Examining respect, autonomy, and mistreatment in childbirth in the US: do provider type and place of birth matter?

Abstract

Background Analyses of factors that determine quality of perinatal care consistently rely on clinical markers, while failing to assess experiential outcomes. Understanding how model of care and birth setting influence experiences of respect, autonomy, and decision making, is essential for comprehensive assessment of quality. Methods We examined responses (n = 1771) to an online cross-sectional national survey capturing experiences of perinatal care in the United States. We used validated patient-oriented measures and scales to assess four domains of experience: (1) decision-making, (2) respect, (3) mistreatment, and (4) time spent during visits. We categorized the provider type and birth setting into three groups: midwife at community birth, midwife at hospital-birth, and physician at hospital-birth. For each group, we used multivariate logistic regression, adjusted for demographic and clinical characteristics, to estimate the odds of experiential outcomes in all the four domains. Results Compared to those cared for by physicians in hospitals, individuals cared for by midwives in community settings had more than five times the odds of experiencing higher autonomy (aOR: 5.22, 95% CI: 3.65–7.45), higher respect (aOR: 5.39, 95% CI: 3.72–7.82) and lower odds of mistreatment (aOR: 0.16, 95% CI: 0.10–0.26). We found significant differences across birth settings: participants cared for by midwives in the community settings had significantly better experiential outcomes than those in the hospital settings: high- autonomy (aOR: 2.97, 95% CI: 2.66–4.27), respect (aOR: 4.15, 95% CI: 2.81–6.14), mistreatment (aOR: 0.20, 95% CI: 0.11–0.34), time spent (aOR: 8.06, 95% CI: 4.26–15.28). Conclusion Participants reported better experiential outcomes when cared for by midwives than by physicians. And for those receiving midwifery care, the quality of experiential outcomes was significantly higher in community settings than in hospital settings. Care settings matter and structures of hospital-based care may impair implementation of the person-centered midwifery care model.

Respectful Care for All: A Midwifery Practice and Policy Imperative

“…For this subset of 1290 respondents, mistreatment was less likely for those giving birth in community settings with midwives compared with physicians in hospital settings. Although autonomy was greater for respondents cared for by midwives in hospitals, reported mistreatment was not different compared with those cared for by physicians in hospitals 3 …”

“…Although autonomy was greater for respondents cared for by midwives in hospitals, reported mistreatment was not different compared with those cared for by physicians in hospitals. 3 Authors of a qualitative analysis of nearly 100 birth stories from 61 participants, analyzed using previously determined domains of mistreatment, found descriptions of mistreatment in 42.7% of narratives. Most instances were classified as poor rapport, such as poor communication, loss of autonomy, and lack of supportive care; none were physical or sexual abuse.…”

“…In group practice settings, raise these questions to the practice level, implementing efforts to improve communication among colleagues and with patients while seeking their input. Midwives must continue work at the system level, assuring that administrators implement policies that allow the full expression and practice of midwifery care within hospital settings 3 and prevent those that may allow mistreatment and disrespect, while explicitly demonstrating that all are welcome and will be treated with respect. System‐level messages must be clear that respectful care and communication are expected in all settings.…”

Exploring online reproductive health promotion in Canada: a focus on behavioral and environmental influences from a sex and gender perspective

“…The postpartum period is mentally, physically, and emotionally complex, involving physical recovery from pregnancy and the competing demands of life with an infant [ 64 ]. Americans [ 65 ] and Canadians [ 28 ] predominantly give birth in hospitals, attended by obstetricians, resulting in a marked decline in reproductive health promotion to postpartum women + [ 64 , 66 ]. Online Canadian government postpartum health promotion for women + emphasized breastfeeding transmission risks associated drugs, alcohol, and tobacco consumption, along with mental health and quality of life benefits of nutrition, and physical activity.…”

Intrapartum time intervals and transfer of nulliparae from community births to maternity care units in Germany

“…1 Birth in the community has also been associated with increased maternal satisfaction, 5,6 even more than a decade after birth. 7 Moreover, giving birth at home or in birth centers is linked to more respectful treatment by care providers, [8][9][10] increased person-centeredness, and opportunities for childbearing people to lead decisions about their care. 11,12…”