ObGyn Intelligence
Evidence Matters
Prepare
Evidence LibraryPregnancy loss and complicated outcomesWhat to ask for
Evidence Library · What to ask for

If you were treated badly, what you can actually do

Complaining and healing are separate projects. You are allowed to do one, both, or neither, and neither one requires you to prove the outcome was wrong.

Being treated badly and having a bad outcome are different claims, and they are answered by different people. You do not have to show that the medicine was wrong in order to say that the conduct was.

The standards you are measuring it against are not your personal preferences. They are written down.

The first of WHO's recommendations on care in labour is that respectful maternity care is recommended. WHO defines that, in its own words, as care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labour and childbirth.

ACOG's ethics committee draws the line between advising firmly and pressuring, and does it in five words: Good intentions can lead to inappropriate behavior. The same document says: it is never acceptable for obstetrician-gynecologists to attempt to influence patients toward a clinical decision using coercion, and lists what that includes: duress, manipulation, coercion, physical force, or threats. If you were told treatment would be withheld, or that you were putting your baby at risk unless you agreed, that is the paragraph that describes it.

Practically, there are usually a few separate ways of raising it, and they do different jobs. Hospitals differ, and this guide has not verified what any particular one offers, so take what follows as things to ask about rather than as a description of what you are owed.

What to ask aboutWhat it may be forWhat it will not do
Patient relations or patient advocacy at the hospitalRecording what happened, getting a meeting, sometimes an apology or a change in practiceChange your clinical record or produce a finding of fault
A meeting with the clinician or the head of the unitUnderstanding decisions, and being heard by the people involvedBe neutral ground, which is why bringing someone with you helps
A formal written complaintCreating a record that outlasts staff turnover, and triggering a review processGive you an outcome quickly

Do this on your own timetable. There is no evidence that complaining early heals anything faster, and no evidence that letting it go does either. What is documented is what happens when women stop raising things at all, which is that the problem becomes invisible in exactly the places that could fix it. CDC's own campaign gives one instruction on this: Continue to share your concerns until you are heard, and your questions are answered. That campaign is supported through a partnership with the CDC Foundation and funded by Merck, through its Merck for Mothers programme, which you are entitled to know when weighing a public health message.

The line under all of itA bad outcome is not evidence that you expected too much. And it does not retrospectively excuse anyone who failed to tell you, failed to ask you, or failed to believe you. Those are separate wrongs, and they stand whatever happened afterward.
Opening the conversation"I want to make a complaint about how I was treated. It is separate from the clinical care, and I am not disputing the medical decisions."
"I was told treatment would be withheld unless I agreed. I want that looked into."
"I would like this recorded even if nothing changes."
Where this comes from:
574. Refusal of medically recommended treatment during pregnancy. ACOG Committee Opinion No. 664. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2016;127(6):e175-82.
204. World Health Organization. WHO recommendations: intrapartum care for a positive childbirth experience. Geneva: World Health Organization; 2018.
465. Centers for Disease Control and Prevention. Hear Her: CDC campaign highlights warning signs of pregnancy-related deaths [press release]. Atlanta (GA): CDC; 10 August 2020.
432. Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, et al; GVtM-US Steering Council. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16(1):77.

Covered in the essential classes

Continue

More from When it did not go that way

This page is educational. It supports the conversation with your own clinicians. It is not consent to any treatment, and it cannot assess you. If you are worried about a symptom now, see urgent warning signs.