# Patterns of respectful care and mistreatment during childbirth in relation to perinatal mental health: a secondary analysis of listening to mothers in California

## TL;DR

This study finds that poor treatment during childbirth is linked to worse mental health for mothers before and after giving birth.

## Contribution

The study identifies distinct patterns of respectful care and mistreatment during childbirth and their specific associations with perinatal mental health symptoms.

## Key findings

- Women with antenatal depression were 3.28 times more likely to experience rough, rude, and discriminatory treatment during childbirth.
- Not feeling supported during childbirth was linked to a 2.06 higher risk of postpartum anxiety.
- Four distinct patterns of care and mistreatment during childbirth were identified using latent class analysis.

## Abstract

Despite mental health conditions being the leading cause of maternal mortality in the United States, the relationship between perinatal mental health and mistreatment during childbirth has been insufficiently examined. The objective was to identify patterns of respectful care and mistreatment during childbirth and examine associations with perinatal mental health.

We conducted a cross-sectional secondary analysis of Listening to Mothers in California (N = 2,539). We conducted latent class analysis of indicator variables describing rough or rude care, discriminatory treatment, support, communication, and encouragement of autonomous decision-making. We conducted multinomial logistic regression to examine symptomatology for antenatal anxiety and antenatal depression in relation to class membership. Logistic regression was used to examine class membership in relation to symptomatology for postpartum anxiety and postpartum depression.

Four latent classes were identified: Class 1 (84.54%): Respected/Supported, Class 2 (6.69%): Not Supported, Class 3 (5.39%): Rough/Rude, Class 4 (3.38%): Rough/Rude/Discriminated. Women with antenatal depression symptomatology were 3.28 times as likely to be classified in Class 4 versus Class 1 (aRRR 3.28, CI95% 1.88–5.73). Women with antenatal anxiety symptomatology had a higher risk of classification in Class 4 than Class 1 (aRRR 2.04, CI95% 1.21–3.43). Compared to women in Class 1, women in Class 2 had 2.06 higher adjusted risk of postpartum anxiety (aRRR 2.06, CI95% 1.26–3.36).

Women who were symptomatic for antenatal anxiety or antenatal depression were at increased risk for mistreatment and not receiving support during childbirth. Women who did not feel supported had increased risk of symptomatology for postpartum anxiety.

The online version contains supplementary material available at 10.1007/s00737-025-01656-0.

Four latent classes of respectful care and mistreatment during childbirth were identified.

Symptoms of antenatal anxiety or antenatal depression were associated with increased risk for rough, rude, and discriminatory treatment.

Not feeling supported during childbirth was associated with increased risk of symptomatology for postpartum anxiety.

The online version contains supplementary material available at 10.1007/s00737-025-01656-0.