Maternal and Child Health Program, Department of Family Science, University of Maryland, College Park, Maryland, USA.
Maryland Population Research Center, University of Maryland, College Park, Maryland, USA.
Birth. 2022 Dec;49(4):823-832. doi: 10.1111/birt.12655. Epub 2022 Jun 2.
Despite the tenets of rights-based, person-centered maternity care, racialized groups, low-income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality.
We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having "high" respectful care. To examine associations between respectful care and self-reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi-Cal (Medicaid) insurance status were assessed.
Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0-1.8). By race/ethnicity, the association was largest for non-Hispanic Black women (2.7 [1.1-6.7]) and Asian/Pacific Islander women (2.3 [0.9-5.6]). Doula support predicts higher odds of respectful care among women with Medi-Cal (1.8 [1.3-2.5]), but not private insurance.
Doula support was associated with high respectful care, particularly for low-income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low-income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.
尽管以权利为基础、以人为中心的孕产护理原则得到认可，但在美国，种族化群体、低收入人群和接受医疗补助保险的人群比收入较高或自认为是白人的人群更经常遭受虐待、歧视和不尊重的护理。本研究旨在探讨导乐（在分娩期间提供持续支持的人）的存在与分娩时尊重护理之间的关系，特别是对于那些因制度不平等而变得脆弱的群体。
我们使用了 1977 名在加利福尼亚州倾听母亲调查（2018 年）中接受采访的女性的数据。在分娩期间报告具有较高决策、支持和沟通水平的受访者被归类为具有“高”尊重护理的受访者。为了检验尊重护理与自我报告的导乐支持之间的关联，我们进行了多变量逻辑回归分析。评估了种族/族裔和私人或 Medi-Cal（医疗补助）保险状况的交互作用。
总体而言，我们发现有导乐支持的女性比没有导乐支持的女性更有可能获得尊重护理（优势比 [OR]：1.4，95%置信区间 [CI]：1.0-1.8）。按种族/族裔划分，这种关联在非西班牙裔黑人女性（2.7 [1.1-6.7]）和亚洲/太平洋岛民女性（2.3 [0.9-5.6]）中最大。导乐支持预测 Medi-Cal（1.8 [1.3-2.5]）而非私人保险的女性获得尊重护理的几率更高。
在加利福尼亚州，导乐支持与高尊重护理相关，特别是对于低收入和某些种族/族裔群体。支持为低收入和边缘化群体扩大导乐服务的政策符合尊重护理的权利，并可能解决产妇体验方面的差异。
