https://orcid.org/0000-0001-5030-5644
Figures
Abstract
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.
Citation: Ibrahim BB, Vedam S, Illuzzi J, Cheyney M, Kennedy HP (2022) Inequities in quality perinatal care in the United States during pregnancy and birth after cesarean. PLoS ONE 17(9): e0274790. https://doi.org/10.1371/journal.pone.0274790
Editor: Yuyan Wang, New York University Grossman School of Medicine, UNITED STATES
Received: October 14, 2021; Accepted: September 5, 2022; Published: September 22, 2022
Copyright: © 2022 Ibrahim et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: Our data is available through openICPSR. Here is the DOI: https://doi.org/10.3886/E169523V1.
Funding: The research underlying this manuscript was completed with support from the Association of Women’s Health, Obstetric, and Neonatal Nurses/ March of Dimes and The Rockefeller University Heilbrunn Family Center for Research Nursing. Dr. Basile Ibrahim was supported in her pre-doctoral studies at Yale University by the NIH T32 Research Training Grant: Self and Family Management (T32NR008346). Dr. Basile Ibrahim’s postdoctoral fellowship during which this manuscript was drafted is supported by the Clinical and Translational Science Institute and the Office of Academic Clinical Affairs at the University of Minnesota. It is housed in the Division of Health Policy and Management at the University of Minnesota School of Public Health. The funding for this fellowship comes from the National Institutes of Health’s National Center for Advancing Translational Sciences, grant UL1TR002494. The information, conclusions and opinions expressed are those of the authors and no endorsement by any funding agencies is intended or should be inferred.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Recognizing the need to humanize birth [1], the World Health Organization and leading maternity care scholars have incorporated respectful maternity care as a central tenet of high quality care, regardless of birth setting or technology and resources available in the country [2–5]. Person-centered maternity care is defined as “care that is respectful of and responsive to women’s preferences, needs, and values [and] is a core component of quality maternity care” [6]. For the purposes of this study, we chose to employ the term “higher quality maternity care” to describe perinatal care that is respectful and facilitates a level of autonomy preferred by the birthing person. In keeping with the self-identification of study participants, we employ the term “women” throughout this manuscript though we recognize that not all people who give birth identify as women and have varying gender identities and preferences for language.
Prior studies have found that women who have a hospital-based vaginal birth after cesarean (VBAC) [7] and those who decline care [8] are more likely to experience mistreatment during childbirth. 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].
Black and Indigenous women in the United States (U.S.) are significantly more likely to die within a year of giving birth [11, 12] and experience disproportionately higher rates of severe maternal morbidity [12, 13]. Nearly half of these maternal events [11] are preventable through improving quality of care [14]. Inequities in the quality of preconception, prenatal, intrapartum, and postpartum care may contribute to racial disparities in maternal health outcomes [11, 15, 16]. Notably, when mode of delivery is disaggregated by race, Black women in the U.S. have the highest rates of cesarean birth, despite similar predisposing factors [17–20].
Improving maternal health and health equity is a key priority of the U.S. Surgeon General [21], and the U.S. Department of Health and Human Services [22]. Racism and racial discrimination are linked to poor health [23, 24], and specifically, negative birth outcomes for women of color and their infants [24–27]. Mistreatment during pregnancy and childbirth has been associated with both short- and long-term adverse mental health outcomes that include pain and suffering, postpartum depression and post-traumatic stress disorder, fear of birth, negative body image, and feelings of dehumanization [28–30].
The purpose of this paper is to describe quantitative findings from a larger mixed methods study designed to investigate how U.S. women who were interested in considering a VBAC experienced maternity care in their subsequent pregnancy and childbirth. In this analysis, we examine associations between experiences of higher quality maternity care with sociodemographic characteristics that may impact the quality of maternity care, such as race, ethnicity, insurance status, model of care, and geographic region. Specifically, we explore the experiences of participants with intersecting identities, such as racialized identity and low socioeconomic status, that place individuals in disenfranchised (or excluded) social positions and at higher risk for poor birth outcomes.
Materials and methods
In this paper, we report results from the survey portion of a convergent, parallel, mixed methods [31, 32] study describing women’s experiences of pregnancy and birth after cesarean in the United States. After Institutional Board Approval (IRB; Yale University IRB protocol # 2000021384), data were collected via a web-based questionnaire from May to October 2018. Signed informed consent was waived by the IRB. The questionnaire was preceded by an online written consent form to which participants had to indicate their agreement before beginning the survey.
Sample and recruitment procedures
English-speaking adults who had experienced cesarean birth and had a subsequent child in the United States within the past 5 years were eligible to participate. Participants were included irrespective of the final mode of birth for their subsequent birth. The survey design and measures, data collection, sampling, recruitment, and results related to VBAC have been previously described in detail [9]. In brief, we designed, pilot-tested, revised, and then distributed a cross-sectional, retrospective, online questionnaire via the Qualtrics (Provo, UT) platform. Recruitment occurred through non-profit, peer-led, birth advocacy and support social media pages with more than 50,000 followers [33, 34].
