EBB 369 – What is Mistreatment in Childbirth? with Dr. Morgan Richardson Cayama from Team EBB

Dr. Rebecca Dekker – 00:00:00:

Hi everyone. On today’s podcast, we’re going to talk with Dr. Morgan Richardson Cayama about mistreatment in maternity care. Welcome to the Evidence Based Birth® Podcast. My name is Rebecca Dekker, and I’m a nurse with my PhD and the founder of Evidence Based Birth®. Join me each week as we work together to get evidence-based information into the hands of families and professionals around the world. As a reminder, this information is not medical advice. See ebbirth.com/disclaimer for more details. Hi, everyone and welcome to today’s episode of the Evidence Based Birth® podcast. This August we’ve been celebrating Team EBB with a special podcast takeover series and it has been such a joy to highlight the voices and stories of the people behind Evidence Based Birth® who are bringing this work that we do to life. We’ve kicked things off by going back to the very start of Evidence Based Birth® with a new recording of episode 1 where I shared my own personal birth experiences and how they shaped my purpose in this work. In Episode 367 we heard from Jen Anderson, registered nurse, doula, and member of our programs team at EBB who unpacked recent concerning trends in labor induction and what those changes mean for birth workers and families. Next, in episode 368, IBCLC, doula, and EBB instructor coordinator, Rikki Jenkins and her husband Nova joined us to share the moving story of their Cesarean birth. If you missed any of these conversations I encourage you to go back to the beginning of August 2025 and catch up because each episode will give you a unique perspective on the work we do here at EBB. Today, we’re wrapping up our team series with Dr. Morgan Richardson Cayama from our research team who is here to talk about respectful maternity care, what that looks like in practice, why it matters, and how it connects to the larger issues of rights and equity in pregnancy and birth. And I’m also excited to announce that along with this episode we’re unveiling a brand new, 2-page handout on the evidence on respectful care in pregnancy and birth. This free resource is packed with evidence-based information about your rights in childbirth, common forms of mistreatment, how to spot red flags and green flags in a care provider, and what the professional guidelines recommend. To get your copy just download through the link in the show notes or head to ebbirth.com/respectfulmaternitycare or you can use ebbirth.com/rmc. Before we dive in I have one more announcement. Tomorrow begins our Labor Day sale in the Evidence Based Birth® shop. For those of you who have been asking, our laminated physical pocket guides are finally back in stock and for the first time ever you’ll be able to build your own bundle. This means you can mix and match any three pocket guides, digital or physical, create your own perfect set and save extra. So if you’ve been waiting to grab guides on comfort measures, labor induction, interventions, or newborn procedures now is the best chance. Just head to ebbirth.com to make sure you’re on our newsletter list so you don’t miss the release happening on Thursday, August 28 and you can get your copy before we sell out. And now let’s get started with today’s episode.      

Today we’re joined by. Dr. Morgan Richardson Cayama who has been a member of the EBB Research Team since she joined us as a research fellow in January of 2024. Dr. Richardson Cayama has her Master’s in public health and recently graduated with her PhD in public health from the University of South Florida. During her time at USF, she completed a fellowship in maternal and child health epidemiology and became interested in the topic of respectful maternity care and mistreatment during pregnancy and childbirth. For her dissertation study, she dove even deeper into this topic, conducting research using data from the Giving Voice to Mothers survey, and interviews with Black women who had recent hospital births in the state of Florida. The purpose of Dr. Morgan’s dissertation study was to learn more about positive and negative birth experiences, to describe what respectful care actually means to families, and get their recommendations for ensuring respectful and high-quality care. Morgan is also a mother who’s had her own hospital birth experience partway through her doctoral program, and she is trained as both a doula and childbirth educator. Dr. Morgan, I’m so happy you’re here. Welcome to the Evidence Based Birth® Podcast.

Dr. Morgan Richardson Cayama – 00:01:50:

Yeah, thanks for having me. I’m super excited.

Dr. Rebecca Dekker – 00:01:52:

So, I was wondering if you could start off by taking us back to like choosing your career and what inspired you to go into public health?

