The present study aimed to explore the objective and subjective experiences of “mistreatment” in maternity care in a diverse cohort of women who gave birth in New York City hospitals to identify the prevalence and risk factors of mistreatment and measure the relationship between mistreatment and mental health (Bohren et al., 2015). The study utilized a mixed-methods cross-sectional approach. To collect the quantitative data, 109 participants <1 year postpartum completed an anonymous online survey comprising a self-report measure of demographic, health and mental health information, several mental health questionnaires and two measures of mistreatment in maternity care. 8 of these participants were interviewed about their childbirth experience. The quantitative data was analyzed utilizing linear regression, moderation analysis and path analysis, and the qualitative data was thematically coded then analyzed using Reflexive Thematic (RT) analysis. These data were then triangulated using a mixed-methods model of mistreatment.
In total, 10-15% of the sample experienced mistreatment in the form of Low to Very Low respect and/or autonomy in decision making in their maternity care. Forms of mistreatment included unwanted procedures, provider pressure to undergo procedures, dismissal of women’s concerns, racial discrimination, abandonment, and medical neglect. Approximately 25% of respondents received an unwanted intervention; this was the most significant predictor of mistreatment. This relationship was moderated by race, parity and birth plan. Black, Latinx and Hispanic women experienced the lowest levels of respect in maternity care. Mistreatment in maternity care was correlated with increased risk for postpartum mental illness: decreased respect and autonomy in childbirth was associated with increased postpartum depression and PTSD symptoms.
Eight themes were identified in the qualitative analysis: Discrimination and Unfair Treatment, Confusion and Abandonment, Disregard for Patient Autonomy, Hospital-Level Drivers of Mistreatment, Women Treated as Passive, Normalization of Mistreatment, Self-Advocacy and Vulnerability and, Reclaiming Power through Knowledge. Together, the triangulated mixed- methods data were fit to render a comprehensive “model of mistreatment” to illustrate direct and indirect relationships between mistreatment, mental health, race, trauma history, and childbirth preparation. These findings demonstrate that mistreatment is a multi-determined phenomenon that is interdependent with mental health and requires systematic measurement in healthcare treatment, the integration of anti-racist and patient-centered care and improved childbirth education for patients.
| Identifer | oai:union.ndltd.org:columbia.edu/oai:academiccommons.columbia.edu:10.7916/mtx5-jz43 |
| Date | January 2024 |
| Creators | Alix, Anika F. |
| Source Sets | Columbia University |
| Language | English |
| Detected Language | English |
| Type | Theses |
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