Freedom From Mistreatment

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Freedom From Mistreatment

Freedom from mistreatment is a human right. Participants in this study reported mistreatment by providers and health systems. They expressed a desire for freedom from mistreatment, freedom from criticism and judgment for their choices; and freedom from non-consented procedures.

Key Findings

The most common types of mistreatment participants reported were being shouted at, scolded, and threatened. Many reported being ignored when they asked for help. People also frequently described being pressured into accepting tests and procedures, and some reported having unconsented procedures and tests.

Mistreatment is 2-3x more frequent for Black and Indigenous people.

People responded to these questions with written comments:

Mistreatment is 2-3x more frequent for Black and Indigenous people.

People responded to these questions with written comments:

What was the worst thing about care?

What was the best thing about your care?

What is one thing you would change about your care?

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

Measuring Mistreatment

What was the worst thing about your care?

“I hated being shouted and lied to by the midwife. I never dreamed that a woman could treat a laboring woman that way. She was abusive and downright mean. I was refused food and water for 26 hours. I wasn’t allowed to move out of bed to walk around. I felt like I lost my autonomy over my own body. I had given up and I remember weeping when my son was born. I was at least glad he was safe. I felt like a child. And I felt so unlike my usual self. These professionals broke my spirit.”

One out of every six of participants experienced some type of mistreatment. Among those of color, twice as many experienced mistreatment.

The United States is a high income country with many hospitals and well prepared health workers; yet, these are the same rates of mistreatment during pregnancy and childbirth being reported in low resource countries.

Giving Voice to Mothers

Reproductive Health 2019

Global Inequities

In this study, about half were cared by physicians and half by midwives. We found large differences in the amount of autonomy, respect, and mistreatment that people experienced, depending on who cared for them.

Rates of Mistreatment by Care Provider

What was the worst thing about your care?

“The worst part was the abuse of power of experienced from my Ob/gyn practice during the first part of my prenatal care. I feel sorry for people who have no choice or are unable to see other options. I was raised to respect doctors and my elders. It was incredibly hard to speak my mind and terminate care with them. It still weighs on me, but I know I did it in the most professional and respectful way I could. I also know that I made the right choice.”

Self-identified as Latinx, gave birth at a freestanding birth center with a midwife in Texas

Place of birth matters.

People who gave birth in hospitals reported more mistreatment.

“There was mutual respect between my providers and myself. It made things flow more gracefully. I felt I had the best care I could ever ask for.”

Self-identified as South East Asian

“There was mutual respect between my providers and myself. It made things flow more gracefully. I felt I had the best care I could ever ask for.”

Self-identified as South East Asian

Who you are matters.

Those participants who identified as a recent immigrant, or who had financial, social or medical challenges experienced significantly more mistreatment, and racialized people were even more at risk.

What is Linked to Mistreatment?

Mistreatment by Race and Additional Socio-Demographic Variables (n=2138)

"I had the option to refuse any test or procedure. I was respected and given the chance to VBAC and I was never separated from my baby."

Self-identified as White, gave birth in Colorado

"Before I switched to a birth center, one military midwife was disrespectful of our cultural needs and refused to accept them. When I mentioned my desires, I was belittled and made to feel incompetent."

Self-identified as Latina, gave birth in California

"One of the white providers was extremely condescending during a visit where he indicated there could be problems with how my baby was growing and refused to refer me to a high risk specialist. I decided on my own to see a specialist and it turned out his measurements were wrong. My baby was a perfectly normal size."

Self-identified as Black, gave birth in Maryland

The type of birth we have matters.

Those people who had unplanned interventions during their labor and birth reported more mistreatment, and less agency in their care.

Rate of Mistreatment by Mode of Birth

A third of respondents reported pressure to accept tests and procedures, and even more reported never giving permission for procedures or tests.

Experience of Non-Consent and Pressure during Perinatal Care in the U.S. (n=1635, 51% POC, 54% White)

Logan et al. , Birth Issues in Perinatal Care (2022)

When Black, Indigenous, Latinx, or Asian persons declined tests or procedures, they were twice as likely to report that providers kept asking them until they agreed, and more likely to report unconsented interventions.

Mistreatment by Race and Context of Care

Why Does it Matter? Mistreatment and Risk of Death

Here’s how participants reflected on their experiences of respectful care:

What was the worst thing about your care?

"The OB who attended my birth was rude and cold. She refused my request to dim the lights, saying no, you're giving birth. She coldly told to stop pushing when I was in the middle of pushing to tell me that I wasn't doing it right. I think she was giving me a perineal massage, but all she was doing was literally tapping on that area. She started giving me local anesthesia, and I figured immediately she was going to give me an episiotomy without my consent. I told her no, I do not want."

Self-identified as East Asian, gave birth in New York State

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

“Normalized medical abuse and interventions without consent are commonplace in labor and delivery. Make sure you choose a care provider who will respect you and your choices or get back up in the form of a doula.”

Self-identified as Black, had a homebirth with a midwife in Iowa

What was the best thing about your care?

“I was educated on my choices with childbirth and knew there were certain things I wanted to avoid such as induction. My OB offered induction with both of my pregnancies and I declined both times. She was supportive of my decision and simply scheduled surveillance (an NST) for my overdue pregnancy. I delivered the morning of my NST.”

Self-identified as Black, had a hospital birth with an OB in Missouri

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