Dr. Morgan Richardson Cayama – 00:02:03:

Yeah, that is a great question. So I was not even actually familiar with public health as a field or a career choice at all until I was mostly done with college and actually had the opportunity to take what was a really innovative course on global health at my university. And it was co-taught by professors in anthropology and philosophy and biology and nutrition. And I was actually an anthropology and a philosophy major because I thought that was really interesting. And I’d come in though originally pre-med and just decided to kind of drop that part of the way through again sort of gravitated towards anthropology and philosophy. But this course really connected the dots for me on how all of these interconnected systems are what really shape people’s health and well-being. So we think about things like culture and community context and economic stability and opportunity, access to and quality of education and health care. And the built environment. So like medical, direct medical care is just one small part of this puzzle. And this was kind of like a light bulb moment for me where I saw how public health and the things that we refer to in public health as the social determinants of health are really what shape people’s opportunity for health and well-being. That really resonated with me. And it was also through that class that I was connected to a Master’s in public health student. And that’s when I learned like, hey, you can go to graduate school for this thing, get specialized training in this. And there are kind of all these different sub-disciplines. I had the amazing opportunity to sort of tag along with her to do a really cool research project in the Philippines. And we worked with community health workers to collect data on HPV and cervical cancer prevention. And I was already kind of into women’s health stuff. I was a pretty big feminist. And I was pretty much hooked after that and was getting more to social justice stuff. And at its core, public health is very justice and equity based. And so that really appealed to me. And I knew I wanted to help people. And so that just seemed like a great way to do that. And it’s sort of, again, burning my interest in anthropology and culture to health and well-being.

Dr. Rebecca Dekker – 00:04:09:

And you did your bachelor’s here in Lexington, Kentucky, where Evidence Based Birth® is based, correct?

Dr. Morgan Richardson Cayama – 00:04:16:

I did. I went to a really small but really cool school called Transylvania University.

Dr. Rebecca Dekker – 00:04:20:

And then what led you down the path to Florida?

Dr. Morgan Richardson Cayama – 00:04:24:

So I knew from that international health experience that, or at least at the time, I was pretty convinced that I wanted to do global health work. And there’s not many schools, and at least this was back in like 2012 or so, that had a global health sort of specific focus. And they did. And they also did kind of like this sort of financial aid talk, reciprocity, where if you lived in a state that you didn’t have a global health program, at the time, UK didn’t have one, and their public health school, U of L didn’t either. So I chose to go to Florida. And so my master’s, even though I have my Master’s in public health, the sort of concentration area was global health practice. And I did even more research and studying in Southeast Asia, which was really, really cool. But then I ended up just coming back here and getting a job and focusing on domestic public health stuff. So I got a job in Michigan, and focused on maternal and child health, and then had sort of maintained that path since then.

Dr. Rebecca Dekker – 00:05:23:

As you were a doctoral student at the University of South Florida, you gave birth to your own child. So can you tell us about that experience and what impact it had on your career path?

Dr. Morgan Richardson Cayama – 00:05:34:

Yeah, so it definitely did. And to just like a backup a little bit, I guess when I went into the public health program at USF again, I was already pretty much interested in maternal and child health. And I was kind of exploring this area called maternal resilience. But I ended up coming across early on in the program, respectful maternity care or respectful perinatal care and obstetric violence and mistreatment. And that was by way of Dr. Batum and the Birthplace Lab study. Their Giving Voice to Mother study, which we’ve talked about at EBB before. But it basically found that one in six people giving birth in the U.S., were experiencing some form of mistreatment. And that was, of course, even higher for people from minoritized and historically excluded communities. And so that really struck a chord with me. And it was then that I was like, okay, I’m going to commit to this and do my dissertation research on this. And so fast forward, like you said, a few years, I’m still in the PhD program because they’re not super short programs necessarily. And I got married and I got pregnant and I actually ended up defending my proposal like five months pregnant. So I was already, again, committed to this area. I was really deep into the literature and the research. And I had my study plan pretty much set already. And I was also completing my own doula and childbirth educator training because I felt like it was a really good compliment to the work I was doing. And also I saw through the research that this was definitely one piece of the puzzle too for how we could improve perinatal care, especially here in the U.S. And I did choose to give birth in a hospital, even knowing from the research, which I can talk a little bit about later, but that hospital births do have high rates of mistreatment compared to community births. But for some of my own anxiety and health issues that I was experiencing, I just felt more comfortable giving birth in a hospital. But I did choose midwifery care, which was offered through that hospital. And I was hopeful that would perhaps mitigate some of that increased risk. 