Study instruments
The questionnaire included a sociodemographic and birth history form and the Mothers on Respect Index (MORi) [35] and the Mother’s Autonomy in Decision Making scale (MADM) [36], both validated with U.S. populations. The MORi measures experiences of respectful maternity care [35] and the MADM measures agency in decision making during pregnancy, labor, and birth care [36]. Both instruments display high reliability and internal consistency [35, 36]. By completing the MADM scale, participants rate their ability to state their preferences in decision-making, whether different care options were presented, and if their choices were respected (7 items, scores range 7–42). On the MOR Index, participants describe their level of comfort with accepting or declining options for care, whether they felt poorly treated because of personal characteristics, and whether their treatment affected their willingness to ask questions (14 items, scores range 14–84). For both scales, respondents select one of 6 Likert-type response options to indicate agreement to statements. Higher scores on each scale indicate greater respect and autonomy when interacting with providers during pregnancy.
Data management and analysis
Higher quality maternity care was defined based on the Quality Maternal and Newborn Care (QMNC) framework [5], and operationalized as measured by the MADM and MORi scales. In order to make the scores on the MADM and MORi more clinically relevant by capturing the overall experience of maternity care we created a dichotomous variable describing the quality of maternity care experienced. We created a dichotomous variable of lower versus higher quality maternity care wherein participants who scored in the lowest quartile of scores in our sample on the MORi (score < 57) and/or MADM (score < 23) were categorized as receiving lower quality maternity care. We categorized those who scored higher than the lowest quartile on both MADM and MORi scores in our sample as receiving higher quality perinatal care, as other studies using the MADM and MORi scales have done [37].
In order to explore associations with power and privilege between dominant versus non-dominant groups during interactions with healthcare providers, we assigned participants into dominant and non-dominant groups [38] and stratified our analyses based on the dominant and non-dominant identities of our participants to better highlight health inequities between groups [39]. A variable for BIPOC identification was created by dichotomizing those participants who self-identified as a race and ethnicity that has been historically or is currently marginalized within the United States (those participants who identified as any race or ethnicity other than white, non-Latinx) into Black, Indigenous, People of Color (BIPOC), and the remaining participants (those who self-identified as white, non-Latinx) into a non-BIPOC group. Participants who reported an annual household income of less than $50,000 were identified as low income, based on USDA criteria for a school age child in a family of four who would qualify for free and reduced school lunch with a 2017 annual income of $45,510 [40].
Descriptive statistics were computed and stratified by quality of maternity care experience and BIPOC identification. MADM and MORi median scores were calculated for the entire sample and stratified by BIPOC identification. Bivariate statistics were computed to determine if there were significant differences between sociodemographic characteristics and experiences of higher versus lower quality maternity care, as well as by BIPOC identification. Logistic regression was used to determine the likelihood of experiencing higher quality maternity care by various sociodemographic characteristics. Statistical analyses were completed using SAS Version 9.4 for Windows (Cary, NC). STROBE guidelines for reporting observational studies were used in reporting the findings of this study [41].
Results
A total of 1711 participants, with a mean age of 34 years, completed the questionnaire (Table 1). Participants experienced a total of 4591 births; most experienced two (55%) or three (27%) births. The most commonly reported year of most recent birth was 2017. Most participants (87%) planned or attempted a VBAC, and 65% of participants had a VBAC for their first birth after cesarean. More than one quarter of participants (n = 487; 29%) reported one or more life adversities since becoming a parent. These included lacking health insurance, being unable to meet financial obligations, being unable to buy enough food, having their heat or electricity turned off, being unable to find work, housing instability, intimate partner violence, incarceration of self or partner, involvement of child protective services, and problems with drug/alcohol dependency. The full sample has been previously described in detail [9].
Of the 1711 participants, 207 (12%) self-identified as a race or ethnicity other than white, non-Latinx and were categorized as BIPOC. Of the 549 (32%) low income participants, 84 (15%) were BIPOC, accounting for 41% of the BIPOC participants (Table 1). Medicaid was the payor for second births for 359 (21%) participants, 64 (18%) of whom were BIPOC, which accounts for 31% of the BIPOC participants. In bivariate analyses, BIPOC participants reported significantly different sociodemographic characteristics of lower household income, higher rates of Medicaid insurance, and higher rates of residence in the Southern United States.
Experiences of lower quality maternity care were reported by 534 (31%) of participants (Table 2). Characteristics indicating social disadvantage were overrepresented in the group who experienced lower quality maternity care: Black, Indigenous, Latinx, Asian and Multiracial groups (p = .004), participants with education less than a 4-year university degree (p < .0001), low income (p = .0002), and those with Medicaid insurance (p < .0001). Participants whose scores indicated lower quality maternity care were significantly more likely to report having an obstetrician (p < .0001), a male provider (p < .0001), shorter travel times for birth care (p = .003), and not having a doula present (p < .0001). Participants who did not plan (p < .0001) or obtain (p < .0001) a VBAC also reported experiencing lower quality maternity care significantly more often. BIPOC women also reported significantly lower median scores for autonomy (MADM) and respect (MORi) in their maternity care (Table 1).
