Most women in the United States report very high satisfaction with the childbirth process (Sakala, Declercq, Turon, & Corry, 2018); however, these reports may be influenced in part by having a healthy baby, recall bias, and characteristics of the women being asked. In the most recent Listening to Mothers survey of 2,539 women who gave birth in California in 2016, women were asked if they were treated unfairly because of their race, ethnicity, language they spoke, type of health insurance, or no health insurance. The vast majority of women (95%-96%) said they did not experience this type of behavior (Sakala et al.). This is good news for most care providers and hospitals, yet on closer examination of results, there were differences in how care was perceived based on ethnicity. Of participants, Black women (11%), Asian/Pacific Islander women (8%), and Latina women (5%) reported sometimes, usually, or always being treated unfairly, and thus had different perceptions as compared with Caucasian women of whom 1% reported experiencing this type of behavior (Sakala et al.). In this survey, approximately one-half of participants were Hispanic, one-quarter Caucasian, 16% Asian/Pacific Islander, and 5% Black, which was representative of women giving birth in California, but different from all women giving birth in the United States (Sakala et al.).

In a survey of 2,700 women who had given birth between 2010 and 2016 in the United States, researchers from the Giving Voice to Mothers group explored mistreatment in maternity care (Vedam et al., 2019). They focused on recruiting women from four ethnic groups (African American, Indigenous, Hispanic, and Asian) and included women who had given birth at hospitals, freestanding birth centers, and at home (Vedam et al.). Data were analyzed based on the 2,138 women who completed the survey, 1,416 of whom were Caucasian. Women from all 50 states participated; 29.7% were from New York state (Vedam et al.). Most reported prenatal care from midwives (71.1%) and half gave birth in birthing centers or at home (49.6%). More women who gave birth in hospitals noted they were mistreated (28%), than women who gave birth in birth centers (7%) or at home (5.1%) (Vedam et al.). Some of the aspects of mistreatment that were asked and that women noted included violation of physical privacy (5.5%), being scolded or shouted at (8.5%), threatening to withhold treatment or forcing treatment that was not wanted (4.5%), being ignored or not receiving a timely response to requests for help (7.8%), and physical abuse that was characterized as aggressive physical contact, inappropriate sexual conduct, and not giving anesthesia for episiotomy, and the like (1.3%) (Vedam et al.). Mistreatment was reported by 17.3% (n = 369) of women, and was different based on ethnicity, with 32.8% of Indigenous women, 25% of Hispanic women, 22.5% of African American women experiencing any type of mistreatment compared with 14.1% of Caucasian women.

These data suggest we can all do better because the findings apply to all settings and all care givers. You may read these studies and note that percentages of women who report mistreatment are low and that some of their reports are likely based on misperception rather than intent of care providers or factual details of medical events. However, that any woman giving birth in the United States feels mistreated, not listened to, not respected, or not cared for in a quality manner is problematic and requires each of us to evaluate how we offer maternity care to women and their families and what we can do as nurses to change things for the better.

References