U.S. Perinatal Care Faces Respect Deficit, Providers Reveal in New Scoping Review
A new scoping review published in BMC Pregnancy and Childbirth reveals a concerning gap between stated values of respectful maternity care and the lived experiences of patients within the U.S. healthcare system, as perceived by perinatal healthcare providers. The study synthesizes findings from 24 qualitative studies, highlighting systemic issues contributing to disrespectful treatment during pregnancy and childbirth, including implicit bias, time constraints, and a lack of adequate training on culturally sensitive communication.
The findings arrive at a critical juncture, as the U.S. continues to grapple with stark maternal mortality rates-particularly among women of colour-and increasing calls for equitable and patient-centered care. Researchers found providers frequently identified pressures within the healthcare system as barriers to providing respectful care, alongside a need for improved accountability mechanisms and a stronger emphasis on shared decision-making. The review underscores the urgent need for systemic changes to foster a more supportive and respectful perinatal care environment.
The scoping review identified several key themes. Providers acknowledged the influence of implicit bias on patient interactions, with some recognizing their own biases and the potential for discriminatory practices [53, 55]. Time constraints and heavy workloads were frequently cited as obstacles to providing individualized, respectful care [56]. Several studies highlighted instances of dismissive or condescending communication from providers, contributing to feelings of disempowerment among patients [54].
Furthermore, the review revealed a perceived lack of accountability for disrespectful behavior, with limited mechanisms for patients to report mistreatment or for providers to receive feedback and training [53]. Doulas were identified as potential facilitators of accountability and bridges to address gaps in care [53].Stigma surrounding issues like opioid misuse also contributed to disrespectful treatment, as providers expressed discomfort or judgment towards affected patients [57].The review also noted the importance of shared decision-making, but acknowledged challenges in implementing this approach within a complex healthcare environment [56].
