As birth workers, we often see things or hear things from our clients that should not have happened. It could be an ultrasound tech sharing an interpretation that is later contradicted by their primary care provider, causing the patient confusion and anxiety. It could be membrane sweeps, AROMs, or episiotomies performed without the client’s consent. Or nurses disclosing information to family members while the client is unconscious, leaving the patient to receive a broken telephone story from their family later.
These incidents range from irritations to serious breaches of practice standards, and things are more likely to “just go wrong” for systemically marginalized people. Clients are usually at a loss as to how to seek accountability or believe they can do nothing to address the harm they’ve experienced.
Some may be aware of complaints processes that exist, but concerns about outcomes on either end of the spectrum – nothing will happen, or the worker will get fired – are often a deterrent. And of course, our clients who have just had babies or experienced a loss may simply not have the time and energy to engage with a complaints process.
In truth, there are far more opportunities to address what happened than most people think. Speaking up can lead to many positive outcomes, including a faster return to well-being for the client, and learning and improved practice on the part of the care provider. The processes focus on restorative justice, learning, and growth, rather than punishing the provider. There is an understanding that the vast majority of workers in the healthcare system care about people and want to help. The options outlined below are suitable depending on the context and seriousness of what happened.
Speaking with the Care provider directly
For my clients who decide to speak up about their experience, this is usually the option they go with. This is especially true of midwifery clients who have an ongoing relationship with their care provider.
We can support clients in this process by clarifying the concerns and rehearsing the conversation to make sure key points are captured and that the client feels empowered to self-advocate.
I’ve seen improved treatment relationships and greater client well-being arise from these conversations. Especially in the case of complex births, creating a safe environment to debrief the experience with the provider is essential. Debriefing a traumatic birth with the care provider is a protective factor against birth trauma.
Engaging the Care Team
If multiple people are involved in a client’s care, sometimes a care provider with whom the client has a positive relationship can be a liaison between them and a provider with whom the client is having challenges. For example, in the case of the oversharing ultrasound tech mentioned above, it might be appropriate for the midwife or OB’s clinic to reach out to the ultrasound clinic to let them know about the impact this had on a client. This leverages the clinics’ mutually supportive relationship that should incorporate giving and receiving constructive feedback.
Patient Relations and other “in-house” processes
Talking with the provider directly isn’t always the right option. This is especially likely to be true in a dynamic where the client felt intimidated or belittled by the provider, such as a discriminatory incident. Our debriefs with clients can explore their level of comfort with the various options.
Depending on the setting in which the care took place, there is usually an internal process for raising concerns. For example, most hospitals have a patient relations department that can work with you to resolve issues. There is often a mechanism for the hospital to anonymize information raised with the provider. Staff within patient relations will investigate the complaint and decide on the best way to address it. This could include seeking an apology from the care provider, supporting them to learn from what happened, or more serious action depending on the nature of the complaint.
Suppose a client has a serious concern about someone involved in their care who is a member of a regulated health profession. In that case, they have the option of filing a complaint with the care provider’s regulatory body. In Ontario, these regulatory bodies are called “Colleges”. They may be called “Boards” or “Associations” in other places. If you’re unsure of the system where you live, I recommend searching for “regulated health profession [your province/state]” and finding out more about health professional regulation where you live, especially for the professions providing perinatal healthcare, such as nursing, midwifery, medicine, pharmacy, and diagnostic imaging.
Professional regulatory bodies fulfill a range of functions including setting educational requirements, registering members, setting professional standards, and investigating complaints and reports.
Anyone can go to the College with a complaint about one of their members. When health professionals work in settings where they have oversight, such as a hospital or clinic, management is legally required to report certain types of information to the regulator. It’s one of the reasons why it’s always best to take the complaint somewhere internal first.
A range of things can happen, such as a letter with recommendations, reflection exercises and activities to support professional development, and a meeting with an expert in an area where more learning is needed. In some instances, the regulator may take no action. In some situations, the College can pursue an internal prosecution of the member. Again, a range of outcomes is possible, including having their license to practice their profession removed. This outcome is very infrequent.
Complaints Commissioner, Ombudsman, etc.
Provinces in Canada have arms-length government bodies that ensure the quality of public services such as healthcare. In Ontario, complaints regarding healthcare can be taken to the patient ombudsman. In Quebec, complaints can be made with the Complaints Commissioner. This 2022 case study explored the advocacy potential of many individuals accessing this complaints process. In 2019, “Obstetric violence” became a focus of media attention in Quebec due to a series of articles published in La Presse about experiences during childbirth, including inappropriate comments, procedures performed without consent, and being separated from babies. In the weeks following these publications, the Complaints Commissioner received an influx of complaints that spoke to a systemic pattern. The Commissioner is well placed to liaise with government policymakers and she produced a report with recommendations aimed at improving perinatal care. This led to several outcomes, including workshops for service providers on communication, information sharing, and consent.
“It’s me, hi! I’m the problem. It’s me”
Transparency with our clients about accountability includes making sure they know what their options are if they have concerns about us! Keeping the lines of communication open so they feel comfortable coming to us with concerns is ideal. If a client has a concern about a certified doula or perinatal educator that can’t be worked out, the client can go to their certification organization. In Ontario, If clients have concerns about how their personal information was used or shared, they can file a complaint with the privacy commissioner.
Seeking accountability has the potential to be healing and empowering for clients, while providing a learning opportunity for the client. When working with diverse humans at a sensitive time, hearing critical feedback compassionately and receptively is integral to our ability to grow in our practice. It may not always feel great in the moment, but if we reflect honestly on constructive feedback, it can be a wonderful catalyst for deepening our practice.
Keira Grant (she/her) Inclusion and Engagement Lead – Racialized Communities
Keira brings a wealth of experience to the Online Community Moderator role. She is a Queer, Black woman with a twenty-year track record in Equity, Diversity, and Inclusion (EDI) education, projects, and community building initiatives.