Being treated badly is not an expectations problem
Some expectations are not too high. They are simply not met, by people rather than by biology.
This topic exists so that nothing else in this section can be misread as an apology for poor care.
A US study invited women who had been pregnant between 2010 and 2016 to describe how they were treated. Of 2,700 who started the survey, analysis was restricted to the 2,138 who completed it. Everything below is out of those 2,138.
| What was reported | Women | Share |
|---|---|---|
| Shouted at or scolded by staff | 182 | 8.5% |
| Ignored, refused help, or help not given in a reasonable time | 166 | 7.8% |
| Physical privacy violated | 117 | 5.5% |
| Threatened with withheld treatment, or with forced treatment | 97 | 4.5% |
| Threatened in some other way | 44 | 2.1% |
| Physical abuse | 27 | 1.3% |
| Private information shared without consent | 26 | 1.2% |
| Any of the above | 369 | 17.3% |
The strongest single association was disagreement. Among women who had a difference of opinion with the clinician caring for them, the crude odds of reporting mistreatment were 22.7 times higher (95% CI 13.9 to 36.9). In plain numbers: among women who had such a disagreement, 83.0% of women of color and 76.4% of white women reported one or more forms of mistreatment.
It also varied by where the birth happened. The first four rows below cover the 1,954 women with a recorded place of birth. The last row is not a fifth setting: it is a group that cuts across the others, so the rows do not add up.
| Where she gave birth | Reported any mistreatment |
|---|---|
| Hospital | 213 of 759 (28.1%) |
| Birth centre inside a hospital | 40 of 167 (24.0%) |
| Freestanding birth centre | 11 of 157 (7.0%) |
| Home | 44 of 871 (5.1%) |
| Transferred to hospital after labor began, a subgroup drawn from the settings above rather than a setting of its own | 37 of 107 (34.6%) |
And it was not evenly distributed. Among women having a first baby, 92 of 282 women of color (32.6%) and 114 of 529 white women (21.6%) reported mistreatment. Among women with low socioeconomic status, 83 of 309 (26.9%) and 74 of 417 (17.7%). Among women with elevated pregnancy risk, 60 of 162 (37.0%) and 60 of 272 (22.1%).
It is not only an American problem. A Dutch national survey of 12,239 women who had given birth in the previous five years found that 36.3% reported at least one situation of disrespect or abuse that they found upsetting. Broken down: lack of choices 39.8%, lack of communication 29.9%, lack of support 21.3%, harsh or rough treatment 21.1%. Having a first baby and having a migrant background were risk factors across all categories. That survey was also self-selected, and it reached the same conclusion in a completely different health system.
"I would like that noted in my record, please."
"I am not refusing. I am asking you to explain it to me first."
"Who can I speak to about how this was handled?"