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Article

Providers’ Perceptions of Respectful and Disrespectful Maternity Care at Massachusetts General Hospital

by
Katherine Doughty Fachon
1,*,
Samantha Truong
2,3,
Sahana Narayan
1,
Christina Duzyj Buniak
1,4,
Katherine Vergara Kruczynski
1,
Autumn Cohen
1,
Patricia Barbosa
1,
Amanda Flynn
1 and
Annekathryn Goodman
1,4
1
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, USA
2
Department of Obstetrics and Gynecology, Boston Medical Center, Boston, MA 02118, USA
3
Department of Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, MA 02118, USA
4
Department of Obstetrics, Gynecology and Reproductive Biology, Harvard Medical School, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
Reprod. Med. 2024, 5(4), 231-242; https://doi.org/10.3390/reprodmed5040020
Submission received: 21 August 2024 / Revised: 28 September 2024 / Accepted: 11 October 2024 / Published: 18 October 2024
Browse Figures
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Abstract

:
Background/Objectives: Disrespectful care of birthing persons during childbirth has been observed as a global issue and a possible factor influencing maternal morbidity and mortality. While birthing persons’ experiences of mistreatment in childbirth have been examined, perceptions from obstetrical providers of respectful maternity care have been understudied. Methods: A mixed-method cross-sectional study was conducted in Boston from April 2023 to January 2024 among 46 labor and delivery physicians, midwives, and nurses at Massachusetts General Hospital. The survey evaluated their observation of disrespectful care, the performance of respectful care, and stress and support factors influencing respectfulness of care. Results: The most reported observed disrespectful behaviors were dismissing patients’ pain (87.0%), discriminatory care based on physical characteristics (67.4%) and race (65.2%), and uncomfortable vaginal examinations (65.2%). Respondents self-reported very high levels of respectful maternity care performance. Reported barriers to respectful care included workload (76.1%) and fatigue (60.9%). Conclusions: Disrespectful care in childbirth is an issue reported by healthcare providers. Implicit bias and the working conditions of health care providers are factors in disrespectful care. This information can be used to strategize future training and other areas of intervention to improve maternity care.

1. Introduction

While the World Health Organization upholds respectful maternity care (RMC) as a vital component of birthing persons’ health, disrespect and abuse (D&A) in childbirth has been identified as a global issue [1]. D&A, also known as obstetric violence, consists of physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment of care, and detention in facilities [2].
Mistreatment of birthing persons during childbirth is an understudied factor influencing maternal outcomes and may influence maternal mortality. Bekele et al. (2020) characterized disrespectful care as “one of the silent causes of maternal mortality and morbidity worldwide” [3]. D&A has been associated with decreased uptake of healthcare services, psychological trauma [4], as well as with maternal and neonatal complications [5]. Birthing people who reported being verbally disrespected during their childbirth were twice as likely to suffer from postpartum depression than those who were not [6]. Vitally, D&A is connected with the unwillingness to seek medical care: Even in high-income countries where care is relatively accessible, birthing people may avoid care if they feel disrespected by healthcare providers [7]. Low uptake of maternity care services, whether by inadequately accessible healthcare services or by avoidance of services, increases the risk of poor outcomes for both the birthing person and the newborn [8,9,10].
The United States faces a public health crisis of maternal morbidity and mortality, the contributors to which are incompletely understood. They include social determinants of health that lead to poverty and chronic disease among poor and marginalized populations, especially Black people [11,12]; an inequitable political landscape that leads to differing access to medical benefit coverage [13], paid family leave [14], and reproductive rights such as abortion [15]; delays in care due to the COVID-19 pandemic [16]; and a nationwide trend toward motherhood at older ages that increases the likelihood of comorbidities and high-risk pregnancies [17]. The maternal mortality rate (MMR), defined by the World Health Organization as the number of deaths during pregnancy and up to 42 days postpartum per 100,000 live births, has increased annually from 17.4 to 32.9 from 2018 to 2021 [18]. An estimated 80% of maternal deaths are preventable [19]. Nation-wide data, on average, obscure the wide disparities by race and geography. Specifically, the MMR for non-Hispanic Black birthing people is 2.6 times the rate of their White counterparts. Mental health conditions, hemorrhage, and coronary conditions were the most common underlying causes of death (22.7%, 13.7%, and 12.8%, respectively) for maternal deaths up to 1 year postpartum [19,20].
In the US context, where mental health conditions and lack of care access significantly contribute highly to mortality rates, understanding D&A is necessary to improve maternal health. However, studies in the US are limited [21,22,23,24]. A nationwide study of US birthing persons found that approximately one in six respondents reported being mistreated, with higher rates of mistreatment reported by younger people, those with higher-risk pregnancies, and by Black, Indigenous, and people of color [23]. The same study found that 28.1% of respondents who gave birth at a hospital reported mistreatment, compared to only 5.1% of those who gave birth at home [23]. In another study of birthing people across six states, the most reported type of disrespect was being ignored or refused (7.6%) followed by being shouted at or scolded (4.1%) [24].
The barriers to respectful maternity care cannot be fully addressed without an understanding of the perspectives of obstetric care providers. Their insights can expand beyond the interaction dynamics of the patient–provider dyad and identify root causes of D&A. Physicians, midwives, nurses, and other birth attendants are uniquely positioned as advocates for respectful maternity care, not only in their patient interactions but also within their healthcare organizations to identify policies and structural influences on best practices. The aim of this study is to examine obstetric care providers’ observation and perception of underlying root causes of disrespect and abuse at an urban tertiary care center in the USA.

