Women’s Health
Respectful Maternity Care and Postpartum Emotional Distress: The Mediating Role of Baby-Friendly Hospital Initiative Practices and Moderation by Support Chidinma Oli* Chidinma Oli Oli Oli Oli Oli Oli Oli University of Florida
Introduction: Respectful maternity care (RMC) is a critical component of high-quality maternal care, yet its relationship with postpartum emotional distress remains underexplored. This study examined whether Baby-Friendly Hospital Initiative (BFHI) practices mediate the association between respectful maternity care and postpartum emotional distress, and whether emotional and practical support modify this relationship.
Methods: We analyzed cross-sectional postpartum survey data from 207 women receiving care at a U.S.-based academic medical center. Respectful maternity care was measured using the Mothers on Respect Index (MORi), and postpartum emotional distress was modeled as a latent construct comprising nervousness, sadness, anhedonia, and worry. We used Structural Equation Modeling with bootstrapped confidence intervals (n=5,000) to test for mediation and simple slope analysis to explore moderation by support.
Results: The median (SD) MORi score was 77.0 (12.0). RMC was associated with lower postpartum emotional distress [β = -.224; 95% CI [-.390, -.059]]. The indirect effect of RMC on postpartum emotional distress through BFHI practices was significant [β = -.044; 95% CI [-.102, -.003]]. Emotional support moderated the association between Respectful Maternity Care and postpartum emotional distress (β = 0.15, p = .014). Specifically, higher RMC was associated with lower distress among women with low emotional support (p < .001), but not among those with high emotional support (p = .884). Practical support showed no moderating effect.
Conclusions: RMC may reduce postpartum emotional distress in part, through the implementation of BFHI practices. The protective effect of Respectful Maternity Care is strongest for women with lower emotional support, highlighting the importance of institutional and social support for all women, especially those with low emotional support.