Frequency and determinants of words, gestures, and attitudes experienced as disrespectful during childbirth and postpartum: A national population-based study.

Introduction

Disrespectful maternity care is receiving increasing attention but remains poorly assessed in high-income countries. The aim was to assess the frequency and determinants of professionals' words, gestures and attitudes experienced as disrespectful by women during childbirth and postpartum stays.

Material and methods

This national quantitative observational study used the population-based Enquête Nationale Périnatale (ENP) 2021 database, which provides a representative sample of women who gave birth in metropolitan France and includes a 2-month postpartum follow-up (n = 7394). At the 2-month follow-up, women were asked about professionals' words, gestures, and attitudes that made them feel uncomfortable, shocked, or offended during childbirth or postpartum stays. Associations between disrespectful care and maternal, obstetric, and maternity ward characteristics were assessed by robust variance Poisson regression. Multiple imputation was used for missing data, and attrition was accounted for by weighting.

Results

Among the 7332 women analyzed, 24.8% (95% confidence interval 23.8-26.0) reported they experienced disrespectful care (especially words or attitudes), predominantly during the postpartum stay. They were more frequently nulliparous, had a high education level, a birth plan (adjusted relative risk [aRR] 1.20, 95% CI 1.09-1.32) and an instrumental or cesarean birth. Women with a psychiatric history or antenatal psychological distress were more prevalent among women experiencing disrespectful care (aRR 1.43, 95% CI 1.26-1.63). Disrespectful care was reported more frequently when women breastfed. No other maternal (age, place of birth, marital status), obstetric (pregnancy's level of risk, delivery complication), neonatal (term of birth, poor neonatal outcome), postpartum (duration of the stay in the unit), or maternity ward characteristics showed an association.

Conclusions

A quarter of women delivering in France felt they had experienced disrespectful care during childbirth and/or postpartum stay. Support for psychological vulnerabilities and awareness campaigns for all maternity care professionals could improve women's experiences. Professionals should address women's expectations respectfully, especially in complex childbirth situations. The healthcare system may play a role in this phenomenon, although its impact is more challenging to quantify. Interventions are necessary to promote and ensure respectful maternity care.

References:

• Bohren MA, Vogel JP, Hunter EC, et al. The mistreatment of women during childbirth in health facilities globally: a mixed‐methods systematic review. PLoS Med. 2015;12:e1001847.
• Sadler M, Santos MJ, Ruiz‐Berdún D, et al. Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence. Reprod Health Matters. 2016;24(47):47‐55. doi:10.1016/j.rhm.2016.04.002
• Chervenak FA, McLeod‐Sordjan R, Pollet SL, et al. Obstetric violence is a misnomer. Am J Obstet Gynecol. 2024;230:S1138‐S1145.
• Ayres‐de‐Campos D, Louwen F, Vivilaki V, et al. European Association of Perinatal Medicine (EAPM), European board and College of Obstetricians and Gynaecologists (EBCOG), European midwives association (EMA). Joint position statement: substandard and disrespectful care in labour – because words matter. Eur J Obstet Gynecol Reprod Biol. 2024;296:205‐207.
• Bowser D, Hill K. Exploring evidence for disrespect and abuse in facility‐based childbirth: report of a landscape analysis. USAID/TRAction Project 2010.