More than one in eight women report feeling mistreated during childbirth, according to a new study from the Columbia University Mailman School of Public Health.
The study found that mistreatment during childbirth is a “regular occurrence,” according to a news release.
Researchers from the Columbia University Mailman School of Public Health collected survey data from nearly 4,500 people from New York City and the states of Kansas, Michigan, New Jersey, Pennsylvania, Utah and Virginia to examine how often mistreatment occurs, what form it takes, and what demographic and social characteristics are more likely to result in mistreatment.
Among the general population, one in eight people said they experienced mistreatment in childbirth, with 7.6% of people saying that they felt “ignored” or that healthcare workers “refused requests for help” or failed “to respond in a timely manner.” Another 4.1% of people said they were “shouted at or scolded” by healthcare providers, and 2.3% of people said that providers threatened to “withhold treatment or force you to accept treatment that you did not want” as part of giving birth.
The odds of facing mistreatment increased if a person identified as LGBTQ+, had a history of substance use disorder, was diagnosed with a mood disorder, was unmarried, had a history of intimate partner or family violence, or had Medicaid insurance. Those who had unplanned cesarean births were also more likely to face mistreatment, the study found. The study tried to see if mistreatment rates varied based on race and ethnicity, age, educational level, area, immigration status and household income, but those results were “ambiguous.”
“Many of our results suggest that pervasive structural social stigma permeates the birth experience and shapes how care is received,” said Chen Liu, a research associate in Columbia Mailman School’s Department of Health Policy and Management, and the study’s lead author. “For example, we found that LGBTQ-identifying individuals were twice as likely to experience mistreatment, driven by higher rates of feeling forced to accept unwelcome care or being denied wanted treatment. These findings align with prior work demonstrating poorer birth outcomes among sexual minorities.”
Recent studies have found the number of people dying of pregnancy-related causes in the United States has more than doubled in the last 20 years. Black women face an increased risk, dying in childbirth at three times the rate of any other group.
The study said that negative experiences, including mistreatment, during childbirth can have long-term consequences including post-traumatic stress disorder, negative body image and changes in future reproductive decisions.
To make changes, healthcare providers should hold their staff accountable and policymakers should develop “effective interventions to improve respectful maternity care,” senior author and health policy and management assistant professor Jamie Daw said in the news release.
The study did not outline specific policy recommendations, but said that officials should focus on developing and establishing “patient-center, multifaceted interventions” that can address biases and allow for inclusive clinical settings.
“No one should experience mistreatment during what is one of the most important moments of their life,” Liu said. “We hope this study is a call to action for implementation and evaluation of patient-centered interventions to address structural health system factors that contribute to these negative experiences.”
