ArticleReproductive health2021
I felt so much conflict instead of joy: an analysis of open-ended comments from people in British Columbia who declined care recommendations during pregnancy and childbirth.
Article in Reproductive health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
14 citing papers in PubMed, 29 citations in OpenAlex.
- Decision-Making and Knowledge Around Inductions of Labor: A Survey Study in Ireland.Birth (Berkeley, Calif.) · 2026Article
- Mapping global research on labor and postpartum pain management: a bibliometric analysis (2000-2025).International journal for equity in health · 2026Review
- Supporting the implementation of a Maternal Early Warning System (MEWS) protocol using Human-Centred Design.BMC health services research · 2026Article
- When the hospital becomes an option again: a qualitative analysis of women's and their partners' experiences with a designated clinic for women who request different care than recommended in the guidelines.BMC pregnancy and childbirth · 2025Article
- "This year is not about carrying the heaviest burden"- a qualitative study on Black women's postpartum experiences.SSM. Qualitative research in health · 2025Article
- Perinatal outcomes following nonadherence to guideline-based screening for gestational diabetes: A population-based cohort study.Acta obstetricia et gynecologica Scandinavica · 2025Article
- Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice.BMC pregnancy and childbirth · 2024Article
- Teaching by texting to promote positive health behaviours in pregnancy: a protocol for a randomised controlled trial of SmartMom.BMJ open · 2024Article
- Author response to "Pitfalls of analyzing perinatal outcomes by health care provider".CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne · 2023Article
- Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration.Health policy and planning · 2022Article
- From coercion to respectful care: women's interactions with health care providers when planning a VBAC.BMC pregnancy and childbirth · 2022Article
- A true choice of place of birth? Swiss women's access to birth hospitals and birth centers.PloS one · 2022Article
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Corrections and comments
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Authors and funding
5 authors at 1 institution in 2 countries.
Funding
Abstract
backgroundNo Canadian studies to date have examined the experiences of people who decline aspects of care during pregnancy and birth. The current analysis bridges this gap by describing comments from 1123 people in British Columbia (BC) who declined a test or procedure that their care provider recommended.
methodsIn the Changing Childbirth in BC study, childbearing people designed a mixed-methods study, including a cross-sectional survey on experiences of provider-patient interactions over the course of maternity care. We conducted a descriptive quantitative content analysis of 1540 open ended comments about declining care recommendations.
resultsMore than half of all study participants (n = 2100) declined care at some point during pregnancy, birth, or the postpartum period (53.5%), making this a common phenomenon. Participants most commonly declined genetic or gestational diabetes testing, ultrasounds, induction of labour, pharmaceutical pain management during labour, and eye prophylaxis for the newborn. Some people reported that care providers accepted or supported their decision, and others described pressure and coercion from providers. These negative interactions resulted in childbearing people feeling invisible, disempowered and in some cases traumatized. Loss of trust in healthcare providers were also described by childbearing people whose preferences were not respected whereas those who felt informed about their options and supported to make decisions about their care reported positive birth experiences.
conclusionsDeclining care is common during pregnancy and birth and care provider reactions and behaviours greatly influence how childbearing people experience these events. Our findings confirm that clinicians need further training in person-centred decision-making, including respectful communication even when choices fall outside of standard care.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.