Abstract:Background
In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this pape… Show more
“…Women who are Black, ethnic minorities, adolescents, poor, with low education levels, drug users, without housing, without prenatal care, and without a companion are more vulnerable to obstetric violence. Keedle et al 49 n = 559 Australian women who planned a vaginal birth after cesarean: n = 171 pregnant and currently planning, and n = 388 following birth Qualitative, open-ended survey/Level III The category of negative interactions between participants and healthcare providers was identified as “Fighting for my birthing rights.” Intensity varied across the sub-categories: the odds were against me, lack of belief in women birthing, and coercion. Obstetric violence was most clearly present in coercion to accept a repeat cesarean.…”
Section: Resultsmentioning
confidence: 99%
“…Examples of obstetric violence were most clearly present in negative interactions as verbal coercion to have a repeat caesarean, threatening, and overt examples of unconsented procedures and having physical force used against the birthing person. 49 Co-researchers from Sweden found that interview participants had experienced psychological and physical abuse during childbirth that was considered obstetric violence. Results included accounts of higher-intensity experiences of obstetric violence that were compared to rape.…”
Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the intensity and brutality of abuse and mistreatment is more easily recognised as problematic. This integrative review aimed to analyse sources about obstetric violence in high-income countries with the objective of identifying gaps in the research, challenges to the study of obstetric violence, and solutions to framing research that meets those challenges. A systematic search was conducted using the PubMed and CINAHL databases from February to June 2022. Empirical and non-empirical sources, published in English, with no date restrictions, were retrieved. Citation searching was also done. Forty-six sources were included. Identified gaps in the research were: (a) scarce attention to obstetric violence in most high-income countries; (b) most US sources are non-scientific and from outside the healthcare disciplines; (c) inconsistencies in terminology; (d) most studies were conducted with samples of women who had given birth, with scant research about healthcare providers and obstetric violence, and (e) the association between obstetric violence and traumatic birth was under-recognised. Identified challenges to the study of obstetric violence were: (1) factors that enable and perpetuate obstetric violence are multilevel and nonlinear; (2) the phenomenon is contextually complex; and (3) blind spots from routinised harmful practices and normalised mistreatment can prevent healthcare providers and birthing people from recognising obstetric violence. A systems approach and complexity theory are guiding frameworks recommended as solutions to the challenges of studying and correcting obstetric violence.
“…Women who are Black, ethnic minorities, adolescents, poor, with low education levels, drug users, without housing, without prenatal care, and without a companion are more vulnerable to obstetric violence. Keedle et al 49 n = 559 Australian women who planned a vaginal birth after cesarean: n = 171 pregnant and currently planning, and n = 388 following birth Qualitative, open-ended survey/Level III The category of negative interactions between participants and healthcare providers was identified as “Fighting for my birthing rights.” Intensity varied across the sub-categories: the odds were against me, lack of belief in women birthing, and coercion. Obstetric violence was most clearly present in coercion to accept a repeat cesarean.…”
Section: Resultsmentioning
confidence: 99%
“…Examples of obstetric violence were most clearly present in negative interactions as verbal coercion to have a repeat caesarean, threatening, and overt examples of unconsented procedures and having physical force used against the birthing person. 49 Co-researchers from Sweden found that interview participants had experienced psychological and physical abuse during childbirth that was considered obstetric violence. Results included accounts of higher-intensity experiences of obstetric violence that were compared to rape.…”
Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the intensity and brutality of abuse and mistreatment is more easily recognised as problematic. This integrative review aimed to analyse sources about obstetric violence in high-income countries with the objective of identifying gaps in the research, challenges to the study of obstetric violence, and solutions to framing research that meets those challenges. A systematic search was conducted using the PubMed and CINAHL databases from February to June 2022. Empirical and non-empirical sources, published in English, with no date restrictions, were retrieved. Citation searching was also done. Forty-six sources were included. Identified gaps in the research were: (a) scarce attention to obstetric violence in most high-income countries; (b) most US sources are non-scientific and from outside the healthcare disciplines; (c) inconsistencies in terminology; (d) most studies were conducted with samples of women who had given birth, with scant research about healthcare providers and obstetric violence, and (e) the association between obstetric violence and traumatic birth was under-recognised. Identified challenges to the study of obstetric violence were: (1) factors that enable and perpetuate obstetric violence are multilevel and nonlinear; (2) the phenomenon is contextually complex; and (3) blind spots from routinised harmful practices and normalised mistreatment can prevent healthcare providers and birthing people from recognising obstetric violence. A systems approach and complexity theory are guiding frameworks recommended as solutions to the challenges of studying and correcting obstetric violence.