Participants reported varying levels of racial concordance with their maternity care provider for their first birth: American Indian Alaska Native (0%), Asian (4%), Black (21%), Multiracial (5%), Other (29%), White (84%). As a group, BIPOC participants reported racial concordance with their provider in less than 9% of cases, compared with 84% of white participants.
Rates of diagnoses of postpartum depression (PPD), posttraumatic stress disorder (PTSD) or birth trauma after their first birth also varied by participants’ race (Table 3). American Indian Alaska Native (PPD 16%, PTSD 11%) and Multiracial (PPD 20%, PTSD 15%) participants reported disproportionately high rates of perinatal mental health diagnoses.
In logistic regression analyses, the likelihood of experiencing higher quality maternity care was significantly lower for BIPOC participants (OR 0.69, 95% CI 0.51, 0.95) compared with white participants, and for low-income BIPOC participants (OR 0.53, 95% CI 0.34, 0.82) compared with the remainder of the sample (Table 4). Those cared for by midwives were more than 3.5 times more likely to experience higher quality maternity care (OR 3.59, 95% CI 2.76, 4.68) relative to those who received care from an obstetrician.
Discussion
Key components of quality maternal and newborn care include respectful communication, care tailored to the birthing person’s circumstances and needs, and strengthens the person’s capabilities [5], which are aspects of care captured by the MADM and MORi scales [36]. In this national study of women with a history of cesarean, the most marginalized participants more frequently reported experiencing lower quality maternity care, according to the measures we employed. Black women, those with less education, those from a low-income household, and participants with Medicaid were overrepresented in the group that experienced lower quality maternity care during their experiences of pregnancy and birth after cesarean. BIPOC women were significantly less likely to experience higher quality maternity care and reported significantly lower scores on measures of autonomy and respectful maternity care, when compared with participants who self-identified with the dominant group of healthcare providers (white, non-Latinx).
We found that having a midwife as primary maternity care provider increased experiences of higher quality maternity care, and that autonomy and respect were more likely to be compromised for individuals who had an obstetrician for their primary maternity care provider, similar to the findings of the Giving Voice to Mothers study [7] and others [37, 42]. Midwifery models of care, which tend to be individualized, person-focused and collaborative, embody some of the core components of respectful, person-centered maternity care [43, 44]. Midwifery models of care are associated with lower rates of intervention, higher levels of respect, a focus on communication and information sharing [2, 5, 45] and high-quality care in support of normal, physiologic birth, including VBAC [5]. Further, midwifery care exemplifies the values described in the quality maternal and newborn care framework [5, 46] and has been shown to improve multiple outcomes for women and their newborns [47, 48].
Our findings are similar to other studies that have demonstrated loss of agency in decision making for childbirth [49, 50], and in particular, less agency in decision making and higher rates of mistreatment and discrimination reported by BIPOC and low-income participants [7, 37, 51, 52]. Lack of high-quality maternity care, exacerbated by poor communication and mistreatment during labor and birth can create a feeling of distrust toward caregivers [53] and distress in the maternity care provider-patient relationship [54].
Improving quality of maternity care, from preconception to postpartum, is critical to reducing health inequities [11, 55, 56]. Black and Indigenous women experience maternity care that is more discriminatory [51, 57], and less respectful and autonomous than white women [7]. Indigenous women are more likely to report experiences of mistreatment by maternity-care providers [7]. American Indian and First Nations communities have cited communication and institutional barriers, interpersonal problems, poverty, abuse, depression, substance use, and a lack of trust in Indian Health Service providers as affecting the quality of their prenatal care [58, 59]. Black women have similarly perceived their prenatal care to be of poorer quality [60]. BIPOC women’s experiences of poor communication from providers, coercion in their reproductive care, and discrimination increase levels of health care system distrust, contributing to and exacerbating racial disparities in health care [61]. These factors also contribute to lower utilization of preventative health services among lower-income Black Americans [62, 63].
BIPOC participants generally reported low rates of racial concordance with their maternity care providers. Saha and colleagues found that satisfaction is greater and people more frequently participate in preventative care when there is racial concordance between a person and their provider [64]. Unfortunately, achieving racial concordance with their maternity care provider may be challenging for BIPOC people as less than 6% of midwives identify as people of color [65] and a small portion of obstetricians are Black (11%) and Latinx (7%) [66]. When racial concordance is not possible, anti-racist and cultural humility trainings for providers and hospital staff [54, 67–69] may help to lessen the experiences of mistreatment due to racial discrimination among women of color.
