Newswise — Chapel Hill, NC – A peer reviewed clinical perspective led by Dr. Kristin Tully, published in Seminars in Perinatology, reveals a critical crisis in U.S. maternity care: too many women and birthing individuals are suffering preventable harm due to outdated and inequitable practices. The research highlights a startling finding—84.2% of pregnancy-related deaths between 2017 and 2019 could have been avoided—and calls for immediate action to make childbirth safer, more respectful, and patient-centered.
For many expectant parents, childbirth is an exciting yet vulnerable time. But the maternity care review finds that for far too many, the experience is marred by mistreatment, medical neglect, and systemic racism. Black, Hispanic, and multiracial mothers face significantly higher rates of mistreatment and negative health outcomes compared to their white counterparts. Many report being ignored, pressured into medical interventions, or treated with a lack of respect and dignity.
“For many expectant parents, childbirth is a time of excitement and vulnerability,” said Dr. Kristin Tully, maternal health researcher at the University of North Carolina at Chapel Hill and founder of Couplet Care, Inc. “But services are not yet structured for what all people need to be safe and well. Every birthing person deserves to feel heard, respected, and safe during one of the most important moments of their lives. There are many interventions that can strengthen the system of care.”
What is Respectful Maternity Care?
Respectful Maternity Care (RMC) is an evidence-based approach that ensures all birthing individuals are treated with dignity, autonomy, and equitable care throughout pregnancy, labor, and postpartum. According to the World Health Organization (WHO), RMC includes:
- Freedom from mistreatment, discrimination, or coercion
- Clear, compassionate, and respectful communication from healthcare providers
- Informed consent and shared decision-making for all medical interventions
- A safe and supportive birth environment, free from fear or bias
Ensuring RMC is standard practice, not a privilege, is essential to improving maternal health outcomes and preventing avoidable deaths.
Key Findings from the Maternal Care Review
The maternal care review exposes glaring inequities in maternity care that directly contribute to preventable maternal deaths and suffering:
- Approximately 30% of Black, Hispanic, and multiracial mothers reported experiencing mistreatment during childbirth—10% higher than the overall rate of 20% among all birthing individuals.
- Experiencing racism in maternity care is linked to higher postpartum blood pressure, increasing risks for life-threatening conditions such as heart disease, stroke, and preeclampsia.
- Many women hesitate to ask questions or advocate for themselves, fearing they will be labeled “difficult” by healthcare providers—leading to delayed or inadequate care.
What Needs to Change?
The maternal care review urges hospitals, healthcare providers, and policymakers to take immediate action by implementing three key reforms:
Ensure Patients Needs are Known and Supported
- Require hospitals to provide childbirth education that informs patients of their rights, the importance of informed consent, and self-advocacy strategies.
- Consider adopting the Mothers’ Autonomy in Decision Making (MADM) scale to measure patient agency and improve shared decision-making.
Support Healthcare Providers in Achieving Respectful Maternity Care
- Offer training on implicit bias, respectful communication, and trauma-informed care to eliminate disparities in maternity care.
- Replace use of outdated medical terminology (e.g., “failure to progress”) with non-stigmatizing language that fosters a supportive and collaborative patient-provider relationship.
- Implement real time patient feedback systems to identify quality practices and improvement opportunities.
Hold Hospitals and Policymakers Accountable
- Require hospitals to track and publicly report patient experiences, including rates of mistreatment and racial disparities in care.
- Implement policies that incentivize hospitals to improve patient-centered care.
- Expand Medicaid postpartum coverage and access to those services to ensure ongoing maternal care for at least 12 months postpartum.
Why This Matters
Every parent deserves a safe, empowering, and positive birth experience—but the current maternity system is failing too many.
- The U.S. has the highest maternal mortality rate among high-income countries, and Black women are nearly three times more likely to die from pregnancy-related complications than white women.
- Disrespect and poor communication contribute to fatal delays in care, increasing the risk of preventable deaths.
- By addressing these disparities, we can save lives and ensure that every birthing individual receives compassionate, high-quality care.
About Kristin Tully, PhD
Founder and Chief Scientist, Couplet Care Inc.
Dr. Tully is a medical anthropologist and Assistant Professor in the UNC Department of Obstetrics and Gynecology. She is also Associate Faculty at Ariadne Labs, a center for health systems innovation at Brigham and Women’s Hospital and the Harvard T.H. Chan School of Public Health. As a founding member of the 4th Trimester Project, Dr. Tully has dedicated her career to improving maternal and infant health outcomes.
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