Respectful Maternity Care and Postpartum Emotional Distress: The Mediating Role of Baby‐Friendly Hospital Initiative Practices and Moderation by Support

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 the mediating role of Baby-Friendly Hospital Initiative practices and moderating effects of support in the association between RMC and postpartum emotional distress. METHODS: We analyzed cross-sectional postpartum survey data from 207 women at a US based academic medical center. RMC 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 = 5000) to test for mediation and simple slope analysis to explore moderation by emotional and practical support. RESULTS: The median (SD) MORi score was 77 (12.0). RMC was associated with lower postpartum emotional distress [β = -0.224; 95% CI [-0.390, -0.059]], and was moderated by emotional support (β = 0.152, p = 0.014). Specifically, higher RMC was associated with lower distress among women with low emotional support (p = 0.002), but not among those with high emotional support (p = 0.968). However, practical support did not moderate the association. The indirect effect through Baby-Friendly Hospital Initiative practices was significant [β = -0.044; 95% CI [-0.102, -0.003]]. CONCLUSIONS: RMC may reduce postpartum emotional distress in part through the implementation of Baby-Friendly Hospital Initiative practices. The protective effect of RMC was strongest among women with lower emotional support. Our preliminary findings call for the need for longitudinal studies and replication in more diverse populations.