Experiencing mistreatment, disrespectful care, and lack of autonomy, as well as the stress and anxiety of “fighting” for a VBAC [9] potentially has long lasting effects for both women and their children. Even mild stress in pregnancy can have negative influences on physiology and psychology for both mother and the developing child, and contribute to negative pregnancy outcomes such as preterm birth and fetal growth restriction [70]. Recent evidence from population level data links high rates of obstetric interventions like cesareans to postnatal maternal and neonatal morbidities and long term adverse child health consequences [71].
Participants who identified as American Indian and Multiracial reported disproportionately higher rates of postpartum depression and birth trauma after their first births. Notably, they also had very low rates of racial concordance with their maternity care providers. Higher rates of posttraumatic stress disorder symptoms were reported after unplanned cesarean [72]. Experiences, even those that may be considered routine by healthcare professionals can cause trauma during childbirth [73] and many women exhibit posttraumatic stress symptoms, while a smaller but still significant percentage meet diagnostic criteria for posttraumatic stress disorder due to their childbirth experiences [74]. These negative, fearful, or traumatic experiences may result in the release of catecholamines in early labor, causing labor to stall [75] and result in a “failure to progress” labor and subsequent cesarean. These experiences may also result in decreased trust in and utilization of the healthcare system in the future, which would lead to decreased screening and follow-up, possibly for the women and their children who need it the most.
Strengths and limitations
A significant strength of this study is that it captured the experiences of a large and geographically diverse sample of women with a history of cesarean. However, our sample is not representative of the racial and ethnic diversity of U.S. individuals with a history of cesarean. [76]. Additionally, the majority (64.7%) of participants had a VBAC, well above the national VBAC rate of 13.9% [77]. Our findings are subject to self-selection bias due to recruitment in birth advocacy social media interest groups. Individuals who were active participants in social media birth advocacy were more likely to have been made aware of the opportunity to participate in this study. A further limitation is the sociodemographic homogeneity and of the sample despite significant efforts to reach out to birth justice groups for women of color, which limited adequate investigation of these potential interactions of intersecting identities. An additional limitation is our English-speaking inclusion criteria which limited our ability to reach non-English speaking people in the U.S. who may be further marginalized in the English-dominant U.S. health system. Further, due to the retrospective nature of the study, we were not able to measure the preferred amount of decision-making autonomy each participant desired during their pregnancy and birth.
Implications for health equity
According to the World Health Organization, women’s experiences of care are equally important to the quality of clinical care provided [78, 79]. Respectful maternity care is an integral part of high quality care [44, 80] and human rights based respectful maternity care can improve women’s experiences and address health inequalities [4]. Our results indicate a disconnect between the aim of delivering person-centered, equitable care and our participants’ experiences of care.
This study illuminates the need for further research in many areas related to health equity in maternal health. In their recent integrative review, Sonderlund and colleagues found that experiences of discrimination predict a range of adverse birth outcomes and physiological markers of allostatic load in mother and child and may be contributing to health inequities [81]. Sudhinaraset and colleagues found that women who experienced more person-centered maternity care were less likely to report maternal or newborn complications or screen positive for depression [6]. Further research exploring the long-term and intergenerational biosocial, physiologic, and psychologic effects of quality of maternity care, especially focusing on marginalized groups (socioeconomically disadvantaged people, racial and ethnic minorities, and rural residents) is necessary.
Our study highlights the inequities in experiences of quality maternity care for a large cohort of women with a history of cesarean birth from all 50 U.S. states. Marginalized and socially disadvantaged women were the least likely to experience high-quality respectful, person-centered maternity care, even while they are the most at risk for adverse birth outcomes. Policy supports to improve access to midwifery care and doula services for Medicaid participants would increase access to experiences of respectful and high quality maternity care. Additional research is indicated to further quantify and measure quality maternity care [78] and to develop interventions that promote respectful maternity care, in both high and low resource settings [82].
References
- 1. Wagner M. Fish can’t see water: The need to humanize birth. International Journal of Gynecology and Obstetrics. 2001;75(SUPPL. 1):25–37.
- 2.
Avery M, Bell AD, Bingham D, Corry MP, Delbanco SF, Leavitt Gullo S, et al. Blueprint for advancing high-value maternity care through physiologic childbearing [Internet]. Washington, D.C.: National Partnership for Women & Families; 2018 [cited 2020 Jan 13]. Available from: www.birthbecomesher.com.
- 3. Yuan C, Gaskins AJ, Blaine AI, Zhang C, Gillman MW, Missmer SA, et al. Association Between Cesarean Birth and Risk of Obesity in Offspring in Childhood, Adolescence, and Early Adulthood. JAMA Pediatrics. 2016 Nov 1;64(1):1–65.
- 4.
World Health Organization. WHO recommendations: Intrapartum care for a positive childbirth experience [Internet]. Geneva; 2018 [cited 2020 Jan 13]. Available from: http://apps.who.int/bookorders.
