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Refusal of treatment during obstetric care can foster tension between patients and care providers

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A new analysis by researchers at the NYU Rory Meyers College of Nursing and the University of British Columbia found that when pregnant people refused recommended treatments such as prenatal testing and epidural anesthesia, tensions between patients and their care providers. Conflicts can arise.

“People should feel safe, respected and engaged in childbirth care, but our findings can foster distrust and avoidance if care providers do not listen to patients. It suggests that, “said Dr. P. Mininiles of MPH, CNM. , NYU Rory Meyers College of Nursing Associate Professor, lead author of this study, and published in the journal. PLOS ONE.. “These situations prioritize human autonomy and preference.”

In recent years with the World Health Organization Lancet We publish the framework about Quality of care During pregnancy, during childbirth, and after childbirth. In particular, they emphasize not only physical consequences, but also a person’s psychosocial experience. These experiences Health care providerIncluding doctors, midwives and nurses — factors such as respect, trust, agent and autonomy have emerged as important aspects of obstetric medicine.

“Providing care is an act of respect and respect, and how we provide care is just as important as the care we provide,” said midwife Niles.

However, in many cases, medical interactions are inadequate, or worse, patients report derogatory and rude behavior by their care providers. Participants in the study explained that they had no treatment options and were experiencing a lack of respect in claiming autonomy. This can discourage self-efficacy, mental health, and future health care.

These interactions occur especially when a pregnant person refuses or refuses the care provided or recommended by the health care provider.To Maternity care, This may include certain of the aforementioned Prenatal testing Researchers at the University of British Columbia and Niles have shown in a recent study that gestational diabetes, genetic testing, etc.), medications (epidural anesthesia, other pain relief, etc.), or childbirth interventions (labor induction, etc.) Reproductive health..

To better understand the experience of women giving birth, Niles and her colleagues conducted a qualitative content analysis of 1,540 written accounts from more than 1,000 women in British Columbia, Canada. This account is part of a 2014 survey of changes in childbirth in British Columbia, conducted using an online survey that includes open-form questions, including questions about the experience of reduced care. it was done.

Four themes emerged.

  • Controversial Interactions: In a tense interaction, participants stated that they “fight” for the right to refuse the kind of care and procedure or intervention they desire.
  • Knowledge as Control and Power: Knowledge has been seen as a source of power for both providers who are considered holders of medical knowledge and patients who have found strength in knowing the procedures and interventions they are refusing. It was.
  • Pathological threat: When pregnant people refused to intervene, healthcare providers posed extreme threats, such as “Do you want your baby to die?” These were particularly powerful during labor and were often experienced as coercion or manipulation to accept the procedures provided.
  • The Importance of Compliance: Many have expressed the feeling that obedience to the clinical recommendations of being a “good client” is important in the medical experience, but it also wants to reject their questions and care. It may suppress the desire.

“Our findings show the complex experience patients experience when they refuse to take care of traditional gender care systems,” says Niles. “As a healthcare provider, learning how to support a patient’s autonomy and decision-making process understands and provides care how we interact when our suggestions do not match the patient’s wishes. It means you have to keep going. “

To support patient autonomy, researchers need to incorporate their values ​​into their care plans, not as an event, but as a continuous process reflected in human-centered care ideas. It is written that.

Although the study focused on British Columbia birthers, researchers note that their findings are part of a global phenomenon and are probably translated into other populations.

“In the United States, one in six people is reportedly abused during childbirth, which includes intimidation and compulsory care. Among colored women, this is in three. “It will increase to one,” Niles added, citing a study that gave a voice to his mother. “Healthcare exists not only as a service, but also in relationships. We are not auto mechanics. Trust, autonomy, respect, and other important things in relationships depend on providers and medical systems. It should be evaluated and supported. ”


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For more information:
P. Mimi Niles et al, “I fought hard”: Experience of the decline of obstetric medical services in British Columbia, PLOS ONE (2021). DOI: 10.1371 / journal.pone.0252645

Quote: Refusal of treatment during obstetric care may foster tension between the patient and the care provider (June 23, 2021).

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Refusal of treatment during obstetric care can foster tension between patients and care providers

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