Respectful Maternity Care Research

(Canadian Institutes of Health Research)

Our multidisciplinary team has launched a national survey examining the quality of pregnancy and childbirth care in Canada, including experiences of respect, support, discrimination, and/or mistreatment. This is the first project of its kind that asked community members to shape the research questions aimed at improving the quality of care for childbearing families in Canada.

The research takes a community-based approach to reach those who are often missed in health care surveys - including people from different identities, circumstances, or backgrounds.

Take the RESPCCT Survey

Learn more and share the RESPCCT Study

(Michael Smith Foundation for Health Research, Vancouver Foundation)

Changing Childbirth in BC is the first study in the province that looks at person centred outcomes for pregnancy and birth. Over 4000 women participated in the study, from all across the province.

The focus of the study was to understand how women experience maternity care in BC, especially women and pregnant people from communities that are typically under-represented in research. More specifically, this study set out to try and understand the experiences of women as they navigate the different options for maternity care in the province, with a special focus on respectful maternity care. 

Learn more about Changing Childbirth in British Columbia here

(American Institute of Research)

Global implementation of the Mothers Autonomy in Decision Making Scale (MADM) and the Mothers on Respect (MORi) index, and the Mistreatment (MIST) index across diverse populations, and contexts for pregnancy and birth care.

Learn more about MADM and MORi here

Learn more about application to research and implementation for accountability here.

(Transforming Birth Fund, Groundswell Fund)

This participatory action study in the US used indicators developed and validated by service users to examine how planned place of birth, race and ethnicity affect pregnancy and birth care, experiences with respect, discrimination, or mistreatment, and access to options for care.

Find an executive summary and learn more about the project and the partners here

Learn about the article based on Giving Voice to Mothers, Inequity and mistreatment during pregnancy and childbirth in the United States, here.

In development via collaboration with multidisciplinary stakeholders and Dr. Molly Altman.

 (BC Support Unit - Patient Centred Measurement Cluster, The Firelight Group, CIHR IRSC)

The overarching goal for this study is to improve the childbirth experiences of Indigenous people who live in remote or rural areas, young parents, and those who experience multiple life challenges (such as incarceration, relocation, substance use, housing instability and/or poverty).  Funded by the BC Support Unit for People and Patient-Oriented Research, this project aims to to develop person-centered measures of respect, disrespect, racism and/or mistreatment as experienced by Indigenous families during pregnancy and childbirth.

This project is led by Indigenous researchers, Dr. Rachel Olson, Co-Director of the Firelight Group and Hon Wanda Phillips-Beck, Seven Generations Scholar, First Nations Health and Social Secretariat of Manitoba, and with the support of Elder Roberta Price and Dr. Saraswathi Vedam, Principal of the Birth Place Lab. With their collective expertise guiding the participatory methods for this research, we invite community members to engage in every step of the research process from visioning how to collect data, leading data collection in community, helping the team to interpret the results and taking the findings back to the communities. We recognize the need to ask for input in culturally safe ways and multiple ways of collecting information such as online survey, talking circles, voice or video recordings made by women who want to share a story through a mobile app, and/or one on one conversations with trusted community leaders and Elders. We will seek guidance and leadership from Indigenous Knowledge Keepers and Elders on respectful ways to collect information in their community members. 

We acknowledge that Indigenous Knowledge Keepers and Elders are integral to our project and must be involved and provide leadership throughout the community engagement phases, to ensure that Indigenous ways of knowing drive Indigenous ways of doing. They also play an important role in providing safe spaces for community members and opportunities for healing during difficult times. This is critical when addressing issues that are so closely linked to colonial histories, harms, and the impacts of systemic discrimination.

We will co-develop a roadmap and strategy for Indigenous communities to lead or meaningfully participate in maternity care research that promotes autonomy cultural safety, and decolonizes birth research.

To find out more about the Firelight Group, please go to https://firelight.ca/.

Implementation: Person-Centred Decision Making and Care

MADM

The Mothers Autonomy in Decision Making scale (MADM) is a scale developed to assess women’s experiences with maternity care.

MADM

It is a reliable and valid instrument, presently MADM version 1.0 is the most recent version and should be used for all new studies.

MOR

The Mothers on Respect index (MOR) is a scale developed to assess the nature of respectful patient-provider interactions and their impact on a person’s sense of comfort, behavior, and perceptions of racism or discrimination.

MOR

The MOR index is a reliable, patient-informed quality and safety indicator that can be applied across jurisdictions to assess the nature of provider-patient relationships, and access to person-centered care. 

MIST

The Mistreatment Index (MIST) is a set of patient designed indicators of mistreatment that align with the seven dimensions of mistreatment identified by the Bohren typology. 

MIST

This scale has been used in a national study in the US.Pregnant persons can use this index to identify which, if any of the dimensions of mistreatment they may have experienced in their maternity care. 

(UBC Teaching and Learning Enhancement Fund)

This course includes 5 online interactive modules on person-centred decision making, inter-professional teamwork, communication, and conflict transformation in maternity care.

Click here to learn more

Click here to see a 40 second animation of our person-centred decision tool

(Vancouver Coastal Health Research Institute)

In collaboration with Dr. Sarah Munro, this project led to the development and piloting of a patient decision aid for choice of model of maternity care and place of birth for BC service users.

(Transforming Birth Fund)

The Undisturbed Labour Birth Index (ULab) is a quality care measure, based on evidence-based indicators, that can be implemented to assess pregnancy and birth care in institutions and at the clinical practice level.

