Mistreatment by health care providers during childbirth ‘common’ in US

Key takeaways:

• One in eight women with a live birth in 2020 reported mistreatment by a health care provider during childbirth.
• Factors ranging from sexual orientation to medical history were tied to experiencing mistreatment.

Mistreatment by health care professionals during childbirth is “common” in the U.S., with one in eight women with a live birth in 2020 reporting mistreatment, according to study results published in JAMA Network Open.

“Negative experiences during childbirth can have long-term consequences for birthing individuals, including PTSD, negative body image, feelings of dehumanization and changes in future reproductive decisions,” Chen Liu, MHS, staff associate in the department of health policy and management at Columbia University Mailman School of Public Health, and colleagues wrote. “However, experiences of mistreatment during childbirth have not been widely documented in the U.S.”

Liu and colleagues conducted a cross-sectional study utilizing representative survey data from 4,458 postpartum women (mean age, 29.9 years; 54.4% white; 58.8% commercially insured) from six U.S. states and New York City who responded to the 2020 Pregnancy Risk and Monitoring System. All women had a live birth in 2020 and participated in the Postpartum Assessment of Health Survey at 12 to 14 months postpartum. Researchers measured mistreatment during childbirth using the Mistreatment by Care Providers in Childbirth scale, a validated measure of self-reported experiences of eight mistreatment types.

Overall, 13.4% of women reported experiencing mistreatment during childbirth.

Being “ignored, refused request for help or failed to respond in a timely manner” was reported by 7.6% of women and was the most commonly reported type of mistreatment. Being “shouted at or scolded” by clinicians was reported by 4.1%, any other mistreatment was reported by 2.7% and having clinicians threaten “to withhold treatment or force you to accept treatment that you did not want” was reported by 2.3%.

The following factors were associated with experiencing mistreatment during childbirth:

• identifying as LGBTQ (OR = 2.3; 95% CI, 1.4-3.8);
• being Medicaid-insured (OR = 1.4; 95% CI, 1.1-1.8);
• being unmarried (OR = 0.8; 95% CI, 0.6-1);
• having obesity before pregnancy (OR = 1.3; 95% CI, 1-1.7);
• having an unplanned cesarean birth (OR = 1.6; 95% CI, 1.2-2.2);
• having substance abuse disorder history (OR = 2.6; 95% CI, 1.3-5.1);
• experiencing intimate partner or family violence (OR = 2.3; 95% CI, 1.3-4.2);
• having a mood disorder (OR = 1.5; 95% CI, 1.1-2.2); or
• giving birth during COVID-19 (OR = 1.5; 95% CI, 1.1-2).

Researchers observed no statistically significant associations of mistreatment with race and ethnicity, age, educational level, rural or urban residency, immigration status or household income.

“In this cross-sectional study conducted in 6 states and New York City, we found that mistreatment during childbirth was a common experience,” the researchers wrote. “To our knowledge, evidence of effective interventions to improve respectful maternity care in the U.S. is scant. There is a need for the development and evaluation of patient-centered, multifaceted interventions that address implicit biases, cultural competence, health care workforce conditions, the inclusivity of clinical settings and other structural factors, including health system factors, to improve childbirth experiences.”