Report Documents Maternity Care Experiences

The most commonly reported experiences of mistreatment were

• being ignored by health care professionals, or having requests for help refused or not responded to (9.7%);
• being shouted at or scolded by a physician, nurse or midwife (6.7%); and
• violations of physical privacy (5.1%).

Multiracial mothers reported the highest instances of being ignored or being shouted at, while Hispanic respondents and those without insurance coverage reported the highest instances of privacy violations.

Overall, patient age, weight and income level were the most commonly reported reasons for discrimination across the study population. However, reasons varied based on the respondent’s race and ethnicity: 

• Age was the most common reason reported by white, Hispanic and multiracial mothers.
• Weight was the most common reason reported by Black and American Indian, Alaska Native, Pacific Islander or Native Hawaiian respondents.
• Differences in opinion with the caregiver about the right care for the mother or baby was the most common reason reported by multiracial mothers.
• Weight and language or accent tied as the most common reasons reported by Asian mothers.

Finally, more than 44% of respondents said that they held back from asking questions or sharing concerns with their health care professional during pregnancy or delivery. The most common reasons respondents gave included thinking that what they were feeling was normal for the pregnancy; feeling embarrassed or not wanting to make a big deal; and having a friend or family member tell them that what they were experiencing was a normal part of pregnancy or that they had the same experience.

Researchers Suggest Solutions

In light of the findings, the report’s authors stressed the importance of respectful maternity care in raising patient satisfaction scores and improving the experiences of mothers during pregnancy and delivery. They also offered recommendations for fostering a culture of respectful maternity care through resources such as the Alliance for Innovation on Maternal Health’s patient safety bundles and the CDC’s Hear Her campaign.

“Health communication campaigns and community engagement can include the perspectives of patients, families and communities to raise awareness to incorporate the components of respectful maternity care, as well as how pregnant and postpartum women and their support system can communicate their questions and concerns,” the authors wrote.

Family Physician Perspective

Buckley noted several key takeaways for family physicians and others.

“We know that there is a lot of work to be done in making birth safer, more equitable and more patient-centered,” Buckley said. “I do think that, fortunately, this is work that is finally being strongly emphasized, so there are opportunities to be better individually and as a health care system by identifying and reflecting upon our biases and then figuring out our pathway to improve.”

Buckley also suggested that family physicians use prenatal care visits to discuss topics related to labor and delivery to ease concerns and help patients prepare as the pregnancy progresses.

“One of the strengths of being family physicians is our ability to know and listen to our patients and see them for everything that they are, not just the medical condition that they are presenting with,” said Buckley. “This report should really encourage us all to emphasize our abilities.”

Buckley expressed concerns with some of the report’s limitations. For example, patient experiences were self-reported, leaving them open to social desirability bias. In addition, many respondents reported on experiences of pregnancies or deliveries of children that occurred several years ago, making those responses subject to recall bias. Furthermore, the survey was not weighted and did not use probability sampling.

“I do think the limitations of the study are important to recognize, and should present an opportunity to figure out how to collect this information in a more timely and validated way which includes all birthing persons who are representative of the populations that we are caring for,” Buckley said. “In addition to this, if we (as health care professionals) want to be better, we need evidence-based ways to improve based on the above needed research.”

Noting that some patients in the report felt uncomfortable or scared to ask questions or thought that the clinicians caring for them seemed rushed, Buckley offered several approaches to improving communication, especially in situations where clinicians may be asked to care for new patients.

“Part of effective communication is intentionally creating space to make sure our patient is able to voice their thoughts and be heard. Some specific ways may include sitting down during conversations, putting the laptop away, making good eye contact, utilizing active listening skills, summarizing what our patients told us, and explaining to our patients what we are seeing and hearing.”

AAFP Member Resources

The Academy has long worked to address maternal mortality crisis with efforts that include a report on maternal morbidity and mortality, a position paper and policy on birth equity and education.

Education on the topic includes an ongoing series of products to help members deliver high-quality maternal care.

The Academy’s Advanced Life Support in Obstetrics (ALSO®) course outlines a standardized, team-based approach for family physicians and others to improve patient safety and positively affect maternal outcomes. A companion course, Basic Life Support in Obstetrics (BLSO™), is geared toward first responders, emergency personnel, students and medical assistants.

The AAFP’s CME includes programs to educate members on family-centered pregnancy care, the fourth trimester model of care, pregnancy care in the wake of Dobbs v. Jackson Women’s Health Organization, and prenatal alcohol and other substance use.

A substantial number of maternal care resources are available on the Academy’s Maternal Health webpage. These include links to the AAFP’s clinical preventive service recommendations on various maternal health topics, toolkits on breastfeeding and screening for postpartum depression, and a guideline on planning for labor and vaginal birth after cesarean delivery. In addition, the Academy has assembled a vast collection of maternity care clinical recommendations and guidelines that members can access in one convenient location.