- 5. Renfrew MJ, McFadden A, Bastos MH, Campbell J, Channon AA, Cheung NF, et al. Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care. The Lancet [Internet]. 2014;384(9948):1129–45. Available from: pmid:24965816
- 6. Sudhinaraset M, Landrian A, Golub G, Cotter SY, Afulani P. Person-centered maternity care and postnatal health: Associations with maternal and newborn health outcomes. AJOG Global Reports. 2021 Jan 27;100005. pmid:33889853
- 7. Vedam S, Stoll K, Khemet Taiwo T, Rubashkin N, Cheyney M, Strauss N, et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reproductive Health [Internet]. 2019 [cited 2019 Jun 15];16(77). Available from: pmid:31182118
- 8. Attanasio LB, Hardeman RR. Declined care and discrimination during the childbirth hospitalization. 2019 [cited 2020 Sep 27]; Available from: https://doi.org/10.1016/j.socscimed.2019.05.008
- 9. Basile Ibrahim B, Knobf MT, Shorten A, Vedam S, Cheyney M, Illuzzi J, et al. “I had to fight for my VBAC”: A mixed methods exploration of women’s experiences of pregnancy and vaginal birth after cesarean in the United States. Birth [Internet]. 2020 Dec 3 [cited 2020 Dec 13];48(2):164–77. Available from: https://onlinelibrary.wiley.com/doi/10.1111/birt.12513 pmid:33274500
- 10. Keedle H, Schmied V, Burns E, Dahlen HG. From coercion to respectful care: women’s interactions with health care providers when planning a VBAC. BMC Pregnancy and Childbirth [Internet]. 2022 Dec 1 [cited 2022 Mar 6];22(1):70. Available from: /pmc/articles/PMC8793226/ pmid:35086509
- 11. Howell EA. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clinical Obstetrics and Gynecology. 2018 Jan 16;1. pmid:29346121
- 12. Kozhimannil KB, Interrante JD, Tofte AN, Admon LK. Severe Maternal Morbidity and Mortality Among Indigenous Women in the United States. Obstetrics and gynecology [Internet]. 2020 Feb 1 [cited 2020 Jun 16];135(2):294–300. Available from: https://www.hcup-us.ahrq.gov/partners.jsp. pmid:31923072
- 13. Somer SJH, Sinkey RG, Bryant AS. Epidemiology of racial/ethnic disparities in severe maternal morbidity and mortality. Seminars in Perinatology. 2017;41:258–65. pmid:28888263
- 14. Berg CJ, Harper MA, Atkinson SM, Bell EA, Brown HL, Hage ML, et al. Preventability of Pregnancy-Related Deaths. Obstetrics & Gynecology. 2005 Dec;106(6):1228–34.
- 15. Howell EA, Zeitlin J. Improving hospital quality to reduce disparities in severe maternal morbidity and mortality. Seminars in Perinatology [Internet]. 2017 Aug [cited 2018 Mar 20];41(5):266–72. Available from: http://www.ncbi.nlm.nih.gov/pubmed/28735811 pmid:28735811
- 16. Howell EA. Racial disparities in infant mortality: A quality of care perspective. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine [Internet]. 2008 Jan [cited 2018 Mar 20];75(1):31–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18306240 pmid:18306240
- 17. Bryant AS, Worjoloh A, Caughey AB, Washington AE. Racial/ethnic disparities in obstetric outcomes and care: prevalence and determinants. American Journal of Obstetrics and Gynecology. 2010 Apr;202(4):335–43. pmid:20060513
- 18. Getahun D, Strickland D, Lawrence JM, Fassett MJ, Koebnick C, Jacobsen SJ. Racial and ethnic disparities in the trends in primary cesarean delivery based on indications. American Journal of Obstetrics and Gynecology. 2009;201(4):422.e1-422.e7. pmid:19788975
- 19. Kozhimannil KB, Muoto I, Darney BG, Caughey AB, Snowden JM. Early elective delivery disparities between non-Hispanic black and white women following statewide policy implementation. Women’s health issues: official publication of the Jacobs Institute of Women’s Health. 2018 May 1;28(3):224.
- 20. Snowden JM, Osmundson SS, Kaufman M, Peterson CB, Kozhimannil KB. Cesarean birth and maternal morbidity among Black women and White women after implementation of a blended payment policy. Health Services Research. 2020 Oct 1;55(5):729–40. pmid:32677043
- 21. Adams J U.S. Department of Health and Human Services. The Surgeon General’s Call to Action to Improve Maternal Health. 2020.
- 22.
U.S. Department of Health and Human Services. Healthy Women, Healthy Pregnancies, Healthy Futures: Action Plan to Improve Maternal Health in America. 2020.
