1 in 5 women say they were mistreated while giving birth
Nearly 1 in 5 pregnant women overall reported that they felt mistreated during the process of giving birth. At the same time, between 2018 and 2021, the maternal death rate nearly doubled.
The Centers for Disease Control and Prevention suggests those two facts are related. A new report issued this week notes that reducing mistreatment could be an important strategy to reduce maternal death.
In that four-year period, the maternal death rate rose from 17.4 to 32.9 deaths per 100,000 live births. Dr. Debra Houry, CDC chief medical officer, told reporters at a press conference that the CDC estimates 80% of pregnancy-related deaths can be prevented.
“We’ve been saying for some time that too many women die during and after pregnancy in this country,” she said, noting that “women from some racial and ethnic minority groups are more affected than others.”
“It is disheartening to hear how common mistreatment is,” Dr. Wanda Barfield, director of the public health agency’s reproductive health division, said in a statement quoted by ABC News.
The negative experiences reported, by order of frequency, were:
Requesting help and being either refused or ignored by health care providers.
Being shouted at or scolded by health care providers.
Having physical privacy violated.
Being threatened with withholding of treatment or forced to accept treatment that was not wanted.
But even among those who reported some mistreatment, the report said just over 75% were generally satisfied with the care they received during pregnancy.
The report, though, says general satisfaction isn’t good enough.
“Respectful maternity care (e.g. preventing mistreatment, communicating effectively and providing care equitably) can be integrated into strategies that aim to improve quality of care and reduce pregnancy-related deaths,” according to the new Vital Signs report.
When women don’t have a good experience with maternal care, the report noted, they are less apt to seek follow-up care or future prenatal care.
Racial differences
The highest rate of maternal mortality is among Native Hawaiian and other Pacific Islander, Black, and American Indian and Alaska Native individuals, per the report.
It found that among Black, Hispanic and multiracial mothers, 3 in 10 felt mistreated. Roughly 4 in 10 of those moms reported discrimination during maternal care. The New York Times reported that age, weight or income were the most common reasons for discrimination.
“Maternal mortality review committees have identified discrimination as one factor contributing to pregnancy-related deaths,” the report said. “The concepts of mistreatment, engaging with effective communication and discrimination have been used to evaluate respectful maternity care.”
Related
Nearly half — 45% — of all mothers said they held back from asking questions or telling their provider about their concerns. Their reasons included thinking maybe what they were feeling was normal, feeling embarrassed or unwilling to create an issue, being told by someone they trusted that it was normal and “worrying that their maternity care provider might think they were being difficult.”
Each of those was reported by at least 20% of women who didn’t ask questions or raise concerns.
The report also noted that uninsured women (28%) or those with public insurance (26%) when they delivered their baby experienced more mistreatment than those who were privately insured (16%).
The fix
Among other suggestions to improve maternal care, the report suggests that health care systems offer “training for health care providers on recognizing unconscious bias and stigma, shared decision-making, improved interactions and communication with patients and cultural awareness.”
The report said that “higher patient-centered maternity care scores are associated with lower risk for pregnancy complications. Improving respectful maternity care can improve the experiences of mothers during pregnancy and delivery care.”
The report has some caveats. The authors note women opted in to answer the survey and the results were not weighted, so there’s no claim it’s nationally representative of women giving birth. And self-reporting may not be objective. They also only asked women about a single birth experience, so other deliveries could have gone better or worse. Finally, the authors said all the respondents were fluent in English, which could have left some out.
CDC has launched a “Hear Her” campaign to try to improve maternity-related outcomes. It contains resources, including warning signs of problems.
