Providers’ Perceptions of Respectful and Disrespectful Maternity Care at Massachusetts General Hospital

Abstract

Background/Objectives: Disrespectful care of birthing persons during childbirth has been observed as a global issue and a possible factor influencing maternal morbidity and mortality. While birthing persons’ experiences of mistreatment in childbirth have been examined, perceptions from obstetrical providers of respectful maternity care have been understudied. Methods: A mixed-method cross-sectional study was conducted in Boston from April 2023 to January 2024 among 46 labor and delivery physicians, midwives, and nurses at Massachusetts General Hospital. The survey evaluated their observation of disrespectful care, the performance of respectful care, and stress and support factors influencing respectfulness of care. Results: The most reported observed disrespectful behaviors were dismissing patients’ pain (87.0%), discriminatory care based on physical characteristics (67.4%) and race (65.2%), and uncomfortable vaginal examinations (65.2%). Respondents self-reported very high levels of respectful maternity care performance. Reported barriers to respectful care included workload (76.1%) and fatigue (60.9%). Conclusions: Disrespectful care in childbirth is an issue reported by healthcare providers. Implicit bias and the working conditions of health care providers are factors in disrespectful care. This information can be used to strategize future training and other areas of intervention to improve maternity care.