But without going into my whole birth story, and yes, it definitely absolutely sort of strengthened my commitment, I would say to this field and gave me a lot of perspective. But, I ended up 36 weeks. Going into preterm prom. So my water broke. It’s considered late preterm, but it was still preterm. I show up at the hospital. I had a really great doula. So we had kind of talked about the pros and cons of, you know, if I show up at the hospital, the clock starts ticking, right? But again, because I had some anxiety, I did go to the hospital, no dilation, no contractions, and just immediately faced what we refer to as the cascade of interventions. So I was recommended Cytotec. I ended up getting a Foley catheter or bulb, which honestly might have been the worst part of the whole experience. And things just moved really slowly with my labor. So eventually, Pitocin was of course recommended. And at that point, I opted for an epidural. Because it was just a lot. It was a lot of time. I was very fatigued. I was having a lot of back labor. And even though I had a really great doula who was really supportive, we were doing hip squeezes and abdominal lifts. I was in the shower doing like all the things for relief and labor progression. It was still just choosing to have an epidural was like the right choice for me at the time. So I labored down a little bit after that, recovered, it was super helpful. And I started pushing. But after a while, I was pushing my midwife. Did a check and realized that my daughter’s head was kind of tilted in the pelvis and she was a little bit stuck. At that point, I was offered the option for potentially having a vacuum birth. She felt like that might be the best way to still sort of honor my preference for a vaginal birth and see what we could do with a vacuum. So that required pulling in an obstetrician who came in and basically the ultimatum was kind of set. Like you have three pushes basically with the vacuum birth before we’re going to wheel you into the OR and you’re going to have a Cesarean. And it was the third and final push. And I just dug as deep as I could and felt my daughter come earth side. And so I just nearly missed an unplanned Cesarean situation. 

And even being a researcher in this field, even knowing what I knew through my own birth worker training, having a really great doula, I still faced this birth that was such a deviation from what I had expected and was just totally swept up in this very medicalized experience in the hospital. And there were times I certainly didn’t feel like I had a lot of control. Things weren’t explained as well as I would have liked them to be by healthcare providers. And there were definitely some good things too. Like I was encouraged to labor in all these different positions. I had a freedom of movement, which was great. I did eat during labor, but still it really had a profound impact on my perspective from there on out. And then I could easily see how some situations are just very ripe for mistreatment and just how easily lack of autonomy and lack of informed consent can happen when you’re in this very vulnerable space giving birth. And I already had kind of come at research from what we call a constructivist perspective, where I acknowledge that researchers are people and it’s really hard to remove yourself entirely and objectively from the thing that you’re studying. Like even researchers who do quantitative research, right? Still choose what they research for a specific reason. Like we still have our own motivations and beliefs and perspectives and biases as well. And there are methods for, you know, kind of trying to get a little bit more objective in research, practicing what we call reflexivity, where you reflect on your experiences. And I journaled a lot while I was doing this study, reflecting on my own birth and how what I was hearing from birthing people sort of resonated with me and my experiences and was transparent about that too when I was writing up results. Overall, I just think that my experience really helped me relate and connect. Like I knew birth would and being pregnant and giving birth would do that. But just my experience in particular with the preterm PROM, with all the interventions, the narrow sort of avoiding the Cesarean birth really helped me connect to many of the stories that people shared with me. And I had also already read about up until that point from qualitative research like around the U.S. and what people experienced during their own labor and birth.

Dr. Rebecca Dekker – 00:11:56:

So that obstetrician who gave you the ultimatum, what were your thoughts about that afterwards as you process that or how did you feel about that?

Dr. Morgan Richardson Cayama – 00:12:05:

Like, I think in the moment I was just so determined and just like I had been in here I’d been in the hospital for I don’t know like two days three days at that point I was just like I whatever we have to do at this point to just get her to come out. But, but that was also like motivation for me of like, I’ve already experienced and endured all of these interventions. Like I, I have to just like do this, right? Like I have to take control of this and like do this now. And I mean, obviously I felt powerless as well. And like kind of reflecting back on that, I did have a lot that I processed after that where I was like, dang, you know, like I… that wasn’t presented as a choice for me, right? Like we can do this or this. You know, it was like pretty much told as a statement, like you. This third push if it doesn’t happen that’s it like you know we’re we’re gonna go to the OR so, yeah, I had a lot to reflect on and kind of process like with my doula afterwards. And I am super proud of myself as well for, for- experiencing everything that I experienced and coming out the other side of it. But, but it was hard. It was definitely a challenge.

Dr. Rebecca Dekker – 00:13:11:

Yeah. Very challenging scenario.

Dr. Morgan Richardson Cayama – 00:13:14:

Correct.

Dr. Rebecca Dekker – 00:13:14:

You’re sleep deprived and, you know, we’ve just been through so much and then having to make these decisions where you’re not really feeling empowered, but more like your back’s up against the wall and you’re trying to fight your way through something.

Dr. Morgan Richardson Cayama – 00:13:29:

Exactly. Yeah. Yeah. I was exhausted.

