Evidence Library · Being heard

Why some women do not come back

The complaint has consequences, and the profession has said so in print.

Women who feel dismissed do not always complain. Some of them leave.

When 160 US women who chose home birth were asked in their own words why, their reasons were coded into themes. The three most common were safety, avoiding unnecessary intervention, and a previous negative hospital experience, which appeared in 37 of 508 statements and was essentially tied with the other two. A separate study looked only at women who had a hospital birth and then chose home birth for the next one. One of its five named themes is "disrespect and dismissal," and the study describes clinicians as having been "more focused on the laboring woman's uterus." Another described what women had concluded: that hospital care was emotionally unsafe, and that returning risked further trauma.

The largest survey of mistreatment in US maternity care found it varied sharply by setting: reported by 28.1% of women who gave birth in hospital, 24.0% in hospital-based birth centers, 7.0% in freestanding birth centers and 5.1% at home. Among women of colour the gap was wider still, 33.9% against 6.6%.

Read that number carefullyThis was a self-selected online survey, and women who choose home birth are a self-selected group who often chose it precisely because of a previous bad hospital experience. It measures reported experience, not a fair head-to-head comparison, and it cannot tell you what would have happened to the same woman in the other setting. It is still the largest dataset there is on this question, and the size of the difference is not explained away by the study design alone.

Numbers of planned home births in the United States rose about 60% between 2016 and 2023, to 46,918.

This tool does not take a position here on where you should give birth. That is a separate decision with its own risks, and it deserves its own honest conversation with your own doctor rather than a paragraph here. What belongs here is the finding that feeling unheard is not a small complaint about manners. It changes what women do next.

The profession's own wordsWriting in the Journal of Clinical Ethics, Chervenak, McCullough and Grünebaum stated that the professional responsibility model of obstetric ethics "requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients' concerns about excessive interventions," and that a culture of safety "informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility." Writing later in Seminars in Perinatology, the same group said obstetricians have "the professional responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital."

Your dissatisfaction is not a personality problem. Senior obstetricians have written in the literature that remedying it is part of the job.

Where this comes from:

254. Vedam S, Stoll K, Taiwo TK, Rubashkin N, Cheyney M, Strauss N, et al. The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States. Reprod Health. 2019;16(1):77.

366. Boucher D, Bennett C, McFarlin B, Freeze R. Staying home to give birth: why women in the United States choose home birth. J Midwifery Womens Health. 2009;54(2):119-126.

367. Bernhard C, Zielinski R, Ackerson K, English J. Home birth after hospital birth: women's choices and reflections. J Midwifery Womens Health. 2014;59(2):160-166.

368. Grünebaum A, Chervenak FA. Why do women choose home births. J Perinat Med. 2024;52(6):575-585.

262. Chervenak FA, McCullough LB, Grünebaum A, Arabin B, Levene MI, Brent RL. Planned home birth in the United States and professionalism: a critical assessment. J Clin Ethics. 2013;24(3):184-191.

369. McCullough LB, Grünebaum A, Arabin B, Brent RL, Levene MI, Chervenak FA. Ethics and professional responsibility: essential dimensions of planned home birth. Semin Perinatol. 2016;40(4):222-226.

261. Chervenak FA, McLeod-Sordjan R, Pollet SL, De Four Jones M, Gordon MR, Combs A, et al. Obstetric violence is a misnomer. Am J Obstet Gynecol. 2024;230(3S):S1138-S1145.

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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.