Yale University School of Nursing, Orange, CT, United States of America.
Department of Family Practice, Birth Place Lab, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
PLoS One. 2022 Sep 22;17(9):e0274790. doi: 10.1371/journal.pone.0274790. eCollection 2022.
High-quality, respectful maternity care has been identified as an important birth process and outcome. However, there are very few studies about experiences of care during a pregnancy and birth after a prior cesarean in the U.S. We describe quantitative findings related to quality of maternity care from a mixed methods study examining the experience of considering or seeking a vaginal birth after cesarean (VBAC) in the U.S.
Individuals with a history of cesarean and recent (≤ 5 years) subsequent birth were recruited through social media groups to complete an online questionnaire that included sociodemographic information, birth history, and validated measures of respectful maternity care (Mothers on Respect Index; MORi) and autonomy in maternity care (Mother's Autonomy in Decision Making Scale; MADM).
Participants (N = 1711) representing all 50 states completed the questionnaire; 87% planned a vaginal birth after cesarean. The most socially-disadvantaged participants (those less educated, living in a low-income household, with Medicaid insurance, and those participants who identified as a racial or ethnic minority) and participants who had an obstetrician as their primary provider, a male provider, and those who did not have a doula were significantly overrepresented in the group who reported lower quality maternity care. In regression analyses, individuals identified as Black, Indigenous, and People of Color (BIPOC) were less likely to experience autonomy and respect compared to white participants. Participants with a midwife provider were more than 3.5 times more likely to experience high quality maternity care compared to those with an obstetrician.
Findings highlight inequities in the quality of maternal and newborn care received by birthing people with marginalized identities in the U.S. They also indicate the importance of increasing access to midwifery care as a strategy for reducing inequalities in care and associated poor outcomes.
高质量、有尊严的产妇护理已被确定为重要的分娩过程和结果。然而，在美国，关于剖宫产后妊娠和分娩期间护理体验的研究非常少。我们描述了一项混合方法研究的定量发现，该研究调查了在美国考虑或寻求剖宫产后阴道分娩（VBAC）的经历。
通过社交媒体群组招募有剖宫产史和近期（≤5 年）后续分娩史的个体，让他们完成一份在线问卷，其中包括社会人口统计学信息、分娩史以及尊重产妇护理的验证性措施（尊重母亲指数；MORi）和产妇在分娩护理中的自主权（母亲决策量表；MADM）。
来自全美 50 个州的 1711 名参与者完成了问卷；87%的人计划剖宫产后行阴道分娩。社会地位最低的参与者（受教育程度较低、生活在低收入家庭、拥有医疗补助保险的参与者，以及自我认同为少数族裔的参与者）以及那些将妇产科医生作为主要提供者、男性提供者、没有导乐的参与者，报告的产妇护理质量较低的比例明显更高。在回归分析中，与白人参与者相比，被认定为黑人、印第安人和有色人种（BIPOC）的个体更不可能体验到自主权和尊重。与妇产科医生相比，有产婆提供者的参与者经历高质量产妇护理的可能性高出 3.5 倍以上。
研究结果突显了美国具有边缘化身份的分娩者在获得产妇和新生儿护理方面的不平等现象。它们还表明，增加获得助产护理的机会作为减少护理不平等和相关不良结局的策略的重要性。