Dr. Rebecca Dekker – 00:13:31:

Yeah. Yeah. I know we’ve had your doctoral advisor on the podcast before, Dr. Jessica Brumley, and she came on episode 338 and talked with us about respectful maternity care. And I was wondering if you could share your definition and perspective on that phrase and what it looks like.

Dr. Morgan Richardson Cayama – 00:13:48:

Yeah. Yeah, she was my defense chair. I love Dr. Brumley. She’s great. And like I think that she mentioned in her episode, there are different, but related definitions floating around off there, kind of depending on the organization that you come across. And one that I see a lot and that I tend to like reference the most is the World Health Organization definition, which is good. And broadly, it states that respectful maternity care is care provided to everyone, regardless of background that maintains your dignity, your privacy and confidentiality, that’s free from harm and mistreatment, and that enables things like informed choice and continuous support through labor and birth. And I mean, I think that’s a really universally good definition, clear definition, although, you know, what, may be considered harm and mistreatment can really vary, I think, across the board. And that’s what we see, too, with the research. And so there are some researchers who support the idea of local or even community-based definitions for respectful care. That sort of think that context is really important as well. And again, like, you know, what might be considered respectful care in one community over one population might be a little bit different from another one. And what might be more likely to sort of manifest as mistreatment in one place might be a little bit different in somewhere else. 

And so, I think that’s also why it’s important that we research respectful care across and within different communities and places. You have people who focus more specifically in sort of low-income contexts or international contexts. And then the research has really started to gain and grow a lot here in the U.S. and we see different things depending on the different health systems. And even folks who, like Dr. Altman, who works on queer birth and what that looks like for queer families as well. So I think it’s really important, again, that we sort of research this broad sort of perspective. And then to get to your other question, sort of in practice and in its most basic form, I think that respectful care is person-centered, is a huge component of it. It’s culturally centered. It’s trauma-informed just as a standard of practice. And it treats everyone as if they are the authority on their own bodies. I think that’s really one of the most important pieces is that it honors bodily autonomy. And part of what Dr. Brumley, I think, mentioned too in her episode is that requires and necessitates access to unbiased, evidence-based information. Like you can’t really practice true autonomy or true informed consent if you don’t have access to information and to options. And to choose whether something happens to you, you have to have access to all of this information to make an informed choice. So that’s another really important piece that she highlighted that I think is important to understand too.

Dr. Rebecca Dekker – 00:16:35:

Yeah, I think it’s cool because that’s kind of where you’re able to make connections at Evidence Based Birth®, working on the team as well as is bringing that information out and helping us interpret the research and make it available so people have better information to make decisions with. How about mistreatment, Morgan? So how common is mistreatment during childbirth care in the U.S.?

Dr. Morgan Richardson Cayama – 00:16:57:

Yeah, so mistreatment is another kind of like broad, interpreted in different ways term, as I kind of talked about. And when I talk about mistreatment, I tend to draw upon, there was a systematic review that was published back in 2015 by this group of researchers. And so they looked at research from like all over the world, a lot of it, again, outside of the U.S. at the time, to see what was happening during childbirth experiences and what people were reporting in all these different places. And at the time, it was kind of referred to as disrespect and abuse. They started referring to it as mistreatment. So that’s kind of what sort of stuck. And they fit it into these sort of seven broad categories of what they saw happen. And that included things like physical abuse. So in some places, people reporting being restrained during pregnancy or, I’m sorry, during labor and birth. Sexual abuse, which you can even consider like unconsented cervical exams as part of that. Verbal abuse, which includes things like being scolded or even threatened or blamed, which again, we do here in the U.S., you hear people say or being told that, you know, if you don’t agree to do this, then your baby could die. Right. Which is a lot of fear based and like sort of threatening and coercion. And it also included things like stigma and discrimination for various different reasons. People felt like they were discriminated against based on race, ethnicity, religion, socioeconomic status. It also included failures to meet professional standards of care. And that kind of means like, providers who neglect patients, who don’t practice informed consent like they should be, who aren’t respecting patient autonomy. And then experiences that were broadly categorized as poor rapport between patients and providers, like care providers not communicating well with patients, lacking empathy, and not practicing shared decision making. And again, these are all kind of related experiences, but these were just sort of the buckets that they put them in. 

