Bearing witness: disrespectful maternity care

An important study published in Birth further illustrates the disrespectful care and abuse that some women experience during childbirth. Morton et al (2018) used Maternity Support Survey data from 2781 respondents to investigate doulas’ and nurses’ reports of witnessing six types of disrespectful care in the US and Canada.

A key finding was that, “Doulas and nurses frequently said that they witnessed verbal abuse in the form of threats to the baby’s life unless the woman agreed to a procedure, and failure to provide informed consent.” (Morton et al 2018)

The importance of informed decision making is something that I have written about in depth, and hearing that this is not being facilitated is always concerning. But the problem does not seem to be going away. In Morton et al’s (2018) study, “Verbal abuse in the form of threats to the baby’s life was reported by one-third of respondents, with doulas significantly more likely than nurses to report this behavior occurring occasionally or often. Although concern about fetal well- being can be justified in many situations, childbirth professionals refer to the use of unwarranted threats as “playing the dead baby card.” Since both doulas and nurses reported witnessing this threat, we assume that respondents in both roles are able to distinguish between a truly emergent situation where concerns about fetal status are valid compared with when the threat is empty and used as a coercive mechanism to obtain compliance.” (Morton et al 2018)

Morton et al (2018) also found a strong association between observing disrespectful care in childbirth and intention to leave the field, raising important considerations for strategies to improve maternity care quality and outcomes. MSWs who support women during labor and birth can also experience secondary trauma after witnessing disrespectful care, especially if they feel powerless to intervene. Doulas have long struggled with ways to sustain their practice in an occupation characterized by the stresses of being on- call, and allegiance to a woman- centered model of care that is often at odds with the care they observe in hospital-based births. Our study shows that L&D nurses who witness disrespectful care may also be at risk of leaving the work force, possibly because of emotional burnout and moral distress.”
This paper is freely available for those who wish to read it in full.

The Research

Background: Disrespectful care and abuse during childbirth are acknowledged global indicators of poor quality care. This study aimed to compare birth doulas’ and labor and delivery nurses’ reports of witnessing disrespectful care in the United States and Canada.
Methods: Maternity Support Survey data (2781 respondents) were used to investigate doulas’ and nurses’ reports of witnessing six types of disrespectful care. Multivariate analysis was conducted to examine the effects of demographics, practice characteristics, region, and hospital policies on witnessing disrespectful care.
Results: Nearly two thirds of respondents reported witnessing providers occasionally or often engaging in procedures without giving a woman time or option to consider them. One fifth reported witnessing providers occasionally or often engaging in procedures explicitly against the patient’s wishes, and nurses were more likely to report witnessing this than doulas. Doulas and nurses who expected to leave their job within three years were significantly more likely to report that they witness most types of disrespectful care occasionally or often (OR 1.78- 2.43).
Conclusions: Doulas and nurses frequently said that they witnessed verbal abuse in the form of threats to the baby’s life unless the woman agreed to a procedure, and failure to provide informed consent. Reports of witnessing some types of disrespectful care in childbirth were relatively uncommon among respondents, but witnessing disrespectful care was associated with an increased likelihood to leave maternity support work within three years, raising implications for the sustainability of doula practice, nursing work force shortages, and quality of maternity care overall.
Morton CH, Henley MM, Seacrist M et al (2018). Bearing witness: United States and Canadian maternity support workers’ observations of disrespectful care in childbirth. Birth: Issues in Perinatal Care.  https://doi.org/10.1111/birt.12373

 

photo credit: S.Escuredo Olvido via photopin (license)

1 comment for “Bearing witness: disrespectful maternity care

  1. Denise Hynd
    August 2, 2018 at 7:14 am

    I think a similar survey here (Australia) would find misinformation and fear mongering is rife!

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