Can Listening to Patient Voices Improve Childbirth Outcomes in America?

Childbirth is one of life’s most important moments — but many people say their voices aren’t heard during their prenatal care and birth. 

Pointing to scientific literature, Rachel Blankstein Breman, PhD, MPH, RN, FAWHONN, assistant professor at the University of Maryland School of Nursing, said, “We have recently seen an uptick in people reporting that they don't feel heard and that their preferences and their options aren't necessarily being explained to them by their providers. And so I created CHOICEs to measure the patient experience, because I felt that we needed something to objectively measure what people were saying was happening.” 

CHOICEs — CHildbirth Options, Information, and Person-Centered Explanation — is the first patient-reported measure designed to capture what people experience in maternity care. Unlike traditional metrics such as C-section rates or newborn Apgar scores, it centers the patient voice. 

“What CHOICEs does is — because it's what is called a patient-reported experience measure — it objectively reports what patients are experiencing,” Breman explained. “Why that's important is because there's no other metric for this.” 

Already in use in Texas, Illinois, and Maryland, CHOICEs aims to show providers, administrators, and families that patient voices matter and that listening to those voices can improve shared decision-making, elevate the care experience, and ensure childbirth is treated as a dignified event for every family. 

In a new video Q&A, Breman shares more about how listening to patients can improve outcomes for families and transform childbirth in America. 

Questions

How does trauma-informed care connect to shared decision-making in childbirth?

"When we talk about trauma, informed care, that is really the basic way to communicate with all patients. And in maternity care and in childbirth, trauma can be a part of that — whether it's past trauma or preventing trauma during birth,” Breman said. “So when we talk to patients in a trauma informed way, and we manage their care thinking about trauma, we're able to respect their autonomy, respect their personhood, and really provide a space for them to ask questions and engage in shared decision-making."

What change do you hope CHOICEs will inspire?

"What I'm really hoping CHOICEs will do is demonstrate to health care providers, administrators, nurses, doulas, parents, women who give birth that their voice is important,” she said. “We can shift care to improve shared decision-making and improve this patient reported experience in childbirth, so that birth is a dignified event here in the United States — and that all people feel like they received the care they deserved and the best care possible."