And so that typology, a lot of people frame their study results within that typology as well to kind of report on what they see happening or what people report happening. And, so mistreatment can include all of these things again, but it can also be perceived differently by different groups. And in the U.S., we have a few studies now, one of which I just spoke of earlier, the Giving Voice to Mothers study, which were observational. So surveys that were conducted with people from around the U.S., that asked about their experiences and that were really guided to by that typology to kind of capture, like, did this happen to you? Yes or no. And what we see is that about 20 to 25% of people in the U.S. experience some type of mistreatment during birth. It’s like 20% kind of when you look across all births and then jumps up to 25% or higher when you just focus in on hospital-based births. So mistreatment rates are lower. We see lower rates in community birth settings like home births and birth centers. We also see lower rates among people whose care is led by midwives here in the U.S.. There are a lot more qualitative studies too that really kind of dive into birthing people’s experiences, my dissertation included. But something that I did too as part of this research process is I conducted a scoping review of respectful maternity care research in the U.S., where I attempted to kind of look at all of these different studies, quantitative and qualitative, to summarize what birthing people were reporting happening to them. And what I found was that in over 80% of studies, birthing people described challenges around lack of autonomy, around poor communication. 

For example, they felt like their concerns were dismissed or that they were rushed or they were not given complete or clear explanations of things that were happening to them. Stigma discrimination was the second most common thing people reported. And this was reported for a variety of reasons. People felt like they were discriminated against based on their race or ethnicity or their social and economic status, for example, if they had Medicaid or public insurance. And then some other ones too. Younger people felt like they were discriminated against more. If you spoke a language that was different from what your care team spoke, seemed to put to at higher risk for mistreatment as well. And then people who experienced pregnancy complications as well, or who had health issues, also were more likely to feel like they were discriminated against or stigmatized during care as well.

Dr. Rebecca Dekker – 00:21:08:

Yeah, that lines up with what we hear at EBB from just in general anecdotal reports that get sent our way. What about Florida? So I know that’s where you’re based and where you focused your dissertation research. Are there any unique factors related to giving birth in Florida?

Dr. Morgan Richardson Cayama – 00:21:25:

Yeah, Florida is like an anomaly, right? So it’s technically sort of part of the southern region of the U.S. and parts of Florida are very south. But there’s also a ton of diversity in Florida. There’s some really thriving immigrant communities in Florida as well that make it its own sort of unique context. And I mean, it has challenges with maternal morbidity and mortality as well, especially when you look at, you know, birthing people of color and Black birthing people. But there’s so many languages spoken here. There’s so much diversity here. And I did do like a sub-analysis of that Giving Birth to Mothers study here in Florida. And I found that for the most part, people’s experiences really align with what we see in the broader U.S., high reports of being shouted at or scolded during birth, which obviously isn’t great. And then again, that can include those like threats that like, if you don’t do this, then this is going to happen, which is again, that coercion that we see a lot. Physical abuse was surprisingly something that kind of came out. And this was a quantitative measure. So it and it was part of that separate study. So I didn’t really have any more background or contextual information about that. But that can be interpreted by people in different ways. Again, that might include like something like an unconsented cervical exam or feeling like they were held down. There was somebody who kind of wrote in an open-ended response that they felt like their, the anesthesiologist like held them down and that they were having trouble like breathing while they were getting their epidural, which is obviously really concerning. But yeah, in general, like I think Florida has so many communities and they might have so many different sort of expectations about birth or about the care that they receive that we’re going to need more research that really dives into some of those different communities and explores what’s happening and what they want to see happen or what respectful maternity care would mean to them and how that would be practiced in their community.

Dr. Rebecca Dekker – 00:23:11:

And so you were part of that solution of research because you did your final part of your dissertation study interviewing birthing people in Florida. So can you talk about, you know, what your purpose was for the study and who your participants were?

Dr. Morgan Richardson Cayama – 00:23:27:

Yeah, of course. So this was my favorite part of my study. I love qualitative research. I love diving into people’s stories and experiences. And so the purpose was to specifically explore people’s experiences during pregnancy and their childbirth care. And again, enlisted their recommendations for respectful and high quality care. So again, we have these definitions of respectful care. But if you ask somebody who’s giving birth, what does this mean to you? I think there’s a lot more that we can glean from what they describe. And I also really wanted to know positive and negative experiences. You know, how do people describe an experience when they talk about good things that happened and bad things that happen? And can we see sort of a mixture of that in people’s experiences? So, for example, in my interviews, I did do interviews with Black birthing people. So people who self-identified as Black or African-American in Florida. And I chose this because, again, this is a population that experiences higher rates or where higher rates of mistreatment are perpetrated against them. And I also did choose to focus on hospital births because, and I think Dr. Brumley spoke about this as well in her interview, but that is where like over 98% of births in the country happen, for better or worse. At least that’s kind of the reality we’re faced with right now. And what can we do to really get into hospitals to improve care and to make respectful care the standard? And so what do people say is happening to them in that experience? And so in these interviews, I ask people questions. Really, it just started off by, you know, can you just tell me about your recent birth experience? And I listened to their stories wherever they started. And I followed up with questions and kind of probed as needed to say, you know, well, how was your experiences with your health care providers? Who supported you? Did you feel like your care met your expectations? Why or why not? How did you feel like you were treated? And then, you know, what comes to mind when you think about respectful and high quality care, just to sort of organically see what terms do people use and what do they say when they hear those terms?