Learn more here

(Transforming Birth Fund, Professional Organizations, sponsors)

The Birth Place Lab convened a multi-stakeholder group of leaders to develop a strategic implementation plan for emerging evidence, tools, and models of care that can eliminate inequities, and enhance quality of care across all communities.

Learn more here

As healthcare systems seek to reorganize and redeploy resources to protect the quality, safety, rights and dignity of pregnant people during periods of crisis, we are marshalling the collective wisdom, expertise and lived experiences of members of the Global Perinatal Task Force on Quality Perinatal Care during COVID-19. We are co-creating an accessible virtual platform to bring critical, evidence-based guidance and pragmatic information to communities globally. Together we are designing, developing, and disseminating the Quality Perinatal Care Rapid Response Repository (QPC-RRR), an interactive, digital repository of resources and a mapping tool of culture-matched strategies that are immediately accessible to a wide range of stakeholders across multiple levels of service and connectivity.

Learn more about the Global Task Force here

Learn more about the Task Force Members

Place of Birth and Provider

(Transforming Birth Fund)

In collaboration with colleagues at the University of Technology Sydney and a global Delphi panel of multidisciplinary experts we developed a, reliable and practical tool that can be used to rate the quality of research that examines the effects of birth place on health outcomes.

Learn more here

(Transforming Birth Fund)

The AIMM Study, explores the relationships between access, integration, and density of midwives in the United States with key pregnancy, birth, and newborn outcomes. Findings are now informing policy initiatives and activities at the state and regional levels.

Access the interactive maps, view a state-by-state comparison, and access the full report and social media graphics here

Best Practice Guidelines: Transfer from Planned Home Birth to Hospital

What are the guidelines?

These guidelines were designed to facilitate the safe and mutually respectful transfer of care from planned home birth to a hospital.

How can I apply the guidelines?

Three model transfer forms: Maternal, Infant and Nurse are available for individual practitioners and institutions to support the implementation of the guidelines.

Click here to learn more

Best Practice Guidelines for Interprofessional Collaboration Between Community Midwives and Specialist Providers

Why do we need Interprofessional Collaboration?

Collaborative care throughout the antepartum, intrapartum, and postpartum periods is crucial to safety in all birth settings, including hospital, birth center, and home. It improves health outcomes and meets the diverse needs and preferences of families.

Details

Addressing the various levels of interactions between care providers from discussion, through consultation, collaboration, up to transfer of care from one provider to another. Best practices for community midwives and collaborating providers and system level requirements for collaborative care are identified.

Click here to learn more

The Home Birth Summits brought a cross-section of the maternity care system into one room to discuss improved integration of services for all women and families in the United States. In 2011, 2013, and 2014 the Home Birth Summits convened a multidisciplinary group of leaders, representing all stakeholder perspectives, to address their shared responsibility for care of women who plan home births in the United States. 

Learn more here

Midwifery Workforce

(Transforming Birth Fund)

The AIMM Study, explores the relationships between access, integration, and density of midwives in the United States with key pregnancy, birth, and newborn outcomes. Findings are now informing policy initiatives and activities at the state and regional levels.

Learn more here.

Scaling up access to patient-centered, high quality models of health care delivery is a provincial priority, yet only a small proportion of families can access midwifery care and the profession is facing numerous challenges that threaten its growth and sustainability. A study conducted by Stoll & Gallagher (2018) revealed that 40% of BC midwives have seriously considered leaving the profession in the 12 months preceding data collection and 1 in 10 were actively making plans to leave.

Click here to learn more about studies about midwifery burnout and to assess your own level of burnout. 

Informed by two years of data collection with BC midwives and midwifery leaders across the country, the Sustainable Midwifery Practice Taskforce used an appreciative inquiry framework to identify solutions to occupational stress and burnout among BC midwives. The report includes actionable recommendations at all levels, from government to the individual midwife, to help improve the sustainability of midwifery as a career in BC and enhance the wellbeing of BC midwives.

Click here to view the report.

The International Confederation of Midwives recommends that all pregnant people should have access to midwifery care.

The benefits of midwifery-led care for women with complex needs are well-documented. McRae et al. (2016) published a scoping review that showed women with low socio-economic position (SEP) who had antenatal midwifery care had reduced odds of preterm births (PTB), low and very low birthweight babies (LBW) and their babies spent fewer days in the NICU, compared to women under the care of physicians. Using BC perinatal date, McRae et al. (2018 a,b) were able to demonstrate that women with low SEP, and those affected by substance use and mental illness had lower odds of small for gestational age babies, PTB and LBW.

More research is needed about the changing profile of midwifery clients over time and the lived experience of midwives caring for this population, to advocate for better supports for midwives.

Learn more about this project here

Attitudes About and Preferences for Birth

An often-neglected consequence of the institutionalization of childbirth is that children have no or few opportunities to observe and learn about birth. Childbirth is something that happens at the hospital, behind closed doors. Over the past ten years Dr. Stoll has worked with a team of midwifery and nursing researchers from eight countries, to understand the attitudes of young people towards birth. We demonstrated empirically what we already knew anecdotally: lack of exposure to and lack of knowledge of birth is linked to increased fear. Fear, in turn, is linked to preferences for Cesarean section and other interventions.

Click here to learn more about research into the attitudes and preferences of young people who plan to have children, how to measure childbirth fear among young adults and how early education led by midwives might decrease misperceptions and fears around birth.