How Do We Treat Women as They Become Mothers?
By Andrew
My wife recently gave birth to our second daughter. Despite scary complications - everyone is now healthy; thankfully - she was fortunate to receive good care at a suburban hospital that is part of an extensive statewide healthcare network. Her team of providers was clinically effective, and to a person, dignified and respectful.
I left the hospital grateful, but also curious.
How are women treated across the U.S. as they become mothers? Specifically, were the overwhelmingly positive interactions between my wife and her team and her experience with the facility and the system typical?
I am differentiating these questions from those associated more explicitly with maternal mortality, which is nothing short of a crisis, particularly for black women, who, regardless of socioeconomic status, die at similar rates as expecting and new mothers in Uzbekistan, Malaysia, and Mexico.
Surprisingly, maybe naively, despite international consensus that maternal treatment during childbirth affects the health and well-being of mom, baby, and family, until recently, there was minimal knowledge of the quality of treatment of childbearing mothers in the U.S.
Slivers of light shined on this issue over the summer, when the results of a first-of-its-kind national survey of women who experienced pregnancy in the U.S., Giving Voice to Mothers (GVtM-US) was released. The study reached 2176 women who gave birth at least once - or were pregnant - between 2010 and 2016. It focused on mistreatment indicators, such as patient-provider interactions and treatment decisions. These indicators were based on a well-respected framework developed by the World Health Organization.
Here’s what we learned from the study:
One in six women in the study reported mistreatment.
Women who self-reported being White, having a vaginal birth, giving birth at home or in a freestanding birth center, having a midwife as the primary prenatal provider, and having a baby after 30 years of age were less likely to experience mistreatment.
Women who reported being low-income, experiencing pregnancy complications, and/or having a history of social risks, including substance use or incarceration, reported among the highest mistreatment rates.
White women with a white partner reported the least mistreatment.
These findings are troubling.
The Centers for Medicaid and Medicare Services has brought attention to maternal health challenges.
Maternal mortality, as a policy issue, has generated interest. The gaggle of democratic candidates running for president has thoughtful ideas.
Source: Healthaffairs.org
Source: Healthaffairs.org
These proposals generally address the symptoms, not the causes (there are exceptions, Senator Bookers’ proposed legislation includes a demonstration project that codifies improved treatment as a goal).
To address how women are treated as they become mothers more intentionally and with greater intensity, we offer a few observations:
Research examining the extent to which maternal mistreatment correlates with or causes maternal mortality is warranted.
Research examining the conditions under which interventions to combat unconscious bias in the treatment of women becoming mothers are successful is desperately needed. Note: available data do not allow for the identification of consistently effective interventions to reduce unconscious bias. So, this is easier said than done.
Policymakers should consider legislation that codifies expecting and new mother’s rights.
Policymakers should consider adding the treatment of women becoming moms to healthcare accountability frameworks.
The conversation around maternal health tends to focus narrowly on mortality. If we want to address the mortality epidemic, we must start by treating every expecting and new mom as my wife was; with compassion, respect, and dignity.