2. Materials and Methods

A cross-sectional study of labor and delivery staff was carried out from April 2023 to January 2024 at Massachusetts General Hospital (MGH) in Boston, Massachusetts. MGH is an academic teaching hospital that provides care for an estimated 3800 births annually. The care team on the labor and delivery floor consists of physicians (including resident physicians, Ob/Gyn physicians, Maternal Fetal Medicine physicians, and Anesthesia and Neonatology physicians as ancillary team members), midwives, and nurses. Midwives attend low-risk births, in addition to providing antenatal care and triage assessments. Specialized labor and delivery nurses attend to one or two patients during their labor, with a 12 h two-shift schedule applied to the entirety of the multidisciplinary team. On labor and delivery, all new nursing graduates receive specific practice training, which includes shared decision-making and trauma-informed care. The results presented here are data from an online survey (Supplementary File S1), which was conducted as part of a mixed-method study that also included qualitative interviews.
Participants in this study were health care professionals (HCPs) who provided care to people in childbirth. Inclusion criteria encompassed physicians (including resident physicians), midwives, and nurses who had worked on the hospital labor and delivery floor for at least 1 year. Medical students and resident physicians with less than 1 year of clinical experience were excluded.
The study protocol was approved by the Mass General Brigham Human Research Committee. Data were collected through an open and anonymous voluntary electronic survey using the REDCap application for online surveys. To ensure confidentiality, the data collection tool was available as an open survey. Participants received a written statement of the research study’s aims and risks before voluntary completion of the online survey. The study was advertised through department-wide emails, presentations at staff meetings, and flyers posted on the labor and delivery floor.
The survey contained questions about demographic characteristics, observation of disrespectful behaviors at MGH, performance of respectful care, stress and support factors, and opinions on disrespectful care. The domains of disrespect were based on the framework first categorized by Bowser and Hill [2]: physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment of care, and detention in facilities. The last category, detention in facilities, was excluded, as it has not historically been applicable to MGH. Questions about respectful care were modified from the US Person-Centered Maternity Scale (PCMC-US) [25] and adapted to fit the provider’s perspective of respectful maternity care performed. Stress was assessed with the four-item Perceived Stress Scale (PSS-4) [26]. The study questions were primarily closed-ended but included several open-response questions. The survey was pilot-tested by a physician, a nurse, and a midwife to check for clarity. The full questionnaire is available as Supplementary Data.
The survey received 56 responses. Ten entries were removed due to lack of completion. Since the open nature of the survey allowed for the possibility that a single respondent could answer multiple times, data were examined for duplicate responses. Data were cleaned and analyzed using R version 023.03.0. For the primary analysis, we calculated descriptive statistics of proportions and frequencies of variables of interest. Exploratory analysis examined the difference in proportions between different occupations (physicians, midwives, and nurses) using Fisher’s exact test. Due to the relatively small sample size, occupation was the only demographic category examined for differences in proportion. Open-response questions were coded using Dedoose version 9.0.107, a qualitative analysis software.

