing people feeling invisible, disempowered and in some cases traumatized. Loss of trust in healthcare providers were also described by childbearing people whose preferences were not respected whereas those who felt informed about their options and supported to make decisions about their care reported positive birth experiences. Conclusions Declining care is common during pregnancy and birth and care provider reactions and behaviours greatly influence how childbearing people experience these events. Our findings confirm that clinicians need further training in person-centred decision-making, including respectful communication even when choices fall outside of standard care.

INTRODUCTION: Abnormal weight and its effects on health and fertility are poorly understood by patients. We aimed to evaluate differences in knowledge of abnormal weight and its effect on fertility between patients seen for infertility and general gynecology (GYN) at a rural, resident-run clinic. METHODS: Participation in this 12-question survey-based analysis of weight/fertility knowledge was offered to patients seen in our rural, resident-run clinic. Survey assessed knowledge of abnormal weight and its effect on fertility, yielding a “Fertility Knowledge Score” and “Physician Education Score.” Visit number, age, visit type, and body mass index (BMI) were collected via chart review. The mean correct scores of both groups of patients (infertility and GYN) were compared using 2 sample T-test and Chi-squared test. RESULTS: Surveys for 44 infertility patients and 51 GYN patients were included. Infertility patients had higher mean BMI (37.5) than gynecology patients (32.9), (p=0.0263); 91% of fertility patients and 80% of GYN patients were overweight/obese. Infertility patients (p=0.0239) and patients with higher BMI (p=0.0112) reported discussing weight/BMI with a physician more often. There was no difference in survey scores between new and established patients overall or when these scores were analyzed by patient weight. CONCLUSION: Both infertility and GYN patients have little insight into their own BMI, with no change over visits. BMI is higher among infertility patients. Though, infertility patients have high general knowledge of effects of abnormal weight on fertility. This suggests we are not effectively discussing individual implications of weight/BMI despite large numbers of overweight/obese patients under our care.