A majority of Canadian women who have given birth say they were disrespected or mistreated in the birthing process, a national survey published in June shows.
“It’s certainly disturbing, surprising and shocking that the number is so high in a country that values, and is known globally for, their courtesy and civility,” said Saraswathi Vedam, a professor of midwifery at the University of British Columbia and the lead investigator on the study.
Indigenous women were most likely to report experiencing disrespect and mistreatment, the study says.
Researchers involved in the study say it points to a need to improve care during childbirth, especially for Indigenous women.
‘Great stress’
The study surveyed nearly 6,100 women about their experiences with pregnancy and childbirth. Participants reported if they had experienced disrespect or mistreatment during childbirth.
Disrespect included having health-care providers make negative comments about a woman’s sexual activity, culture or physical appearance. It also included feeling neglected by health-care providers when needing care.
Most women reported being disrespected: 58 per cent of white women, 69 per cent of Black and racialized women, and 75 per cent of Indigenous women.
Mistreatment included being scolded or shouted at by health-care workers, ignored or refused help, or being forced to accept treatment that is not wanted.
Mistreatment was slightly less common but still prevalent: 49 per cent of white women, 51 per cent of Black and racialized women, and 63 per cent of Indigenous women reported mistreatment.
About two per cent of Black, racialized and Indigenous women and 0.6 per cent of white women reported being sterilized without their consent.
In general, giving birth is a highly stressful and emotional experience, says Wanda Phillips-Beck, an associate professor of nursing at the University of Manitoba and lead author of the study.
“Women are under a great deal of stress, both emotionally and physically. I think that environment creates a lot of room for either miscommunication or communication that maybe is not helpful for the women or families,” she said.
Disparities
The high numbers of Indigenous women who report disrespect and mistreatment during childbirth is particularly troublesome, says Vedam, of the University of British Columbia.
Some examples of disrespect or mistreatment were more commonly reported among Indigenous women, who accounted for five per cent of all study participants.
Nearly 35 per cent of Indigenous women reported having requests for help ignored or denied, compared to 25 per cent of racialized women and 19 per cent of white women.
About 19 per cent of Indigenous women said health-care providers made negative remarks about their physical appearance, compared to about five per cent of racialized women and eight per cent of white women.
The study shows there are system-wide problems that particularly hurt Indigenous women, says Vedam.
“This is not calling out a particular provider or group of providers or region,” she said. “This is really looking at the whole system, and what are the structural things that cause disparities in outcomes across populations.”
‘Common’ negative experiences
The study findings do not surprise Diane Simon, a Mi’kmaw midwife from Nova Scotia who is now a PhD candidate in the health research methodology program at McMaster University.
Indigenous people experience mistreatment throughout the entire health-care system, she says. “It’s more common to hear negative experiences than the positive ones because [positive experiences] tend to be less frequent.”
The study’s release is timely.
In July, Assembly of First Nations delegates unanimously approved a resolution calling for a better understanding of the barriers, racism and discrimination First Nations women face in health care. The resolution was named after Jaali Sutherland-Weenie, a 24-year-old mother who died after her pre-eclampsia went untreated. Her baby was born shortly after she died.
“Birth is a very vulnerable time for anyone,” said Simon. “But I think particularly for First Nations.”
Women often have to leave their First Nations communities to deliver their babies, says Simon, and health-care providers may assume First Nations women cannot care for their children. Children’s protective services are also more likely to be involved if the family is First Nations.
On top of that, because of the impact of residential schools, some women are just learning about traditional cultural childbirth practices.
Cultural practices and traditions can help while giving birth, says Phillips-Beck, who is Anishinaabe and has studied maternal and child health in First Nations communities.
“Some of our respondents reported that they were either not allowed to practise their cultural traditions, or they were made fun of and made to feel like they were superstitious,” she said.
Benefits of midwives
In the study, Indigenous women who used midwives reported less mistreatment and disrespect than Indigenous women who did not have midwives.
Phillips-Beck says that midwives are often trained more to focus on an individual woman’s needs. They are often more open to women giving birth in different positions, like squatting, or allowing more people to be present during the birth, she says.
“If we were able to have midwifery care in our Indigenous communities, it would go a long way to supporting women’s health holistically, as well as connecting them to services beyond the community,” she said.
More midwives are needed in Indigenous communities, particularly those that are rural and remote, she says. “It’s just not reaching the people that need it most.”
In Simon’s lifetime, she has seen growth, although slow, in the number of Indigenous midwives.
She herself had a Metis midwife for two of her own three children’s births. She found her midwife was more respectful of her cultural practices and preferences during birth, like having the first word spoken after her children’s birth to be in Mi’kmaq.
“We’re starting to see growth in First Nations, Inuit, and Métis health-care providers,” she said. That gives her hope.
But it is a hope that has only come after years of work.
“A lot of work we’re doing ourselves because the system isn’t changing as fast as we need it to.”