3. Results

3.1. Demographics

Forty-six providers completed the survey out of 115 eligible providers. The response rate to the open Internet survey varied depending on the profession: 58.6% of physicians, 66.7% of midwives, and 40.5% of eligible nurses responded. Nurses constituted half the respondents in the sample, reflecting the significant role and number of nurses in the makeup of the labor and delivery workforce. The racial and ethnic diversity of the sample was limited, with 80.4% of respondents identifying as white and 91.3% identifying as non-Hispanic. This is consistent with the demographics of hospital staff at MGH. Of 10, 9 of the respondents in the sample were women, reflecting the outsized participation of women in the obstetrics and nursing field in the USA [27]. A slight majority (58.7%) were relatively new to MGH, with less than 5 years of experience. The full demographics of the sample are shown in Table 1.

3.2. Knowledge of Disrespectful Care

Respondents reported a high baseline knowledge of D&A/OBV. A large majority (84.8%) believed that disrespect and abuse are issues in the obstetrics field, and a smaller majority (67.4%) believed that it is an issue at MGH specifically. “Disrespect and abuse” was a more familiar term than “obstetric violence”, although both terms were recognized by most respondents. Figure 1 graphs providers’ knowledge and beliefs about D&A.

3.3. Disrespectful Care Witnessed

The most reported observed disrespectful behavior was dismissing patients’ pain (87.0%), followed by discriminatory care based on physical characteristics (67.4%) and race (65.2%), and uncomfortable vaginal examinations (65.2%). The full results are listed in Table 2.
Qualitative responses further elaborated on the dismissal of pain or other concerns, one noting they had witnessed “Dismissing concerns about fetal status, nausea, anxiety”. Reports of derogatory comments in the patient’s presence were not as common (30.4%), though some noted that some verbal disrespect may be unintentional, or not take place in the birthing person’s presence.
Selected open-ended responses:
“There are times when I feel the language people use, whether intentionally or not, can sound rude and disrespectful.”
(Respondent 33)
“Conversations outside of the room about a patient or family member that is judgmental or unkind.”
(Respondent 27)
Others noted poor communication and lack of true informed consent, with three write-in responses specifically mentioning “coercion.” One response elaborated in this way:
“Adequate consenting by providers for medications and procedures in labor feels inadequate. Many of the information that I hear providers offer to patients during care planning feels incomplete and biased towards what the provider most wants the patient to do/feels most convenient.”
(Respondent 16)
Uncomfortable vaginal examinations (65.2%) and not allowing patients to give birth in their preferred position (63%) were the most noted types of physical disrespect, while restraining (9%) was very rarely witnessed. When asked to elaborate further, five responses specifically noted Cook balloon placement as being problematic, for example:
“Trying multiple times to place cook balloons on patients who are uncomfortable.”
(Respondent 41)
“After traumatic cook balloon placement, MD agreed he wasn’t going to put balloon to tension right away and then pulled balloon so hard that patient had vagal response and prolonged deceleration that resulted in unnecessary intervention and unnecessary emotional and physical trauma to patient.”
(Respondent 13)
Compared with other domains of disrespect, unnecessary procedures or procedures performed without explanation were less frequently reported. The most problematic procedures were artificial rupture of membrane (39.1% reported witnessing or hearing about this being performed without explanation); episiotomy (34.8%); and stripping membrane (34.8%). Fewer than one-fifth of respondents reported witnessing an unexplained Cesarean section (C-section), stitching, transfusion, sterilization, injection, shaving, or catheter placement. Neglect was also relatively common; a slight majority noted neglecting a patient (52.2%) and leaving a patient unattended (54.3%).
A majority reported discriminatory care based on race (65.2%), culture (60.9%), or physical characteristics (67.4%). About 45.7% reported discrimination based on language, and several qualitative responses expounded upon this type of discrimination:
“Often a lack of respect and consideration of patients whose primary language is not English—increasing volume, not addressing them directly, making side comments to staff.”
(Respondent 42)
The proportion of respondents who reported observing disrespectful behaviors was similar across occupations, with some exceptions. Nurses were significantly more likely than physicians to report witnessing or hearing about a patient being threatened with an unnecessary C-section (69.6% of nurses compared to 12.5% of midwives and 13.3% of physicians, Fisher’s exact test p = 0.0004126). They also were more likely to report C-sections being carried out to speed the birth process when the mother and the fetus were not compromised (52.2% of nurses compared to 12.5% of midwives and 13.3% of physicians, Fisher’s exact test p = 0.02005).

3.4. Respectful Care Performed

Respectful care is illustrated in Figure 2. Staff reported performing respectful care behaviors often. A vast majority (84.8–100%) of respondents reported performing most respectful items fairly or very often, except for asking patients for their preferred name (56.5%) and knocking and waiting for an answer when entering patient’s rooms (45.6%).