Dr. Rebecca Dekker – 00:25:21:

So kind of open-ended questions to let them share their experience.

Dr. Morgan Richardson Cayama – 00:25:25:

Exactly. Very, very open-ended.

Dr. Rebecca Dekker – 00:25:28:

Yeah. And so what did you find?

Dr. Morgan Richardson Cayama – 00:25:30:

Yeah. So the stories that people shared with me, first off, I just want to say it was really an honor to be able to listen and to witness a lot of these stories and testimonials. And they were so rich and full of both positive and negative experiences. And like, fortunately and unfortunately. So even though some participants had. Really challenging and difficult experiences that were really, really hard to get through. Everyone still reflected on at least one positive interaction or experience with a healthcare provider. And I think that’s like really important to understand is that no matter what you’re going through, you can still think about, you know, I had this really kind nurse or I had this really supportive provider who really helped sort of get me through this, this experience. And so I kind of launched people’s experiences into these categories and like codes that we call them in research and in qualitative research specifically. So positive experiences reflected health care providers and staff who listened to them. That means they heard their concerns, they answered their questions, and they honored their birth plans when they said that they had a preference for something or would try and want to avoid something. Their healthcare providers also had good attitudes. So they were kind and attentive and empathetic and just good people. Their care providers also kept them informed and in the loop with their care, which helped early people feel and participants feel more calm and more prepared for the things that did happen, even the unexpected things that happened. 

Then they also had choices in their care and healthcare providers presented them these choices and consulted them about the different options and kind of talked through the risks and benefits and asked for their consent was really important. That was something that just, again, organically came out through a lot of people’s stories is they really felt like they had a choice. And then some also described having healthcare providers, particularly nurses and doulas who helped advocate for them. And that was important for a few people. They really felt like someone stood up for them when they needed it, when they were sort of caught up in a situation or could not find their voice. They had someone who sort of reaffirmed, no, this is what the patient wants. And some of them even stood up to their colleagues and to other healthcare providers and said like, no, this client or this patient really wants pain medication. We need to do something to address their pain. And that came through people’s positive experiences as well. On the flip side, of course, every single person that I talked to, regardless of whether they had a relatively uneventful labor and birth experience, also recounted at least one negative experience or interaction with staff as well. And several participants experienced what I ended up coding and referring to as medical oversights, but other researchers have just blatantly referred to as medical errors or competency issues. And this included things like botched analgesia placements. 

There were a few participants whose analgesia did not work during their Cesarean, and they actually felt part of their Cesarean birth, which is obviously very traumatic. And they ended up needing general anesthesia part of the way through the process. And it also included overlooked health issues during pregnancy and birth that a lot of participants attributed to some of the complications that they ended up facing during their labor and birth. And having even more interventions and poor care during labor and birth. So, for example, there was one participant who was experiencing high blood pressure readings throughout her pregnancy. And she talked about how she vocalized this concern to her doctors. And she said, you know, should I be taking aspirin? And she was already kind of aware of preeclampsia that was on her radar because she knew some family who had dealt with that issue during pregnancy. And the providers were dismissive. They kept reassuring she was fine. She was young. She was healthy. It was nothing to worry about. And then she ended up going into labor. She was at the hospital. Her blood pressure was very high. They say, you know, you’re preeclampsic. And then she ended up facing all of these different interventions during her labor and birth. And she’s like, if only they had listened to me early on in my pregnancy or if only they had taken me seriously or just, you know, given me the green light to take aspirin, then maybe this whole thing could have been avoided. And she did not end up simply having a Cesarean birth that she really attributed to that sort of overlooked diagnosis during her pregnancy. 

