Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool

Related Experiment Video

Updated: Jul 16, 2025

Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse POP Quantification System

Anogenital Distance and Perineal Measurements of the Pelvic Organ Prolapse POP Quantification System

Published on: September 20, 2018

Claudia M Limmer¹, Kathrin Stoll², Saraswathi Vedam³

¹Hannover Medical School, Midwifery Research and Education Unit, Carl-Neuberg-Str. 1, Hannover D-30625, Germany; Department Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Science, Alexanderstr. 1, Hamburg D-20099, Germany.

|September 9, 2023

Abstract

Introduction:

Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed.

Research Aim:

The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth.

Methods:

A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018.

Findings:

More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively).

Conclusions:

This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.

Keywords:

Birth experience Birth trauma Mistreatment Obstetric violence Postpartum PTSD Psychometric validation Respectful maternity care

More Related Videos

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting

Published on: January 12, 2018

Assessment of Child Anthropometry in a Large Epidemiologic Study

Assessment of Child Anthropometry in a Large Epidemiologic Study

Published on: February 2, 2017

Related Concept Videos

Milgram's Obedience to Authority

Milgram's Obedience to Authority

Obedience to authority is classically demonstrated in a more famous series of social psychology experiments performed by Stanley Milgram. He was a social psychology professor at Yale who was influenced by the trial of Adolf Eichmann, a Nazi war criminal. Eichmann’s defense for the atrocities he committed was that he was “just following orders.”

Obedience

Obedience

According to obedience research, we may harm others under the forceful pressures of an authority figure (Milgram, 1974). How about if the inappropriate orders were delivered with less force? The increasing interdependence between nurses and physicians compelled Hofling and his colleagues to explore nurses’ reactions to a potentially harmful medical request made by the perceived authority figure, the doctor (Hofling, Brotzman, Dalrymple, Graves, & Pierce, 1966). In this situation,...

Guidelines For Measuring Vital Signs

Guidelines For Measuring Vital Signs

Following these guidelines can help nurses accurately measure vital signs, assess changes in patient conditions, and provide timely treatment when necessary. Adhering closely to the guidelines ensures the accuracy and reliability of the results.
Before taking a patient's vital signs, a nurse would consider and assess the patient's comfort level and ensure appropriate equipment is available.

Assessment of blood pressure in brachial artery(one-step method)

Assessment of blood pressure in brachial artery(one-step method)

This procedural guide systematically measures blood pressure using an oscillometric digital sphygmomanometer, emphasizing accuracy, patient safety, and comfort.
Prepare for the Procedure:

Parenting Styles

Parenting Styles

Diana Baumrind's four parenting styles — authoritarian, authoritative, neglectful, and permissive — each influence children's socio-emotional development differently.
Authoritarian Parenting
This style is strict and controlling, with little room for open dialogue. Authoritarian parents demand obedience and often enforce rules with minimal warmth. Children raised this way may lack social skills and initiative, usually comparing themselves to others unfavorably.
Authoritative...

Special considerations while measuring blood pressure

Special considerations while measuring blood pressure

When assessing blood pressure (BP), healthcare professionals must consider various factors and potential unexpected outcomes to ensure accurate readings and provide proper patient care. Adhering to these guidelines is essential to achieving the most reliable results.
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.

Articles linked to this work by shared authors, journal, and citation graph.

Midwifery academic educators' experiences and knowledge on managing students' moral distress and psycho-emotional trauma during clinical placement: A qualitative study protocol.

AIMS public health·2026

"Do not leave me behind and do not put me in your box": family-planning access and care needs among women with migration histories in Berlin, Germany-a mixed-methods study.

Reproductive health·2026

Navigating study demands in first-year midwifery education: Mixed-methods insights from students, university lecturers and clinical mentor midwives.

Nurse education in practice·2026

A multi-faceted hospital-based intervention for intrapartum care in sub-Saharan Africa: a stepped-wedge cluster-randomized trial.

Nature medicine·2026

[Comparison of cesarean section rates at the facility level using the Robson classification: A retrospective cohort study at a tertiary university perinatal center (2019-2021)].

Zeitschrift fur Evidenz, Fortbildung und Qualitat im Gesundheitswesen·2026

Birthing injustice: unmasking structural racism and the illusion of reconciliation in indigenous perinatal care in Canada, insights from the RESPCCT study.

Frontiers in global women's health·2026

See all related articles