Being Respected

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Being Respected

Overall, the study showed that, for the person receiving care, quality and safety in perinatal care is linked to being respected by and having trusting relationships with their care providers.

Key Findings

The GVtM survey included the Mothers on Respect Index (MORi), the Mothers Autonomy in Decision Making (MADM) scale and several items that measured whether people were treated with respect and dignity during encounters with their health care providers.

Study participants used these to rate their sense of agency, stigma and discrimination, and comfort seeking information.

Most respondents (87.1%) reported they felt comfortable asking questions, and their overall MORi scores suggested feeling respected and heard.

Proportion of service users who agreed or strongly agreed with MORi items

What was the best thing about your care?

"The affirmation of my choices."

Self-identified as Native American, had a planned home birth

"We were completely surrounded with love and support from our family, friends, and caregivers."

Self-identified as Native American, had a planned hospital birth

"I felt valued, respected, and not treated as if there was a medical problem simply because I was pregnant. I was cared for at the hospital where I worked as a Labor and Delivery nurse. My provider and colleagues knew and respected my wishes. Also having a doula was essential to my successful unmedicated birth."

Self-identified as African American, had a planned hospital birth

However, nearly a quarter of women (23.7%) reported that they did not choose the care options they received, and 1 in 5 felt that their personal preferences were not respected.

Almost a quarter (23.8%) of respondents disagreed or strongly disagreed that they were comfortable with declining tests or procedures.

Nearly 10% reported feeling pushed into accepting options suggested by a care provider.

"I was dropped by my provider at 37 weeks pregnant because I refused the fourth glucose test. I took it anyway, and they sent me a firing note the day after. I had to ask them to take me back as a client, since no other provider would help me, and they required me to sign something stating I would do whatever they asked me."

People reported that being listened to and respected as the experts in what they needed for care was very important throughout the course of their pregnancy.

What was the best thing about your care?

"My ob/family practice doctor was amazing. She let me labor how I wanted to, even with my blood pressure being as high as it was. She knew it was important to me, but she still made sure that myself and my child were healthy as well. She did not push her own thoughts and opinions on me."

Self-identified as Southeast Asian, had a planned hospital birth

"I had two hospital births before my most recent pregnancy and they were events I needed to emotionally recover from. They weren't pleasant. This pregnancy and labor/birth was a breath of fresh air! I felt supported but TRUSTED with my own body and baby! I came into myself as a mother. My midwife knew when to make her presence known and when to let me be. A wonderful relationship and bond was formed. I never knew birth could be so beautiful."

Self-identified as White, had a planned homebirth

What was the worst thing about your care?

"They decided I don't want meds so I must be fine and left me alone all night even when I said I need to push! Residents not introducing self [and then] examining...[me]."

Self-identified as South Asian, had a planned hospital birth

"All of it. I was made fun of about postpartum depression. I was told inappropriate jokes about my husband's genitals and my depression. I didn't get the birth I wanted at all."

Self-identified as Black West African, had a planned hospital birth

What was the best thing about your care?

Being able to trust the information they were given was linked to feeling safe and well cared for.

What was the best thing about your care?

"How supportive my MW was. The OB I was seeing was at first, then decided to not support VBAC like I thought."

Self-identified as African American, had a planned hospital birth

Having a midwife as their prenatal care provider, having a home birth, and vaginal birth were all linked to higher autonomy.

"Our midwife was just awesome - the level of information she provided about every decision was fantastic. She gave us sheets of information showing pros/cons about every major decision we had to make (prenatal testing, newborn care - Vitamin K, eye drops, etc.) and then gave us at least 1 week to think over the information and come back to our next appointment. She respected our choices but also made her own recommendations when we asked her to. She was comprehensive in her care."

Self-identified as African American, had a planned hospital birth

Autonomy was more likely to be low for those who had obstetricians as their primary prenatal care providers, those who gave birth at the hospital, and women who experienced an emergency Caesarean or instrumental vaginal birth.

Women who were induced, those who were transferred from the community to the hospital, and women who reported newborn health problems reported reduced autonomy.

Women of color (especially Black women), young women, first time mothers and those with low SES, pregnancy or social risks were more likely to report low autonomy.

If you found out that a close friend or family member was pregnant, what would be the most important advice you could give them?

“Make sure that you choose a provider that respects your preferences and decisions. You can't expect someone who has been unsupportive your entire pregnancy to change his or her tune because you have a birth plan.”

Self-identified as bi-racial, had homebirth with a midwife in California

Physician patients most often hesitated to ask questions because they felt their doctor might think that they were being difficult, they wanted maternity care that differed from what their doctor recommended, or because their doctor seemed rushed.

A few midwifery clients also held back questions because they felt their midwife might think that they were being difficult.

Women under 30, women who had never given birth before or had only given birth once before, and women with low SES, pregnancy risk factors or social risks, i.e., history of incarceration (herself or partner), substance use or involvement of child or family services, and/or intimate partner violence, were at increased risk for experiencing disrespectful behavior.

"Out of the eight midwives and doctors who cared for me, only one shamed me for my weight and tried to push dieting on me - and it was easy to avoid seeing her again. Other than that, all my providers treated me with respect and took me, my concerns, my opinions, and my health - and my baby's - seriously."

Self-identified as White, had a planned hospital birth

Women of color were at increased risk for reporting disrespect from care providers, with Black and Indigenous women being the most likely to report disrespectful behaviors (as measured by MORi).

People reported that the most frequent reason for being treated poorly was a difference of opinion with their caregivers.

The most vulnerable to disrespectful treatment by care providers were Indigenous women and women with social risks.

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