- 23. Came H, Griffith D. Tackling racism as a “wicked” public health problem: Enabling allies in anti-racism praxis. Social Science & Medicine. 2018 Feb 1;199:181–8. pmid:28342562
- 24. Carty DC, Kruger DJ, Turner TM, Campbell B, Deloney EH, Lewis EY. Racism, Health Status, and Birth Outcomes: Results of a Participatory Community-Based Intervention and Health Survey. Journal of Urban Health: Bulletin of the New York Academy of Medicine. 2011 Feb 27;88(1):84–97. pmid:21271359
- 25. Alio AP, Richman AR, Clayton HB, Jeffers DF, Wathington DJ, Salihu HM. An Ecological Approach to Understanding Black–White Disparities in Perinatal Mortality. Maternal and Child Health Journal. 2010 Jul 27;14(4):557–66. pmid:19562474
- 26. Chae DH, Clouston S, Martz CD, Hatzenbuehler ML, Cooper HLF, Turpin R, et al. Area racism and birth outcomes among Blacks in the United States. Social Science & Medicine. 2018 Feb;199:49–55. pmid:28454665
- 27. Alhusen JL, Bower K, Epstein E, Sharps P. Racial Discrimination and Adverse Birth Outcomes: An Integrative Review. Journal of Midwifery and Women’s Health. 2016;61(6):707–20. pmid:27737504
- 28. Reed R, Sharman RR, Inglis C. Women’s descriptions of childbirth trauma relating to care provider actions and interactions. BMC Pregnancy and Childbirth. 2017;17(21):1–10. pmid:28068932
- 29. Hameed W, Avan BI. Women’s experiences of mistreatment during childbirth: A comparative view of home- and facility-based births in Pakistan. 2018.
- 30. McMahon SA, George AS, Chebet JJ, Mosha IH, Mpembeni RN, Winch PJ. Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy and Childbirth 2014 14:1. 2014 Aug 12;14(1):1–13.
- 31.
Creswell JW, Clark VLP. Designing and Conducting Mixed Methods Research. 2nd ed. Los Angeles, CA: SAGE Publications; 2011. 457 p.
- 32. Meissner HI, Creswell JW, Klassen AC, Clark VLP, Smith KC. Best Practices for Mixed Methods Research in the Health Sciences. [cited 2017 Oct 19]; Available from: https://www2.jabsom.hawaii.edu/native/docs/tsudocs/Best_Practices_for_Mixed_Methods_Research_Aug2011.pdf
- 33.
International Cesarean Awareness Network. ICAN—Home, Facebook [Internet]. [cited 2020 Jan 13]. Available from: https://www.facebook.com/ICANonline/
- 34.
Improving Birth. Improvingbirth.org—Home, Facebook [Internet]. Available from: https://www.facebook.com/ImprovingBirth/
- 35. Vedam S, Stoll K, Rubashkin N, Martin K, Miller-Vedam Z, Hayes-Klein H, et al. The Mothers on Respect (MOR) index_ measuring quality, safety, and human rights in childbirth. SSM—Population Health. 2017;3:201–10.
- 36. Vedam S, Stoll K, Martin K, Rubashkin N, Partridge S, Thordarson D, et al. The Mother’s autonomy in decision making (MADM) scale: Patient-led development and psychometric testing of a new instrument to evaluate experience of maternity care. PLoS ONE. 2017;12(2):e0171804. pmid:28231285
- 37. Basile Ibrahim B, Kennedy HP, Combellick J. Experiences of Quality Perinatal Care During the US COVID-19 Pandemic. Journal of Midwifery and Women’s Health. 2021. pmid:34432368
- 38. Beatty Moody DL, Waldstein SR, Leibel DK, Hoggard LS, Gee GC, Ashe JJ, et al. Race and other sociodemographic categories are differentially linked to multiple dimensions of interpersonal-level discrimination: Implications for intersectional, health research. PLoS ONE. 2021;16(5 May). pmid:34010303
- 39.
Canadian Institute for Health Information. In Pursuit of Health Equity: Defining Stratifiers for Measuring Health Inequality—A Focus on Age, Sex, Gender, Income, Education and Geographic Location [Internet]. Ottawa; 2018 [cited 2022 Mar 7]. Available from: www.cihi.ca
- 40. United States Department of Agriculture. Child Nutrition Programs: Income Eligibility Guidelines. Federal Register. 2017;82(67):17182–5.
- 41. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and Elaboration. Annals of Internal Medicine. 2007 Oct 16;147(8):W163–94. pmid:17938389
- 42. Keedle H, Peters L, Peters L, Schmied V, Burns E, Keedle W, et al. Women’s experiences of planning a vaginal birth after caesarean in different models of maternity care in Australia. BMC Pregnancy and Childbirth. 2020;20(1):1–15. pmid:32605586
- 43.
World Health Organization. WHO recommendation on respectful maternity care during labour and childbirth [Internet]. Geneva; 2018 [cited 2019 Dec 3]. Available from: https://extranet.who.int/rhl/topics/preconception-pregnancy-childbirth-and-postpartum-care/care-during-childbirth/who-recommendation-respectful-maternity-care-during-labour-and-childbirth
- 44.