3.5. Stress and Support Factors

The median Perceived Stress Scale (PSS-4) score was 6 (interquartile range: 3–8) out of 16, with 16 indicating the highest level of stress. The frequency of responses to stress factors is displayed in Figure 3. The most commonly reported stress-related barriers to RMC were related to being overburdened at work: 76.1% cited workload and 60.9% cited fatigue. Open-ended responses also pointed to inadequate number or experience level of staff, with one respondent noting “Leaders not creating a system with adequate staffing to compassionately, safely provide excellent care to all our patients” (Respondent 3). While lack of time may be an issue, lack of supplies does not seem to be a major barrier: Less than 1 in 10 cited a lack of medications and/or a lack of instruments as a problem.
This study surveyed 46 obstetrical providers to assess their observation of disrespectful care, performance of respectful care, and perception of barriers to respectful care at MGH. While respectful maternity care was performed at MGH in the majority of encounters, providers identified that D&A/OBV remains an issue in childbirth. Specific clinician observations included the dismissal of pain, discriminatory behavior based on physical characteristics and race, and uncomfortable vaginal examinations. Clinicians reported that the most common stress-related barriers to providing respectful maternity care included workload and fatigue, indicating that lack of adequate staffing may be an issue.
This study corroborates findings from other US-based studies surveying patients who report discrimination based on sociodemographic factors [23,28]. This particularly highlights the need for interventions to address both clinician implicit and explicit bias toward patients from marginalized backgrounds [29]. These findings stress the interplay between D&A/OBV and maternal outcomes, specifically “delay, denial, and dismissal” as contributing factors to obstetric racism in maternal morbidity and mortality [30]. Particularly notable in the results were the high levels of both witnessed disrespectful care and self-reported performance of respectful care. This may suggest that instances of respect and disrespect can coexist in patients’ encounters. It is also possible that providers may have different perceptions of the respectfulness of their own care provision than they do of their colleagues.
While the most existing respectful maternity care-related studies in the US focus on the patient experience during childbirth, our study is among the first investigations of specifically clinician perspectives. We noted only one other study, conducted by Morton et al. (2018), which surveyed American and Canadian doulas and nurses, quantifying their reports of witnessed disrespect [22]. The aforementioned study found that 65.4% of nurses and doulas occasionally or often witnessed providers engaging in procedures without giving the patient a choice or time to consider the procedure [22]. While unexplained procedures were less commonly reported in our study, these results point to a lack of adequate informed consent as a type of D&A of particular importance. While other global studies have been performed on clinician perspectives of root causes of disrespect in Nigeria and Kenya, these may not be fully generalizable to the US context. Notably, Afulani et al.’s analysis in Kenya highlights provider stress and burnout, system infrastructure, and provider bias as contributing factors in D&A/OBV [31]. Our study also highlights the contributions of clinician burnout and structural factors such as workload, lack of support, and fatigue on patient experiences of care. Our findings affirm the need for provider-based interventions as pointed out by the CDC’s Morbidity and Mortality Weekly Report’s call to action for clinician training surrounding “discrimination, stigma and unconscious bias, cultural awareness, and communication techniques in the context of broader quality improvement initiatives” [32].
The limitations of our study include its small sample size and low survey response rate and, therefore, may not be generalizable to other settings. The response rate for nurses (40.5%) was lower than the physician and midwife response rates (58.6% and 66.7%, respectively), which could be due to the irregularity of many nursing shifts and number of nurses working per diem. Our response rates are consistent with those reported in a review of health professional response rates in online surveys, which ranged from 36.77 to 57.4% [33]. When interpreting the results, it is important to note that clinician reports of D&A/OBV may not correlate with individual patient experiences. The proportion of providers who report witnessing D&A/OBV should not be conflated with the true prevalence of such incidences. Multiple providers may have observed the same incident, and providers who have worked at a facility over a longer period have had more years of experience over which to witness such incidents. Social desirability bias may also reduce reports of observed D&A/OV on the labor and delivery unit, and selection bias could be present if respondents who were more knowledgeable about D&A had higher response rates than those who were less knowledgeable.
It is also likely that the sensitivity of the subject may have deterred providers from participating. Healthcare providers have shown some level of apprehension with the use of “obstetric violence” as a term to capture disrespectful maternity care [34] and may describe disrespectful care using other terminology such as “birth trauma” instead [35]. One commentary suggests changing the term to “obstetrical mistreatment” to better define the challenge to respectful care and reduce stigma when care falls short [34]. It is possible that the ongoing debate and confusion around defining such mistreatment in care, and the role in which a provider may play, was a significant deterrent and thus a reason for the low response rate. Providers, as key stakeholders in the pursuit of respectful maternity care, must be empowered to improve the quality of care without being overly subjected to blame for system-level drivers. Sustained progress in respectful maternity care requires moving from a “blame culture” to a “just culture”, balancing individual accountability with systems-level accountability, with an emphasis on organizational learning and continuous improvement [36].
Future directions of research should include examining the experiences of birthing people. Comparing the patient and provider experiences within the same setting can provide a fuller picture not only of the prevalence of RMC and D&A but also of the factors that influence care delivery. This can help assess the efficacy of clinician-facing interventions in the provision of respectful maternity care for birthing persons.
In addition, education and training modules to examine and analyze respectful and disrespectful care are being developed at MGH for quality improvement, continuing medical education, and reducing unintentional disrespect to birthing people.

