Learning from childbirth experiences: The importance of respectful care and consent during labour and birth

This thesis focuses on the extent to which women experience disrespect and abuse (D&A) during labour and birth in the Dutch maternity care system, with a specific focus on informed consent. Concerning client-care provider interaction, our study showed that women who gave birth in the Netherlands gave high marks for their care regarding respect, communication, confidentiality, and autonomy.[Chapter 2] Nevertheless, women reported disrespectful or abusive care during labour and birth. The negative and traumatic experiences shared in the #genoeggezwegen stories provide insight: women described a lack of informed consent, not being taken seriously, not being listened to, a lack of compassion and the use of force, which often left them feeling powerless.[Chapter 3] The results of a national survey showed that over half of the women reported at least one form of D&A and over one third experienced at least one form of D&A that they considered upsetting. Situations with lack of choices, lack of communication, lack of support and/or rough treatment/physical violence were reported most often.[Chapter 4] Experiencing D&A was found to have a strong impact on the overall childbirth experience; with every additional experienced situation of upsetting D&A, the number of (very) positive labour and birth experiences decreased and the number of very negative ones increased.[Chapter 4] When looking at informed consent for procedures during labour and birth, consent was most often not asked for postpartum oxytocin administration (48%) and episiotomy (42%). The percentage of cases in which a woman’s refusal was overruled was much lower; most often reported for augmentation of labour (2%) and episiotomy (2%).[Chapter 5] Episiotomy was one of the most common unconsented procedures reported in the national survey. Episiotomy should not be performed without consent, as consent is an ethical and legal requirement for performing medical procedures.[Chapter 5 and 6] We recommend an individualised approach where the antenatal period is used to exchange information and explore values and preferences with respect to consent for procedures that may take place during labour and birth.[Chapter 6] Three measurement tools examining women’s experiences with labour and birth, The Mothers Autonomy in Decision Making Scale (MADM), the Mothers on Respect Index (MORi) and the Childbirth Experience Questionnaire 2.0 (CEQ2.0), were evaluated in the Dutch context. These tools were found to be valuable in terms of reliability, validity, and acceptability.[Chapter 7] The results of this thesis show that although most women have positive birth experiences, disrespect and abuse do take place in Dutch maternity care. Consent requirements are often not met, and an experienced lack of choice and support are also prevalent. This negatively impacts overall childbirth experiences and can have major short- and long-term consequences for women. Respectful Maternity Care based on women’s individual preferences, preferably discussed prior to labour and birth, is needed to improve care provision.