And there were other negative experiences too, again, like the sort of inverse or opposite of the positive experiences where participants didn’t feel listened to. They didn’t feel like they were informed. They were told like they had to do something or they couldn’t do something without being told why or why not. They felt discriminated against. So a few participants described encountering the stereotype around pain tolerance of Black women, where it’s just sort of assumed that Black women have a higher pain threshold or don’t need pain medication. And so they felt like they were dismissed or denied that opportunity. And then participants also described interactions with health care providers who had bad attitudes, who just were rude, aggressive, impatient, or even acted annoyed or bothered by participants when they would ask for questions or extra help. And, you know, all of this sort of happened early on in the interviews when I was asking them to recount these experiences. And then when I asked them, okay, well, then what are your recommendations or what does this mean to you? That, of course, shaped their responses. And so most of their recommendations did end up being targeted towards health care providers. But they also gave some insight as well for advice for other mothers and birthing people, which I thought was really interesting. For healthcare providers, and again, this might sound like a broken record, but it was just so straightforward and so common to hear them say that providers just need to remember their bedside manner. That is so important to practice with empathy, to not talk down to patients, to withhold judgment, and just to remember that the person that you’re talking with is a human being, right? 

Other things, again, were providing clear and comprehensive communication with simple language, avoiding jargon. And to be honest with people, there was one story that stood out particularly in my mind where, a woman and I’ll refer to some of the patients or the participants as women because they all identified as women, but she was having an emergency situation. She ended up having a still birth for her first birth. And she remembers all the providers coming in and sort of this being a flurry of activity around her in the room. And no one was talking with her. No one was telling her what was happening. And she described it as, you know, they were talking in code. And she said, they made an assumption that I didn’t know what they were talking about. And no one would just tell me what was happening. But she said that, you know, I had a medical background. I had education. I knew the acronyms that they were using and the things that they were saying. And I knew that my baby was no longer alive at that point. And that really stood out for her and shaped her approach to birth going forward. And she made sure that the next time she had candid conversations with her obstetrician later about, you know, I need to be kept in the loop no matter what is happening. I need you to be honest with me.

Dr. Rebecca Dekker – 00:32:45:

Mm-hmm.

Dr. Morgan Richardson Cayama – 00:32:46:

Pursue all along that same line, respecting patient choice and autonomy, respecting their preferences and their boundaries, and presenting that full range of options and risks and benefits of those. But for other mothers and birthing people, and I think this was something that I found really interesting too. Multiple participants recommended to have other people, like their advice for other mothers or people who are pregnant was do the research and ask other birthing people for advice when it comes to picking a healthcare provider and picking a hospital. Don’t be afraid to interview multiple providers if you have the option to do so. And really make sure that you find someone who is willing to support your birth preferences and your birth plan and who makes you feel comfortable and who you feel like you can trust. And don’t be afraid. And again, this kind of comes from sometimes a privileged position as well. Some people might not have much choice, but if you can, don’t be afraid to switch providers if needed. They also talked about the importance of speaking up and being vocal about what you want and what you need in your care. Trust your intuition. Trust your gut if something feels off. And if you need to, or it was actually recommended to enlist the support of a family, of a friend, or even a doula who could advocate on your behalf and step in if you did feel like you were losing your voice or losing some of that autonomy in the birth room. And to prepare for your birth experience by making a birth plan, listening to birth stories. A few people recommended as well and asking others about their experiences. So you kind of come in with an idea of what might happen, what could happen and what your options might be.

Dr. Rebecca Dekker – 00:34:22:

Well, Morgan, I feel like, just got like a crash course in how people should be treated for respectfully when they’re giving birth. And as you’re thinking, I had so many thoughts going through my head. I was trying to like stay present with you, but I kept picturing this, like almost a circle, like. Because you were talking about the medical errors like botched anesthesia and… You know, basically malpractice and negligence during prenatal care, people’s not having their blood pressures taken seriously, which like that’s an actual quantitative number that, you know, you should be able to be like, here’s actual proof something is wrong. And then the people not being treated with respect or that they’re humans. And it almost seems like there’s this like and we talk about, you know, the cascade of interventions or we talk about the pain, tension, fear cycle, you know, in childbirth education. I’m thinking there’s like a respect and medical error or disrespect medical error cycle where like the less you see somebody as human or worthy of respect, the more careless the provider is going to be. Right. Right. The more mistakes they’re going to make because they’re not caring as much. They’re not following standards of care. They’re not practicing at the top of their skill level because they don’t think you’re worth it. So it’s kind of this like. Negative spiral. And you can also go the opposite direction where the more you respect someone, the more you care for them and value their life as a human being, the better you’re going to practice as a healthcare provider. And it seems to me we need to get people like spinning in that direction instead of the other way.

