Respect in the maternity ward

The anticipation, the excitement, the unknown, and the unrelenting desperation to deliver a healthy baby are shared by every woman in pregnancy. Respect and the opportunity to participate in one’s own decisions in childbirth are likely assumed as automatic. But according to the World Health Organization (WHO), that is not necessarily so. 

In response to WHO’s report on the mistreatment of women during childbirth in health facilities, childbearing women in BC have created a new tool to measure respectful maternity care. WHO conducted a review across 34 countries of documented claims of human rights abuses in childbirth but was left to conclude there is no consensus on how to measure disrespect in maternity care practices. However, the work of Dr Saraswathi Vedam, principal of the University of BC’s Birth Place Lab and associate professor of midwifery at BC Women’s Hospital, is changing that. 

Funding from partners at the Vancouver Foundation, BC Women’s Hospital Foundation, and the Michael Smith Foundation for Health Research enabled Changing Childbirth in BC, a community-led research project, and led to the development of the MADM (Mother’s Autonomy in Decision Making) scale and MORi (Mothers on Respect index). These tools recently received an Innovation Award from the National Quality Forum. With new tools in place to quantify a patient’s experience, this data could now be used to measure current practices and inform new ones. 

More than 4000 women across BC were surveyed about their childbirth experiences and reported variations in respect and autonomy during pregnancy depending on their health status and preferences for care, as well as where and how they gave birth. Overseen by Dr Vedam, the project is run through a steering group of women from different cultural and socioeconomic backgrounds. Despite the diversity of the participants, Dr Vedam says they all raised similar concerns.

Women who were dissatisfied with their role in decision making had very low MADM scores, indicating a lack of autonomy. Dr Vedam’s research also found women with higher medical or social risks during pregnancy were four times as likely to have low MORi scores, indicating they felt less respected by their care providers. Recent immigrants and refugees, or women with a history of substance use, incarceration, poverty, or homelessness were twice as likely to have low MORi scores. Women with midwifery care reported higher MADM and MORi scores compared with women with just physician care. 
—J. Stewart 
Senior Director Communications and Media Relations, BC Women’s Hospital Foundation