White Ribbon Alliance. Respectful Maternity Care: The Universal Rights of Childbearing Women. Washington, D.C.; 2011.
- 45. Renfrew MJ, Homer CS, Downe S, McFadden A, Muir N, Prentice T, et al. Midwifery An Executive Summary for The Lancet’s Series. The Lancet [Internet]. 2014 [cited 2020 Feb 19];8. Available from: www.thelancet.com
- 46. Kennedy HP, Yoshida S, Costello A, Declercq E, Dias MA, Duff E, et al. Asking different questions: research priorities to improve the quality of care for every woman, every child. The Lancet. 2016;4:e777–9. pmid:27663682
- 47. Bohren MA, Hofmeyr G, Sakala C, Fukuzawa R, Cuthbert A. Continuous support for women during childbirth (Review). Cochrane Database of Systematic Reviews. 2017;(7):130.
- 48. Nove A, Friberg IK, de Bernis L, McConville F, Moran AC, Najjemba M, et al. Potential impact of midwives in preventing and reducing maternal and neonatal mortality and stillbirths: a Lives Saved Tool modelling study. The Lancet Global Health. 2021;9(1):e24–32. pmid:33275948
- 49. Vedam S, Stoll K, McRae DN, Korchinski M, Velasquez R, Wang J, et al. Patient-led decision making: Measuring autonomy and respect in Canadian maternity care. Patient Education and Counseling. 2019;102(3):586–94. pmid:30448044
- 50. Hall WA, Tomkinson J, Klein MC. Canadian care providers’ and pregnant women’s approaches to managing birth: Minimizing risk while maximizing integrity. Qualitative Health Research. 2012;22(5):575–86. pmid:21940939
- 51. Gadson A, Akpovi E, Mehta PK. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome. Seminars in Perinatology. 2017 Aug 1;41(5):308–17. pmid:28625554
- 52. Attanasio LB, Kozhimannil KB, Kjerulff KH. Factors influencing women’s perceptions of shared decision making during labor and delivery: Results from a large-scale cohort study of first childbirth. Patient Education and Counseling. 2018 Jun 1;101(6):1130–6. pmid:29339041
- 53. Fries K. African American Women & Unplanned Cesarean Birth. The American Journal of Maternal/ Child Nursing. 2010;35(2):110–5.
- 54.
Oparah JC, Arega H, Hudson D, Jones L, Oseguera T. Battling Over Birth: Black Women and the Maternal Health Care Crisis in California, Executive Summary. Oakland, CA: Black Women Birthing Justice; 2016. 24 p.
- 55. Harper M, Dugan E, Espeland M, Martinez-Borges A, McQuellon C. Why African-American Women Are at Greater Risk for Pregnancy-Related Death. Annals of Epidemiology. 2007 Mar 1;17(3):180–5. pmid:17320785
- 56. Johnson MB. Prenatal Care for American Indian Women. MCN: The American Journal of Maternal/Child Nursing. 2020 Jul 1;45(4):221–7. pmid:32282338
- 57. Salm Ward TC, Mazul M, Ngui EM, Bridgewater FD, Harley AE. “You Learn to Go Last”: Perceptions of Prenatal Care Experiences among African-American Women with Limited Incomes. Maternal and Child Health Journal. 2013 Dec 21;17(10):1753–9. pmid:23180190
- 58. Hanson JD. Understanding Prenatal Health Care for American Indian Women in a Northern Plains Tribe. Journal of Transcultural Nursing. 2012;23(1):29–37. pmid:22052090
- 59.
Gupton AJ. Implementing a Community Education Campaign to Improve Prenatal Care Among Navajo Women. Northern Arizona University; 2019.