Dr. Morgan Richardson Cayama – 00:36:04:

Right. Yeah. And I think there’s a lot you can say there too about, you know, you’ll hear some providers sort of defend their behaviors and that by saying, well, we’re sober now and we’re so overworked and the system sort of forces us to manage all of these patients. And I think all of that is absolutely true. And I absolutely hear those concerns. And I think that is also a systemic issue. And again, why we’re so much more prone to seeing these experiences in hospitals as well. Yeah. And there’s a lot of different angles that we can come at this by, but at the end of the day, it is remembering that shared humanity that you have with people. And there was a participant who said, you know, for these people, these doctors and nurses, this is just another day for them. They’ve, you know, maybe delivered, I don’t know how many babies that day already. But for us, this is a matter of life and death, especially being Black birthing people. They talked about, you know, we know the stats, we hear the stories. And for us, like we think, we consider that you have our life in your hands. And this is a very big deal for us. And people walk away with all of these experiences from the hospital. And this might be some of their only interactions with the healthcare system or the formal healthcare system or a hospital. And this sets the precedent for all of those future interactions and their approach to birth and healthcare later. So it’s really important.

Dr. Rebecca Dekker – 00:37:18:

Exactly. I mean, healthcare trauma is real. And I have plenty of friends and family who don’t seek care for, or they don’t do preventative care or wellness care even because of their traumatic experiences in like hospital institutions. So on the other hand, I know other people have positive experiences. And, but I think in general, I see more people who are afraid and fearful of medical providers and hospitals than the opposite.

Dr. Morgan Richardson Cayama – 00:37:47:

Yeah, I think that for the most part, it’s just, again, really important that care providers keep in mind just how much impact that they have on people’s birth stories and perceptions of their experience. Like we just said, like even in really challenging scenarios, providers’ ability to maintain kindness, maintain that compassion can make all the difference in whether somebody walks out of the hospital with a lot of grief and confusion and fear and whether they reflect positively or negatively on their experience. And good bedside manner, again, just makes a huge impact. And people also want to be kept in the loop with what’s happening. I think that that’s important. And I think doulas and people in the birth space can also help people giving birth and labor be a part of that conversation as well. Participants also wanted more information and education that includes that full range of possible experiences. So for this audience, birth workers and childbirth educators, making sure that you don’t just cover what we all might desire for is like a physiological, vaginal, low intervention birth. But you do present options. Like in the case of that something unexpected happens, here’s what your options might be for X, Y, and Z. I think that was like an important thing that came out as well. Yeah, it’s just important that pregnant people know their rights during care, have access to that evidence-based information, and listen to their gut and their intuition. But I think those recommendations and what people said could really go a long way for helping ensure that we have more respectful, person-centered birth and hospitals.

Dr. Rebecca Dekker – 00:39:16:

Now I want us to make a little infographic to post on Instagram with the steps that your research participants recommended because, you know, they have been there. They know what works and what doesn’t work. And we should listen to their advice.

Dr. Morgan Richardson Cayama – 00:39:31:

Yep.

Dr. Rebecca Dekker – 00:39:32:

Thank you everyone for listening today, and I’d like to encourage everyone to head to ebbirth.com/respectfulmaternitycare and grab the free 2-page handout that Dr. Morgan wrote for EBB all about the evidence on respectful care in pregnancy and birth.This download has evidence-based information about your rights in pregnancy and birth, common forms of mistreatment, how to spot red flags and green flags from care providers, and what the professional guidelines recommend about respectful maternity care. It’s an incredible resource that Dr. Richardson Cayama has put together for us and it is completely free to you. Again, just go to ebbirth.com/respectfulmaternitycare that’s all one word “respectfulmaternitycare” or you can shorten it to ebbirth.com/rmc and that will take you to the same page. Thanks everyone and I look forward to seeing you next week on the podcast for Episode 370 where Dr. Morgan and I will be covering new research on diagnosing gestational diabetes. We’ll see you then, thanks everyone. Bye! 

Dr. Rebecca Dekker – 00:39:40:

This podcast episode was brought to you by the book, Babies Are Not Pizzas: They’re Born, Not Delivered. Babies Are Not Pizzas is a memoir that tells the story of how I navigated a broken healthcare system and uncovered how I could still receive evidence-based care. In this book, you’ll learn about the history of childbirth and midwifery, the evidence on a variety of birth topics, and how we can prevent preventable trauma in childbirth. Babies Are Not Pizzas is available on Amazon as a Kindle, paperback, hardcover, and Audible book. Your copy today and make sure to email me after you read it to let me know your thoughts.