1 in 5 Women Have Bad Patient Experience in Maternity Care

The maternal health crisis encompasses more than just the nation’s growing maternal mortality rate. New data from the Centers for Disease Control & Prevention shows that nearly one in five women have had a bad patient experience marked by mistreatment from their maternity care providers.

What’s more, those bad patient-provider relationships are more common among women of color, who are also more likely to have poor maternal health outcomes. One in three Black, Hispanic, and multiracial women said they’ve faced mistreatment from a maternity care provider, per the CDC report, which used data from the Porter Novelli View Moms survey.

CDC defined mistreatment as not receiving respectful maternity care, or not receiving “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 labor and childbirth.”

The survey of 2,407 mothers showed that it’s not uncommon for maternity care to lack that definition of respect.

Overall, 20 percent of mothers said they experienced mistreatment when getting maternity care for their youngest child. Poor patient experience was more common among women of color, with 30 percent of Black women, 29 percent of Hispanic women, and 27 percent of multiracial women reporting mistreatment in their maternity care.

Four in 10 Black, Hispanic, or multiracial reported healthcare discrimination.

The most common types of mistreatment included:

• Not receiving a response to requests for help
• Being shouted at or scolded
• Lack of physical privacy protections
• Being threatened with withholding treatment or being made to accept unwanted treatment

These poor experiences led many women to hold back in patient-provider communication, the survey added. Nearly half (45 percent) of women said they held back from asking questions or expressing concerns during pregnancy or delivery. In some cases, women said they thought—or a family member told them—that what they were feeling was normal. For others, they feared they were making a big deal out of something small, or they felt embarrassed raising concerns.

In other cases, women said they feared how they’d be perceived by their healthcare providers. Some said they thought their clinicians would think they were being difficult. Other women were not confident that they knew what they were talking about. Some women did not raise concerns because they felt like their provider was rushed or did not have time to talk.

Reports of a bad maternity experience are worrisome, considering the nation’s bad track record with maternal health outcomes. Between 2018 and 2021, the maternal death rate in the United States nearly doubled from 17.4 to 32.9 per 100,000 live births. Maternal mortality rates are worse for Native Hawaiian and other Pacific Islander, Black, and American Indian/Alaska Native persons, CDC said, citing its own data.

According to The Commonwealth Fund, the US has the worst maternal outcomes and maternal health equity in the developed world.

And yet, 80 percent of maternal deaths are preventable, CDC added. While improving the maternal mortality rate will require key process and patient safety changes, it will also entail better patient-provider relationships. For one thing, better perceptions of respectful care could encourage better patient access to maternity care, the lack of which is a leading cause of poor maternal outcomes.

Moreover, better patient-provider communication during maternity care could help flag some potential adverse patient safety events early on and before issues can spiral.

The CDC report showed that women do not feel emboldened to raise concerns. It is incumbent upon healthcare providers to encourage all women to raise concerns and ask questions when something does not feel right.

“Clinical organizations representing health care providers have highlighted the importance of providing respectful maternity care to improve outcomes for mothers and children by ensuring effective communication and shared decision-making with patients and their families and strengthening coordinated care teams,” CDC explained.

The agency recommended that healthcare organizations create formalized and standard avenues for teaching implicit bias and cultural awareness to healthcare providers. These efforts should be informed by community advocacy groups, patients, and their family members, CDC advised.