- 60. Mazul MC, Salm Ward TC, Ngui EM. Anatomy of Good Prenatal Care: Perspectives of Low Income African-American Women on Barriers and Facilitators to Prenatal Care. Journal of Racial and Ethnic Health Disparities [Internet]. 2016 [cited 2018 May 3]; Available from: https://link.springer.com/content/pdf/10.1007%2Fs40615-015-0204-x.pdf pmid:26823064
- 61. Armstrong K, Putt M, Halbert CH, Grande D, Schwartz JS, Liao K, et al. Prior experiences of racial discrimination and racial differences in health care system distrust. Medical care. 2013 Feb;51(2):144–50. pmid:23222499
- 62. O’Malley AS, Sheppard VB, Schwartz M, Mandelblatt J. The role of trust in use of preventive services among low-income African-American women. Preventive Medicine. 2004 Jun;38(6):777–85. pmid:15193898
- 63. Musa D, Schulz R, Harris R, Silverman M, Thomas SB. Trust in the health care system and the use of preventive health services by older black and white adults. American journal of public health. 2009 Jul;99(7):1293–9. pmid:18923129
- 64. Saha S, Komaromy M, Koepsell TD, Bindman AB. Patient-physician racial concordance and the perceived quality and use of health care. Archives of Internal Medicine. 1999;159(9):997–1004. pmid:10326942
- 65. Fullerton J, Sipe TA, Hastings-Tolsma M, McFarlin BL, Schuiling K, Bright CD, et al. The Midwifery Workforce: ACNM 2012 and AMCB 2013 Core Data. Journal of Midwifery and Women’s Health. 2015;60(6):751–61. pmid:26769385
- 66. Rayburn WF, Xierali IM, Castillo-Page L, Nivet MA. Racial and ethnic differences between obstetrician-gynecologists and other adult medical specialists. Obstetrics and Gynecology. 2016;127(1):148–52. pmid:26646119
- 67. Lu MC, Kotelchuck M, Hogan V, Jones L, Wright K, Halfon N. Closing the Black-White Gap in Birth Outcomes: A Life-course Approach. Ethnicity & disease. 2010;20(102):S2-62–76. pmid:20629248
- 68. Eichelberger K, Doll K, Ekpo G, Zerden M. Black Lives Matter: Claiming a Space for Evidence-Based Outrage in Obstetrics and Gynecology. American journal of public health. 2016;106(10):1771–2. pmid:27626348
- 69. Tervalon M, Murray-García J. Cultural humility versus cultural competence: A critical distinction in defining physician training outcomes in multicultural education. Journal of Health Care for the Poor and Underserved. 1998;9(2):117–25. pmid:10073197
- 70. Coussons-Read ME. Effects of prenatal stress on pregnancy and human development: Mechanisms and pathways. Vol. 6, Obstetric Medicine. Royal Society of Medicine Press Ltd; 2013. p. 52–7. pmid:27757157
- 71. Dahlen HG, Thornton C, Downe S, De Jonge A, Seijmonsbergen-Schermers A, Tracy S, et al. Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study. BMJ Open. 2021;11:47040. pmid:34059509
- 72. Kjerulff KH, Attanasio LB, Sznajder KK, Brubaker LH. A prospective cohort study of post-traumatic stress disorder and maternal-infant bonding after first childbirth. Journal of Psychosomatic Research. 2021 May 1;144:110424. pmid:33756149
- 73. Beck CT. Birth trauma: In the eye of the beholder. Nursing Research [Internet]. 2004 [cited 2019 Jan 9];53(1):28–35. Available from: http://www.ncbi.nlm.nih.gov/pubmed/14726774 pmid:14726774
- 74. Beck CT, Gable RK, Sakala C, Declercq ER. Posttraumatic Stress Disorder in New Mothers: Results from a Two-Stage U.S. National Survey. Birth. 2011 Sep 1;38(3):216–27. pmid:21884230
- 75. Lothian JA. Do Not Disturb: The Importance of Privacy in Labor. Journal of Perinatal Education. 2005 Jun 1;13(3):4–6.
- 76. Basile Ibrahim B, Kennedy HP, Holland ML. Demographic, Socioeconomic, Health Systems, and Geographic Factors Associated with Vaginal Birth After Cesarean, An Analysis of 2017 U.S. Birth Certificate Data. Maternal and Child Health Journal. 2020. pmid:33201453
- 77. Osterman MJK, Hamilton BE, Martin JA, Driscoll AK, Valenzuela CP. Births: Final Data for 2020 Figure 1. Live births and general fertility rates: United States. National Vital Statistics Reports [Internet]. 2022 [cited 2022 Feb 7];70(17). Available from: https://www.cdc.gov/nchs/products/index.htm.
- 78. Bohren MA, Tunçalp Ö, Miller S. Transforming intrapartum care: Respectful maternity care. Vol. 67, Best Practice and Research: Clinical Obstetrics and Gynaecology. Bailliere Tindall Ltd; 2020. p. 113–26. pmid:32245630
- 79. Tunçalp Were WM, Maclennan C, Oladapo OT, Gülmezoglu AM, Bahl R, et al. Quality of care for pregnant women and newborns—The WHO vision. BJOG: An International Journal of Obstetrics and Gynaecology. 2015;122(8):1045–9. pmid:25929823
- 80. Miller S, Lalonde A. The global epidemic of abuse and disrespect during childbirth: History, evidence, interventions, and FIGO’s mother-baby friendly birthing facilities initiative. International Journal of Gynecology and Obstetrics. 2015 Oct 1;131:S49–52. pmid:26433506
- 81. Sonderlund AL, Schoenthaler A, Thilsing T. The association between maternal experiences of interpersonal discrimination and adverse birth outcomes: A systematic review of the evidence. International Journal of Environmental Research and Public Health. 2021;18(4):1–31.
- 82. Downe S, Lawrie TA, Finlayson K, Oladapo OT. Effectiveness of respectful care policies for women using routine intrapartum services: A systematic review. Vol. 15, Reproductive Health. BioMed Central Ltd.; 2018. pmid:29409519