Risk Management Tools & Resources

 


Promoting Respectful Maternity Care

Promoting Respectful Maternity Care

Laura M. Cascella, MA, CPHRM

Maternal health has long been an Achilles heel in the U.S. healthcare system, with the United States having the highest rate of maternal deaths of any high-income nation.1 Although recent data show some improvements, maternal morbidity and mortality are still significant issues, particularly for Black women.2

Improving maternal health will require interventions at many levels that target various factors, such as access to healthcare, lifestyle factors, social determinants of health, health disparities, and so on. At the provider level, engaging patients in care and taking a patient-focused approach are essential components of high-quality perinatal care.

Unfortunately, a survey from the Centers for Disease Control and Prevention (CDC) indicates that many women are not satisfied with the care they receive during pregnancy and delivery. Overall, 20 percent of survey respondents reported experiences of mistreatment during maternity care. These percentages were higher for racial and ethnic minorities (30 percent for Black women, 29 percent for Hispanic women, and 27 percent for multiracial women).3

As a result of these experiences, women might lose trust in their providers and be less likely to raise issues, which can further complicate care and lead to suboptimal outcomes. Almost half of the women (45 percent) in CDC’s survey reported holding back from asking questions of, or sharing concerns with, their healthcare practitioners.4 Further, even when patients raise issues, ingrained biases — both implicit and explicit — may increase the risk that these concerns will be overlooked or not receive adequate attention.5

Creating and implementing a framework for respectful maternity care can help address issues related to mistreatment. The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) notes that respectful maternity care “emphasizes the fundamental rights of women, newborns, and families, promoting equitable access to evidence-based care while recognizing unique needs and preferences.”6

The following recommendations can help healthcare organizations and providers adopt strategies that promote respectful maternity care:

  • Implement standardized practices for perinatal care to ensure consistent, equitable care for all patients. Consider using patient safety bundles, such as those offered by the Alliance for Innovation on Maternal Health, to help guide best practices.
  • Recognize cultural competence as a preeminent element of respectful maternity care and a vital component in developing an effective communication process with patients/families. Techniques and methods that can aid in cross-cultural communication include motivational interviewing, the explanatory model, and the RESPECT model.
  • Respect patients’ personal values, experiences, preferences, and expressed needs. Discuss with patients their expectations for maternity care and acknowledge their feelings and concerns.
  • Recognize patients’ autonomy and the right to make decisions about their medical care. Provide patients with comprehensive, evidence-based, and unbiased information related to obstetric and neonatal care and procedures. Doing so will help engage them in the decision-making process and ensure they are making informed choices.
  • Implement strategies to promote patient dignity throughout the course of patient care and treatment, such as knocking before entering exam rooms, providing gowns that fit appropriately, properly draping patients, asking for permission before touching patients, explaining exam steps, and respecting privacy and confidentiality.
  • Create an open dialogue with patients, engage in active listening, and allow patients to speak without interruption. Repeat important information to confirm understanding of the patient’s concerns and viewpoints. Make sure to carefully consider all patient concerns, even if they seem inconsequential.
  • Provide patients with culturally appropriate and easy-to-understand perinatal educational materials. Offer resources in languages that reflect your patient population.
  • Screen patients for conditions that may arise during pregnancy (or be complicated by pregnancy), such as hypertension, preeclampsia, gestational diabetes, and depression. Develop treatment plans to help patients manage those conditions, educate them about when to seek additional care and treatment, and make specialist referrals as necessary.
  • Educate patients/families about urgent maternal warning signs and when to seek immediate medical attention. Make sure accessible and appropriate maternal and newborn emergency care is available.
  • Participate in education and training related to cultural competence and respectful maternity care. Healthcare organizations should consider including this type of training as part of new employee orientation and periodic in-service education.
  • Develop methods to gauge patient experience and patient satisfaction that include domains related to cultural competence and respectful maternity care. Use the results to help drive and measure quality improvement initiatives.
  • Make sure a mechanism is in place for patients to report concerns and complaints, and develop a protocol for addressing reports of disrespectful, dismissive, or abusive behavior. Ensure that the protocol is used consistently when reports are made.7

Improving maternal health and reducing disparities in obstetrical care and outcomes are ongoing goals in U.S. healthcare. Adopting a framework that supports respectful maternity care can help healthcare organizations and providers address potential mistreatment that may play a role in maternal morbidity and mortality. Respectful maternity care can help reduce adverse events, better engage patients as partners, strenghen patient autonomy, uphold patient dignity, and support optimal patient outcomes.

To learn more about respectful maternity care, see the following resources:

Endnotes

1 Gunja, M. Z., Gumas, E. D., Masitha, R., & Zephyrin, L. C. (2024, June 4). Insights into the U.S. maternal mortality crisis: An international comparison. The Commonwealth Fund. Retrieved from www.commonwealthfund.org/publications/issue-briefs/2024/jun/insights-us-maternal-mortality-crisis-international-comparison

2 Hoyert, D. L. (2025, February 5). Maternal mortality rates in the United States, 2023. National Center for Health Statistics Health e-stats. Retrieved from https://stacks.cdc.gov/view/cdc/174577

3 Mohamoud, Y. A., Cassidy, E., Fuchs, E., Womack, L. S., Romero, L., Kipling, L., . . . Cox, S. (2023, September 1). Vital Signs: Maternity care experiences — United States, April 2023. Morbidity and Mortality Weekly Report, 72(35), 961–967. doi: http://dx.doi.org/10.15585/mmwr.mm7235e1

4 Ibid.

5 Association of Women’s Health, Obstetric and Neonatal Nurses. (n.d.). Respectful maternity care implementation toolkit (RMC-IT). Retrieved from www.awhonn.org/resources-and-information/respectful-maternity-care-implementation-toolkit/

6 Ibid.

7 Mohamoud, et al. Vital Signs: Maternity care experiences — United States, April 2023; Centers for Disease Control and Prevention. (2024, July 9 [last updated]). HEAR HER campaign: Healthcare professional. Retrieved from www.cdc.gov/hearher/hcp/overview/index.html; International Confederation of Midwives. (2020). 12 steps to safe and respectful motherbaby-family maternity care. Retrieved from https://internationalmidwives.org/resources/12-steps-to-safe-and-respectful-motherbaby-family-maternity-care/; American College of Obstetricians and Gynecologists. (2022). Respectful care eModules: Respectful care in obstetrics and gynecology. Retrieved from www.acog.org/education-and-events/emodules/respectful-care

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