Who Leads Decisions

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Who Leads Decisions

People want to lead decisions about their bodies, their babies, and where and how to give birth, including options for care. They report lack of autonomy, pressure to accept unwanted interventions and procedures, and a lack of complete and truthful information about their options for care.

Key Findings

More than 90% of 2700 people who completed the survey said it was very important that they lead decisions.

About 30% wanted to consider input from their care providers.

Yet, self reports indicated that it was providers, not them, who made/led the decisions.

For example, when asked who made the decision to have a caesarean section, most people reported the decisions were made by the provider.

Who made the decision to have a CS?

There were important differences based on where people gave birth.

People reported more control over their decision-making, in their own homes or in a birth center, and those who gave birth inside a hospital reported significantly less autonomy.

Autonomy (MADM) scores by place of birth

The study shows that no matter where they birth, people who have midwifery care report greater respect, higher autonomy, more privacy, and more dignity overall.

MADM scores: Autonomy by prenatal provider

Many of us have no choice when it comes to where we give birth or who takes care of us.

"I had little to no options… no doula, no birthing centers, no midwives. There was one hospital and that was it."

Self-identified as biracial, gave birth with an obstetrician in a hospital

Many of us have no choice when it comes to where we give birth or who takes care of us.

"I had little to no options… no doula, no birthing centers, no midwives. There was one hospital and that was it."

Self-identified as biracial, gave birth with an obstetrician in a hospital

People who were Black, Hispanic, and Indigenous found it harder to find a provider to attend a community birth than did people who were white. Black and Indigenous people also reported the most interest in giving birth at home in a future pregnancy.

Interest in birthing at home in a future pregnancy, stratified by race

It can be hard to read about people experiencing pressure and having procedures that they did not want, and but it’s important for these voices to be heard.

“The doctor … who came after I birthed my baby started touching my pelvic area without my knowledge or consent. When I asked what she was doing, she said, 'giving you anesthesia,' … without further explanation. I asked, 'why' and she said, 'because I have to stitch.' I didn't understand. A second later she said, 'because you tore.' I felt violated and not included in my own care of my own body. I did not like the fact that I was injected with things without my knowledge.”

Self-identified as Mexican

People reported on experiences of pressure from providers to have or to avoid interventions, tests or procedures. About half declined to have a test or procedure sometime during their pregnancy or birth.

Proportion of women that felt pressured to have childbirth interventions, stratified by race

White women were more likely to report their decision to decline was respected.

Women of color were twice as likely to be pressured or to have a procedure performed or test against their will.

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

This woman declined a glucose test and was threatened with being dropped from care.

"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."

This woman declined a glucose test and was threatened with being dropped from care.

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