“…In the maternity environment too many women experience coercion, obstetric violence and disrespectful care and are subject to victim blaming 10 11 37. An example of this is healthcare providers dismissive attitudes to birth plans 43 44.…”
Section: Discussionmentioning
confidence: 99%
“…This can lead to assumptions about the wishes and needs of women, such as increased rates of maternal requested caesarean 7 8. International and Australian research has found women often receive mistreatment and disrespectful and abusive care from healthcare providers,9–11 particularly for women of colour 12. Internationally around a third of women identify their previous birth as a traumatic experience,13 14 which can lead to increased rates of psychosocial issues such as post-traumatic stress disorder 15 16…”
ObjectivesTo explore if Australian women would do anything differently if they were to have another baby.Design and settingThe Birth Experience Study (BESt) online survey explored pregnancy, birth and postnatal experiences for women who had given birth during 2016–2021 in Australia.ParticipantsIn 2021, 8804 women responded to the BESt survey and 6101 responses to the open text responses to the survey question ‘Would you do anything different if you were to have another baby?’ were analysed using inductive content analysis.ResultsA total of 6101 women provided comments in response to the open text question, resulting in 10 089 items of coding. Six categories were found: ‘Next time I'll be ready’ (3958, 39.2%) described how women reflected on their previous experience, feeling the need to better advocate for themselves in the future to receive the care or experience they wanted; ‘I want a specific birth experience’ (2872, 28.5%) and ‘I want a specific model of care’ (1796, 17.8%) highlighted the types of birth and health provider women would choose for their next pregnancy. ‘I want better access’ (294, 2.9%) identified financial and/or geographical constraints women experience trying to make choices for birth. Two categories included comments from women who said ‘I don’t want to change anything’ (1027, 10.2%) and ‘I don’t want another pregnancy’ (142, 1.4%). Most women birthed in hospital (82.9%) and had a vaginal birth (59.2%) and 26.7% had a caesarean.ConclusionOver 85% of comments left by women in Australia were related to making different decisions regarding their next birth choices. Most concerningly women often blamed themselves for not being more informed. Women realised the benefits of continuity of care with a midwife. Many women also desired a vaginal birth as well as better access to birthing at home.
“…Women who desired a VBAC, but were unable to plan one, were less likely to experience respectful maternity care or to have autonomy in their decision making for their maternity care than women who planned a VBAC [ 9 ]. Recent studies found that individuals who reported a difference of opinion with their providers about the right care for themselves or their baby were significantly more likely to report mistreatment or to feel disrespected and coerced by their provider [ 7 , 9 , 10 ].…”
Objective
High-quality, respectful maternity care has been identified as an important birth process and outcome. However, there are very few studies about experiences of care during a pregnancy and birth after a prior cesarean in the U.S. We describe quantitative findings related to quality of maternity care from a mixed methods study examining the experience of considering or seeking a vaginal birth after cesarean (VBAC) in the U.S.
Methods
Individuals with a history of cesarean and recent (≤ 5 years) subsequent birth were recruited through social media groups to complete an online questionnaire that included sociodemographic information, birth history, and validated measures of respectful maternity care (Mothers on Respect Index; MORi) and autonomy in maternity care (Mother’s Autonomy in Decision Making Scale; MADM).
Results
Participants (N = 1711) representing all 50 states completed the questionnaire; 87% planned a vaginal birth after cesarean. The most socially-disadvantaged participants (those less educated, living in a low-income household, with Medicaid insurance, and those participants who identified as a racial or ethnic minority) and participants who had an obstetrician as their primary provider, a male provider, and those who did not have a doula were significantly overrepresented in the group who reported lower quality maternity care. In regression analyses, individuals identified as Black, Indigenous, and People of Color (BIPOC) were less likely to experience autonomy and respect compared to white participants. Participants with a midwife provider were more than 3.5 times more likely to experience high quality maternity care compared to those with an obstetrician.
Conclusion
Findings highlight inequities in the quality of maternal and newborn care received by birthing people with marginalized identities in the U.S. They also indicate the importance of increasing access to midwifery care as a strategy for reducing inequalities in care and associated poor outcomes.
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