4. Conclusions

In summary, our study demonstrates that healthcare providers report witnessing disrespect of birthing people in a contemporary US obstetrics unit at a major tertiary hospital. At the same time, they report most of their own care provision to be respectful. They cite factors such as workload and fatigue as barriers to respectful maternity care. Results from this study may guide training initiatives for clinicians staffing the labor and delivery unit to improve patient experiences.

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/reprodmed5040020/s1, Figure S1: Survey collection tool.

Author Contributions

Conceptualization, A.G. and C.D.B.; methodology, A.G., C.D.B., K.D.F., S.T. and K.V.K.; investigation, K.V.K., A.C., P.B. and A.F.; formal analysis, K.D.F. and S.N.; writing—original draft preparation, K.D.F. and S.T.; writing—review and editing, S.N., C.D.B., A.G., K.V.K., A.C., A.F. and P.B.; visualization, K.D.F.; supervision, A.G. All authors have read and agreed to the published version of the manuscript.

Funding

This work was supported by the Massachusetts General Hospital-endowed Global Health Fund—Strength & Serenity, Fund number 1200 020707.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the Mass General Brigham Human Research Committee (protocol 2022P003287, approved 27 February 2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study.

Data Availability Statement

The data underlying this article will be shared upon reasonable request to the corresponding author.

Acknowledgments

We gratefully acknowledge the support and guidance of Susan Hernandez, Legislative Co-Chair, Massachusetts American College of Nurse-Midwives; Rebecca D. Minehart, Division Chief, Obstetric Anesthesiology at Brown University Health; and Jeffrey Ecker, Chief of the Department of Obstetrics and Gynecology at Massachusetts General Hospital.

