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Tanefer Camara had no intention of giving birth at home. She’d planned, with her midwife, to do it in a hospital.
But at 38 weeks, she went into labor. When she called her midwife to say she thought it was time to go to the hospital, the midwife dismissed her, telling her to wait a little longer at home.
Camara then found herself sprawled on her bed with the uncontrollable urge to push. Assisted only by her husband and then-6-year-old son, she gave birth to a daughter within 30 minutes, covering her bed in blood and other fluids.
“I was not prepared for a home birth,” Camara, who’s a lactation consultant in Oakland, California, said. Her husband had to scramble to find something to tie the umbilical cord. He used a shoelace. On the way to the hospital, Camara developed blood clots. When she arrived, she was hemorrhaging and had to take medication to stop the bleeding.
In the end, she and her daughter were healthy. But “every step of the way, I had to advocate for myself,” she said. “If I didn’t have the knowledge that I had around pregnancy, birth, and breastfeeding, it could have been a lot worse.”
One in six women experience mistreatment in childbirth. The numbers are worse for women of color.
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From regular moms like Camara to celebrities like Serena Williams, more and more women are sharing stories about mistreatment during pregnancy and childbirth. But we’ve never had good data to understand exactly how common these experiences are across the US. A new study finds they’re common in childbirth, especially for women of color.
The first quantitative study to examine mistreatment during childbirth in the US was recently published in the journal Reproductive Health. The researchers found 17 percent of the 2,700 women surveyed — or one in six — reported experiencing one or more types of mistreatment, such as verbal abuse, stigma, and discrimination, and having requests for help ignored.
The rates of mistreatment were even higher for certain racial groups: Indigenous women were most likely to report being mistreated (33 percent), followed by Hispanic women (25 percent) and black women (23 percent). Fourteen percent of white women reported being mistreated. Women who gave birth in hospitals, who were 24 years old or younger and lower income, reported higher rates of mistreatment.
“This is a widespread phenomenon,” said the study’s lead author, Saraswathi Vedam, a midwife and professor at the University of British Columbia. “Mistreatment, when you look at it in all of its aspects, certainly includes people being shouted at, scolded, or experiencing physical and verbal abuse. But there’s also ... not being listened to, not being engaged in the decision, not having the ability to self-determine what care happens for you and your body.”
The finding is important because researchers increasingly understand that maternal mistreatment is linked to poorer health outcomes for women, said Vedam, and often leads to the misses and near misses that harm moms and babies. Another study, newly published in the journal Social Science and Medicine, found women who declined medical interventions (such as tests or medications) during childbirth were more likely to report discrimination.
Camara was lucky that she and her daughter survived an unassisted home birth. Serena Williams also got lucky: The day after her emergency C-section, she said doctors and nurses dismissed her complaints about shortness of breath and her history of pulmonary embolisms, accusing her of being confused because of the pain medicine she’d been on. They ran some diagnostics she didn’t need, instead of the CT scan Williams requested, and finally discovered she indeed had small blood clots in her lungs.
“This is a million-dollar athlete who gets paid to understand changes in her body. Of anybody we were going to listen to, it should have been her,” said study co-author Monica McLemore, a nurse and professor at the University of California San Francisco.
But instead, researchers “have repeatedly found missed opportunities for health care providers to listen to people, to recognize signs and symptoms of deterioration and to be able to act differently,” McLemore added. A recent study from the Centers for Disease Control and Prevention determined that most maternal deaths are indeed preventable.
That’s why, Vedam said, the World Health Organization now asserts that respectful maternity care should be considered an outcome in and of itself. But her study shows health care providers have a long way to go.
The most common type of abuse: being shouted at, ignored, and forced to get treatment you don’t want
The most common type of mistreatment women reported in the survey was being shouted at or scolded by their doctors, midwives, or nurses. The next most common was being ignored by their health care providers, or having their requests refused or not responded to for a reasonable amount of time. Five percent of women reported that their health professionals threatened to withhold treatment or forced them into treatment they didn’t want.
That’s what happened in Paress Salinas’s 2007 childbirth. Salinas, an event planner in Los Angeles, said she had to fight her doctors and nurses to get out of a C-section she didn’t want or need.
Salinas’s doctor told her she had to have the surgery because she’d been in labor for hours, but Salinas decided to push “with everything I had” instead.
Within 45 minutes, her nurses told her she was ready to deliver. At first, her doctor dismissed Salinas. Then, she came back into the room, lifted the sheet covering Salinas’s legs, and acknowledged Salinas was ready to deliver. “I had a first-degree tear because there wasn’t enough time to do the massaging and preparing,” Salinas says. And at that point, I didn’t trust anybody to help me.”
But it wasn’t just the physical scar that’s stayed with Salinas; it was the disconnect between her hopes and the reality she found in the hospital. And that’s something that sets childbirth apart from other interactions with the health system, said Columbia University public health professor Lynn Freedman, who was not involved in the Reproductive Health study. “People have different kinds of expectations and desires around childbirth care than perhaps if you break your leg,” she said. “It has a different meaning for people, and they go into childbirth with different kinds of hopes and expectations, and aspirations and meaning. So when things do not go the way they had hoped, it’s meaningfully different for many women.”
Actually fixing the maternal mistreatment problem, particularly among women of color, requires systemic solutions, Freedman argued. “These are broader issues of racism and other social power dynamics that then play out in health system — as well as the education, police, court systems.”
Even before that kind of systems reform, Vedam believes there are measures that can help. “We have the capacity right now to really address these issues,” she said. “These initiatives include diversifying the health care workforce, mandating anti-racism and implicit bias training for everyone who interacts with childbearing families, increasing access to doulas and midwives, and raising public awareness of their human rights. The road may be long and hard, but it is the only right path.”
We want to hear from you
For now, the US remains one of the most dangerous high-income countries in the world for women to give birth. That’s why ProPublica and Vox are teaming up for a reporting project about mistreatment in pregnancy and childbirth, and how gaps in health insurance and access affect women’s health care experiences. Please help our reporting by filling in our callout or emailing the reporters at maternal@propublica.org.
