Mistreatment in Maternity Care: 1 in 5 U.S. Mothers Report It, and 45% Hold Back Concerns

U.S. maternal death rates rose from 2018 to 2021, and more than 80% of pregnancy-related deaths are preventable. Native Hawaiian and Pacific Islander, Black, and American Indian and Alaska Native women have the highest pregnancy-related death rates, and women in some racial and ethnic minority groups are more likely to have negative experiences of care that affect its quality and their health.

A CDC Vital Signs survey of mothers' maternity care experiences found:

Who reported mistreatment

Mistreatment during maternity care, by race and ethnicity and by insurance at delivery. CDC.

The most common kinds of mistreatment:

• no response to requests for help;
• being shouted at or scolded;
• physical privacy not protected;
• being threatened with withheld treatment, or pushed into unwanted treatment.

Satisfaction with care was high overall (90%) but much lower (75%) among mothers who reported mistreatment.

Why mothers stay silent

45% held back questions or concerns. The top reasons:

• they thought — or friends and family told them — that what they felt was normal;
• they didn't want to make a big deal of it, or were embarrassed;
• they thought the provider would see them as difficult;
• the provider seemed rushed;
• they weren't confident they knew what they were talking about.

Good communication makes accurate, timely diagnosis and treatment of life-threatening pregnancy complications more likely. Providers can build trust, take time to really hear concerns, and talk them through.

Respectful maternity care

Respectful maternity care. CDC.

Respectful care:

• keeps dignity, privacy and confidentiality;
• ensures freedom from harm and mistreatment;
• allows shared decision-making and continuous support in labor and childbirth.

Advancing equity

Differences in respectful care are rooted in discrimination and stigma tied to factors including race and insurance, and research links pregnancy complications with experiences of racism or discrimination. A more diverse health workforce can improve patient experiences, satisfaction and access for underserved patients.

CDC works to understand the leading causes of pregnancy-related deaths, supports state quality-improvement teams, and runs the Hear Her campaign to improve communication. Partners build respectful care into patient safety bundles, develop toolkits, and train maternity teams in unconscious bias and culturally appropriate care, especially where complications and deaths are highest.

What each can do

Health care systems

• hire and keep a diverse workforce, and train all staff on unconscious bias and respectful care;
• support communication through doulas and midwifery models of care;
• improve quality with a focus on equally respectful, responsive care, and engage communities.

Maternity care providers

• listen, and ask questions to build trust;
• recognize unconscious bias;
• address patients' concerns;
• make sure patients and companions know the urgent maternal warning signs and when to get help right away.

Everyone

• If you are pregnant or gave birth in the past year, tell your provider about anything that doesn't feel right.
• Listen to pregnant and postpartum women, encourage them to seek help, and go to visits with them.
• Make sure anyone with an urgent warning sign gets care immediately.

Sources

Based on "Many Women Report Mistreatment During Pregnancy and Delivery," Vital Signs, Centers for Disease Control and Prevention, updated September 29, 2023, summarizing Vital Signs: Maternity Care Experiences — United States, April 2023; a work of the United States government in the public domain. The page's decorative icons and collage are not reproduced.