Patient-led decision making: Measuring autonomy and respect in Canadian maternity care

Abstract

ObjectiveThe Changing Childbirth in British Columbia study explored women’s preferences and experiences of maternity care, including women’s role in decision-making. MethodsFollowing content validation by community members, we administered a cross-sectional online survey exploring novel topics, including drivers for interventions, and experiences of autonomy, respect, or mistreatment during maternity care. Using the Mothers Autonomy in Decision-Making (MADM) scale as an outcome measure in a mixed-effects analysis, we examined differential experiences by socio-demographic and prenatal risk profile, type of care provider, interventions received, and nature of communication with care providers. ResultsA geographically representative sample of Canadian women (n = 2051) reported on 3400 pregnancies. Most women (95.2%) preferred to be the lead decision-maker during care. Patients of physicians had significantly lower autonomy (MADM) scores than midwifery clients as did women who felt pressured to accept interventions. Women who had a difference in opinion with their provider, and those who felt their provider seemed rushed reported the lowest MADM scores. ConclusionWomen’s autonomy is significantly altered by model of maternity care, the nature of interactions with care providers, and women’s ability for self-determination. Practice ImplicationsIf health professionals acquire skills in person-centred decision-making experience of autonomy among pregnant women may improve.