Patient-led decision making: Measuring autonomy and respect in Canadian maternity care

Vedam, Saraswathi; Stoll, Kathrin; McRae, Daphne N.; Korchinski, Mo; Velasquez, Raquel; Partridge, Sarah; McRae, Lorna; Martin, Ruth Elwood; Jolicoeur, Ganga

doi:10.1016/j.pec.2018.10.023

Cited by 89 publications

(97 citation statements)

References 37 publications

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“…Evidence in support of person-centered care is extensive, particularly in the reproductive health arena. [25][26][27][28][29] Elements of person-centered care, including individualized care, communication, creating partnerships in autonomy and decision making, and building relationships, are well documented as ways to improve the experience and quality of health care, especially with women of color. 14,29,30 Respectful perinatal care, in relation to experiences of respect, autonomy, and mistreatment, has also been extensively studied and reported upon.…”

Section: Discussionmentioning

confidence: 99%

“…14,29,30 Respectful perinatal care, in relation to experiences of respect, autonomy, and mistreatment, has also been extensively studied and reported upon. 14,26,30 Systemslevel issues such as fragmented care, inflexible schedules, and long wait times are widely known as issues in the current health care system, often disproportionately affecting people of color. 13,31 Potential solutions that have been shown to improve care experience include care navigation and an emphasis on continuity of care.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care

Altman

McLemore

Oseguera

et al. 2020

J Midwife Womens Health

115

108

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Introduction Women of color are at increased risk for poor birth outcomes, often driven by upstream social determinants and socially structured systems. Given the increasing rate of maternal mortality in the United States, particularly for women of color, there is a pressing need to find solutions to improving care quality and access for racially marginalized communities. This study aims to describe and thematically analyze the recommendations to improve pregnancy and birth care made by women of color with lived experience of perinatal health care. Methods Twenty‐two women of color living in the San Francisco Bay Area and receiving support services from a community‐based nonprofit organization participated in semistructured interviews about their experiences receiving health care during pregnancy and birth. Interviews were audio‐recorded and transcribed, and transcripts were analyzed using thematic analysis to highlight recommendations for improving perinatal care experiences. Results Participants shared experiences and provided recommendations for improving care at the individual health care provider level, including spending quality time, relationship building and making meaningful connections, individualized person‐centered care, and partnership in decision making. At the health systems level, recommendations included continuity of care, racial concordance with providers, supportive health care system structures to meet the needs of women of color, and implicit bias trainings and education to reduce judgment, stereotyping, and discrimination. Discussion Participants in this study shared practical ways that health care providers and systems can improve pregnancy and birth care experiences for women of color. In addition to the actions needed to address the recommendations, health care providers and systems need to listen more closely to women of color as experts on their experiences in order to create effective change. Community‐centered research, driven by and for women of color, is essential to improve health disparities during pregnancy and birth.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care

Altman

McLemore

Oseguera

et al. 2020

J Midwife Womens Health

115

108

View full text Add to dashboard Cite

show abstract

“…[2][3][4][5][6][7][8] Work in this area reflects a growing recognition that quality maternity care requires more than increasing access to facility-based care and skilled attendants and that highly medicalized and impersonal care is not just disrespectful, but increasingly unsafe for women and their infants. 1 Respectful maternity care is not a luxury, but a human right with the potential to improve maternal and infant outcomes in all countries.…”

Section: Introductionmentioning

confidence: 99%

“…Interest in measuring and providing respectful maternity care has grown rapidly over the past three decades, and the effort to describe, define, enumerate, and implement the elements of respectful maternity care around the world has led to numerous publications and an impressive consensus of these elements. [2][3][4][5][6][7][8] Work in this area reflects a growing recognition that quality maternity care requires more than increasing access to facility-based care and skilled attendants and that highly medicalized and impersonal care is not just disrespectful, but increasingly unsafe for women and their infants.…”

Section: Introductionmentioning

confidence: 99%

Can respectful maternity care save and improve lives?

Morton

Simkin²

2019

Birth

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“…Pressure from care providers to have an induction or cesarean section was one of the factors signi cantly linked to PTSD symptoms (21). In an analysis of the full Changing Childbirth in BC dataset with 2051 childbearing people from British Columbia Vedam et al (22) identi ed that pressure to have an induction or cesarean section, along with perceived differences in opinion between childbearing people and their providers (about care options), were signi cantly linked to loss of autonomy among childbearing people. These ndings, together with results from the current analysis, establish a rm connection between pressure and coercion from care providers, loss of autonomy, and post-traumatic stress (15).…”

Section: Discussionmentioning

confidence: 99%

I felt so much conflict instead of joy: An analysis of narratives from pregnant people in British Columbia who declined care recommendations

Stoll¹,

Wang²,

Niles³

et al. 2020

Preprint

Self Cite

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Background No Canadian studies to date have examined the experiences of people who decline care during pregnancy and birth. The current analysis bridges this gap by describing narratives from 892 people in British Columbia (BC) who refused a test or procedure that their care provider recommended. Methods In the Changing Childbirth in BC study, childbearing people designed a mixed-methods study that captured experiences of receiving maternity care, including novel items describing provider-patient interactions. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations. Results Close to half of people who participated in the survey (n = 892; 46%) declined a test or procedure. 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.

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Patient-led decision making: Measuring autonomy and respect in Canadian maternity care

Cited by 89 publications

References 37 publications

Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care

Listening to Women: Recommendations from Women of Color to Improve Experiences in Pregnancy and Birth Care

Can respectful maternity care save and improve lives?

I felt so much conflict instead of joy: An analysis of narratives from pregnant people in British Columbia who declined care recommendations

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