Conflicts of Interest

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

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Figure 1. Providers’ knowledge and beliefs about disrespect and abuse in childbirth
Figure 1. Providers’ knowledge and beliefs about disrespect and abuse in childbirth
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Figure 2. Reported frequency of respectful maternity care performed
Figure 2. Reported frequency of respectful maternity care performed
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Figure 3. Frequency of reported stress factors
Figure 3. Frequency of reported stress factors
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Table 1. Respondent demographics (N = 46).
Table 1. Respondent demographics (N = 46).
VariableN (%)
Occupation at MGH
  Nurse23 (50.0%)
  Midwife8 (17.4%)
  Physician15 (32.6%)
Age
  Less than 30 years old10 (21.7%)
  30–39 years old17 (37%)
  40–49 years old8 (17.4%)
  50 or older11 (23.9%)
Gender
  Man4 (8.7%)
  Woman42 (91.3%)
  Other0 (0%)
Education
  Associate’s degree or diploma program (e.g., ADN)1 (2.2%)
  Bachelor’s degree (e.g., BSN)19 (41.3%)
  Master’s degree (e.g., MSN, CNM)11 (23.9%)
  Doctorate degree (e.g., MD, DNP)15 (32.6%)
Race
  Asian or Pacific Islander3 (6.5%)
  Black or African American3 (6.5%)
  White37 (80.4%)
  Multiracial/Other race2 (4.3%)
  NA1 (2.2%)
Ethnicity
  Hispanic or Latino3 (6.5%)
  Non-Hispanic or non-Latino42 (91.3%)
  NA1 (2.2%)
Years of experience at MGH
  1–4 years27 (58.7%)
  5–9 years5 (10.9%)
  10–14 years1 (2.2%)
  15+ years13 (28.3%)
Years of experience in obstetric care
  1–4 years18 (39.1%)
  5–9 years9 (19.6%)
  10–14 years3 (6.5%)
  15+ years16 (34.8%)
Table 2. Disrespectful care witnessed or heard about.
Table 2. Disrespectful care witnessed or heard about.
Domain of DisrespectItemN (%)
Verbal disrespectDismissing/disbelieving a patient’s reports of pain40 (87.0%)
Scolding29 (63.0%)
Threatening with unnecessary C-section19 (41.3%)
Other verbal/psychological disrespect19 (41.3%)
Derogatory comment14 (30.4%)
Physical disrespectVigorous/uncomfortable vaginal examinations30 (65.2%)
Not allowing patients’ position of choice in birth29 (63.0%)
Other physical disrespect9 (19.6%)
Restraining4 (8.7%)
Privacy violations/Neglect/Unnecessary proceduresAsking private questions in the presence of others27 (58.7%)
Leaving patients unattended for long periods of time25 (54.3%)
Neglecting a patient24 (52.2%)
Medically unnecessary C-section15 (32.6%)
Medically unnecessary episiotomy13 (28.3%)
Delivery or examination in public3 (6.5%)
Other disrespectful/abusive actions2 (4.3%)
Discriminatory careDiscriminatory care based on physical characteristics31 (67.4%)
Discriminatory care based on race30 (65.2%)
Discriminatory care based on culture28 (60.9%)
Discriminatory care based on language21 (45.7%)
Discriminatory care based on age20 (43.5%)
Discriminatory care based on immigration status14 (30.4%)
Discriminatory care based on the number of children14 (30.4%)
Discriminatory care based on socioeconomic status13 (28.3%)
Discriminatory care based on gender identity or sexual orientation12 (26.1%)
Discriminatory care based on marital status6 (13%)
Discriminatory care based on insurance status4 (8.7%)
Discriminatory care based on other patient characteristics3 (6.5%)
Performance of procedures without explanationArtificial rupture of membrane18 (39.1%)
Episiotomy16 (34.8%)
Stripping membrane16 (34.8%)
Rectal exam11 (23.9%)
Vaginal exam11 (23.9%)
Placement of FSE or IUPC10 (21.7%)
Placement of Foley catheter7 (15.2%)
C-section6 (13%)
Shaving6 (13%)
Stitching5 (10.9%)
Placement of the straight catheter5 (10.9%)
Injection4 (8.7%)
Use of assistive device for delivery3 (6.5%)
Blood transfusion1 (2.2%)
Sterilization1 (2.2%)
Other procedure1 (2.2%)
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MDPI and ACS Style

Fachon, K.D.; Truong, S.; Narayan, S.; Buniak, C.D.; Vergara Kruczynski, K.; Cohen, A.; Barbosa, P.; Flynn, A.; Goodman, A. Providers’ Perceptions of Respectful and Disrespectful Maternity Care at Massachusetts General Hospital. Reprod. Med. 2024, 5, 231-242. https://doi.org/10.3390/reprodmed5040020

AMA Style

Fachon KD, Truong S, Narayan S, Buniak CD, Vergara Kruczynski K, Cohen A, Barbosa P, Flynn A, Goodman A. Providers’ Perceptions of Respectful and Disrespectful Maternity Care at Massachusetts General Hospital. Reproductive Medicine. 2024; 5(4):231-242. https://doi.org/10.3390/reprodmed5040020

Chicago/Turabian Style

Fachon, Katherine Doughty, Samantha Truong, Sahana Narayan, Christina Duzyj Buniak, Katherine Vergara Kruczynski, Autumn Cohen, Patricia Barbosa, Amanda Flynn, and Annekathryn Goodman. 2024. "Providers’ Perceptions of Respectful and Disrespectful Maternity Care at Massachusetts General Hospital" Reproductive Medicine 5, no. 4: 231-242. https://doi.org/10.3390/reprodmed5040020

APA Style

Fachon, K. D., Truong, S., Narayan, S., Buniak, C. D., Vergara Kruczynski, K., Cohen, A., Barbosa, P., Flynn, A., & Goodman, A. (2024). Providers’ Perceptions of Respectful and Disrespectful Maternity Care at Massachusetts General Hospital. Reproductive Medicine, 5(4), 231-242. https://doi.org/10.3390/reprodmed5040020

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