Meyers College of Nursing, New York University, New York, NY, United States of America.
Birth Place Lab, Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
PLoS One. 2021 Jun 4;16(6):e0252645. doi: 10.1371/journal.pone.0252645. eCollection 2021.
The 2016 WHO Standards for improving quality of maternal and newborn care in health facilities established patient experience of care as a core indicator of quality. Global health experts have described loss of autonomy and disrespect as mistreatment. Risk of disrespect and abuse is higher when patient and care provider opinions differ, but little is known about service users experiences when declining aspects of their maternity care.
To address this gap, we present a qualitative content analysis of 1540 written accounts from 892 service users declining or refusing care options throughout childbearing with a large, geographically representative sample (2900) of childbearing women in British Columbia who participated in an online survey with open-ended questions eliciting care experiences.
Four themes are presented: 1) Contentious interactions: "I fought my entire way", describing interactions as fraught with tension and recounting stories of "fighting" for the right to refuse a procedure/intervention; 2) Knowledge as control or as power: "like I was a dim girl", both for providers as keepers of medical knowledge and for clients when they felt knowledgeable about procedures/interventions; 3) Morbid threats: "do you want your baby to die?", coercion or extreme pressure from providers when clients declined interventions; 4) Compliance as valued: "to be a 'good client'", recounting compliance or obedience to medical staff recommendations as valuable social capital but suppressing desire to ask questions or decline care.
We conclude that in situations where a pregnant person declines recommended treatment, or requests treatment that a care provider does not support, tension and strife may ensue. These situations deprioritize and decenter a woman's autonomy and preferences, leading care providers and the culture of care away from the principles of respect and person-centred care.
2016 年世卫组织改善卫生机构中孕产妇和新生儿护理质量标准将患者对护理的体验确立为质量的核心指标。全球卫生专家将自主权丧失和不尊重视为虐待。当患者和护理提供者的意见不同时，不尊重和虐待的风险更高，但人们对服务使用者在拒绝其产时护理的某些方面时的体验知之甚少。
为了解决这一差距，我们对来自 892 名服务使用者的 1540 份书面记录进行了定性内容分析，这些记录来自不列颠哥伦比亚省一个具有代表性的大样本（2900 名）在网上调查中对产时护理体验进行了开放式问题回答的产妇。
提出了四个主题：1）有争议的互动：“我一路战斗”，描述了充满紧张气氛的互动，并讲述了为拒绝程序/干预措施而“斗争”的故事；2）知识作为控制或权力：“就像我是个笨女孩”，既是提供者对医学知识的掌控，也是客户在他们对程序/干预措施有一定了解时的感受；3）病态威胁：“你想让你的孩子死吗？”，当客户拒绝干预时，提供者会施加胁迫或极端压力；4）合规性作为有价值的：“做一个‘好客户’”，讲述了对医护人员建议的顺从或服从是有价值的社会资本，但抑制了询问问题或拒绝护理的愿望。
我们的结论是，在孕妇拒绝推荐治疗或要求提供护理提供者不支持的治疗的情况下，可能会出现紧张和冲突。这些情况使女性的自主权和偏好处于次要地位，并使护理提供者和护理文化偏离了尊重和以人为中心的护理原则。
