Supporting patient autonomy through respectful labor and childbirth healthcare services

Abstract

Despite childbirth being a leading cause of hospitalization, the system of care has not been optimized for patients in the United States. Rates of maternal mortality are high, increasing, and disproportionate. In addition to disparities in health outcomes, the quality of perinatal care, as assessed by patient experiences of care, is variable. Although clinicians strive to actively support families through labor and childbirth, various forms of mistreatment are common in perinatal care. Such instances of patient mistreatment highlight an urgent need to further enact respectful maternity care principles so that services are more person-focused and supportive. Welcoming clinical environments with relationship-centered care, trauma-informed interactions, and anti-racist practices support maternal autonomy. As a part of these quality care approaches, effective communication by clinicians helps patients understand their healthcare options and the events that shape their childbirth experiences. Nonstigmatizing interactions, using linguistically and culturally appropriate language, and integrating tools for shared decision making are essential elements of quality intrapartum care. A reproductive justice lens focuses attention on the need to eliminate infringements on health and build assurances to enable positive health outcomes and thriving.

Keywords: Autonomy; Childbirth; Decision making; Labor and delivery; Maternal; Respectful maternity care.