Kathrin Stoll1, Jessie J Wang2, Paulomi Niles3,4, Lindsay Wells5, Saraswathi Vedam3. 1. Birth Place Lab, Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada. kathrin.stoll@ubc.ca. 2. Faculty of Medicine, University of British Columbia, 317-2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada. 3. Birth Place Lab, Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada. 4. New York University Rory Meyers College of Nursing, 433 1st Avenue, New York, NY, 10010, USA. 5. Midwifery Education Program, Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada.
Abstract
BACKGROUND: No Canadian studies to date have examined the experiences of people who decline aspects of care during pregnancy and birth. The current analysis bridges this gap by describing comments from 1123 people in British Columbia (BC) who declined a test or procedure that their care provider recommended. METHODS: In the Changing Childbirth in BC study, childbearing people designed a mixed-methods study, including a cross-sectional survey on experiences of provider-patient interactions over the course of maternity care. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations. RESULTS: More than half of all study participants (n = 2100) declined care at some point during pregnancy, birth, or the postpartum period (53.5%), making this a common phenomenon. Participants most commonly declined genetic or gestational diabetes testing, ultrasounds, induction of labour, pharmaceutical pain management during labour, and eye prophylaxis for the newborn. Some people reported that care providers accepted or supported their decision, and others described pressure and coercion from providers. These negative interactions resulted in childbearing people feeling invisible, disempowered and in some cases traumatized. Loss of trust in healthcare providers were also described by childbearing people whose preferences were not respected whereas those who felt informed about their options and supported to make decisions about their care reported positive birth experiences. CONCLUSIONS: Declining care is common during pregnancy and birth and care provider reactions and behaviours greatly influence how childbearing people experience these events. Our findings confirm that clinicians need further training in person-centred decision-making, including respectful communication even when choices fall outside of standard care.
BACKGROUND: No Canadian studies to date have examined the experiences of people who decline aspects of care during pregnancy and birth. The current analysis bridges this gap by describing comments from 1123 people in British Columbia (BC) who declined a test or procedure that their care provider recommended. METHODS: In the Changing Childbirth in BC study, childbearing people designed a mixed-methods study, including a cross-sectional survey on experiences of provider-patient interactions over the course of maternity care. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations. RESULTS: More than half of all study participants (n = 2100) declined care at some point during pregnancy, birth, or the postpartum period (53.5%), making this a common phenomenon. Participants most commonly declined genetic or gestational diabetes testing, ultrasounds, induction of labour, pharmaceutical pain management during labour, and eye prophylaxis for the newborn. Some people reported that care providers accepted or supported their decision, and others described pressure and coercion from providers. These negative interactions resulted in childbearing people feeling invisible, disempowered and in some cases traumatized. Loss of trust in healthcare providers were also described by childbearing people whose preferences were not respected whereas those who felt informed about their options and supported to make decisions about their care reported positive birth experiences. CONCLUSIONS: Declining care is common during pregnancy and birth and care provider reactions and behaviours greatly influence how childbearing people experience these events. Our findings confirm that clinicians need further training in person-centred decision-making, including respectful communication even when choices fall outside of standard care.
Entities:
Keywords:
Care narratives; Childbirth; Declining care; Informed consent; Lived experiences; Person-centered care; Refusal of care; Respectful maternity care; Shared decision-making
Authors: Anne Drapkin Lyerly; Lisa M Mitchell; Elizabeth M Armstrong; Lisa H Harris; Rebecca Kukla; Miriam Kuppermann; Margaret Olivia Little Journal: Obstet Gynecol Date: 2007-04 Impact factor: 7.661
Authors: Saraswathi Vedam; Kathrin Stoll; Kelsey Martin; Nicholas Rubashkin; Sarah Partridge; Dana Thordarson; Ganga Jolicoeur Journal: PLoS One Date: 2017-02-23 Impact factor: 3.240