151
|
Klittmark S, Malmquist A, Karlsson G, Ulfsdotter A, Grundström H, Nieminen K. When complications arise during birth: LBTQ people's experiences of care. Midwifery 2023; 121:103649. [PMID: 37003045 DOI: 10.1016/j.midw.2023.103649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/30/2023] [Accepted: 02/09/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE To explore the care experiences of lesbian, bisexual, transgender, and queer (LBTQ) people during births where complications have arisen. DESIGN Data were collected through semi-structured interviews with self-identified LBTQ people who had experienced obstetrical and/or neonatal complications. SETTING Interviews were conducted in Sweden. PARTICIPANTS A total of 22 self-identified LBTQ people participated. 12 had experienced birth complications as the birth parent and ten as the non-birth parent. FINDINGS Most participants had felt invalidated as an LBTQ family. Separation of the family due to complications elevated the number of hetero/cisnormative assumptions, as new encounters with healthcare professionals increased. Dealing with normative assumptions was particularly difficult in stressful and vulnerable situations. A majority of the birth parents experienced disrespectful treatment from healthcare professionals that violated their bodily integrity. Most participants experienced lack of vital information and emotional support, and expressed that the LBTQ identity made it harder to ask for help. CONCLUSIONS Disrespectful treatment and deficiencies in care contributed to negative experiences when complications arose during birth. Trusting care relationships are important to protect the birth experience in case of complications. Validation of the LBTQ identity and access to emotional support for both birth and non-birth parents are crucial for preventing negative birth experiences. IMPLICATIONS FOR PRACTICE To reduce minority stress and create conditions for a trusting relationship, healthcare professionals should specifically validate the LBTQ identity, strive for continuity of carer and zero separation of the LBTQ family. Healthcare professionals should make extensive efforts to transfer LBTQ related information between wards.
Collapse
|
152
|
Comparing compliance with commencement and use of two partograph designs for women in active labour: A randomised controlled trial. Women Birth 2023; 36:e17-e24. [PMID: 35400605 DOI: 10.1016/j.wombi.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 03/15/2022] [Accepted: 04/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Documentation and assessment of progress in labour using a partograph is recommended by the World Health Organisation to assist in the timely recognition of labour dystocia. Recent studies have tested new designs of partographs that aim to account for more variable rates of labour progress. However, other studies have suggested that poor compliance in the completion of partographs affects utility. The objective of this study was to compare two types of partographs for compliance in documentation and use for managing labour. METHODS Low-risk nulliparous women in spontaneous labour (n = 228) were randomised to either an Action Line (control) (n = 114) or Dystocia Line partograph (intervention) (n = 114). Primary outcome was compliance with instructions for commencement of the partograph following a multifaceted training strategy. Secondary outcomes included compliance with the accompanying clinical management protocol for each partograph; and labour and birth outcomes. RESULTS The compliance rate for commencing the Action line partograph was 43.2% compared to 67.0% (p = 0.02) for the Dystocia line partograph. Other than a reduction in artificial rupture of membranes in the Dystocia Line group there were no other differences in labour management or birth outcomes. The use of centralised electronic display of labour progress may be a contributing factor. CONCLUSIONS Compliance with the commencement and use of either partograph was low. There was little indication that the partograph was being utilized in the assessment and management of prolonged labour. Further studies are needed to explore the current utility of partographs in labour management and the effect of centralised monitoring of progress in high resource settings.
Collapse
|
153
|
A global review of the inferred meaning of woman centred care within midwifery professional standards. Women Birth 2023; 36:e99-e105. [PMID: 35550121 DOI: 10.1016/j.wombi.2022.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 04/19/2022] [Accepted: 05/02/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND As an integral and guiding approach, woman centred care is well-grounded as the cornerstone of midwifery training and practice. A previous global review established that the concept, even though acknowledged as pivotal, has limited attention within the professional standards documents that underpin the discipline [1]. Whilst not detracting from the overall importance of woman centred care, it is further suggested that a broader meaning is generally being implied. OBJECTIVE Whether other related inferences and meanings of the actual term 'woman centred care' are also being utilised, has not yet been established. Therefore, this review of professional documents sought to investigate the occurrence of further depictions of the concept. METHODS With an implied and inferred meaning of 'woman centred care' as the focus, a review and synthesis of narrative from a global sample of midwifery professional standards was conducted. The principles of meta-ethnography were utilised to develop a qualitative approach. Rather than the actual words 'woman centred care' further phrases implying or inferring the concept were sought. 'A priori' phrases were developed and narrative and examples were synthesised for each. FINDINGS Standards and governance documents were located from within Australia, the United Kingdom and New Zealand and a further 139 nations. Overall, the seven phrases, each considered as an inference to woman centred care, were all substantiated. As a proportion of all documents, these were collated with the outcomes being a woman's right to choice (89%), being culturally sensitive (80.5%), a woman's voice and right to be heard (78%), the woman as an individual (68%), universal human rights (40%), being holistic (39%) and being self-determined (17.5%). CONCLUSION The outcomes of this review demonstrate that woman centred care may be a multidimensional concept. There were occurrences of all seven phrases across a broad scope of global professional midwifery documents, and each can be shown through its meaning to contribute something to an understanding of woman centred care. The creation of a universal meaning is recommended.
Collapse
|
154
|
Analysis of the social acceptability of a humanized childbirth intervention in Senegal: A qualitative study. Women Birth 2023; 36:e93-e98. [PMID: 35523705 DOI: 10.1016/j.wombi.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 03/21/2022] [Accepted: 04/27/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND In efforts to improve the quality of women's care and enhance related experiences in Senegal, the Senegalese government implemented an intervention named "humanized childbirth" in their health facilities. AIM To analyze the social acceptability of humanized childbirth as well as its relevance given the social values in Senegal. METHODS A multiple-case study was conducted within four health facilities in Dakar. Breastfeeding mothers (n = 20), pregnant women (n = 4), midwives (n = 8), Bajenu Gox (n = 4), members of the Health Development Committee (n = 4), and men from the community (n = 4) were interviewed individually, and a documentary analysis was done. The thematic analysis was performed using the acceptability theoretical framework. FINDINGS The results show that most participants agreed with the idea of humanized childbirth. However, participants display varying viewpoints as to the social acceptability of various components of the intervention. While there is an overall agreement concerning the benefits of motivated and attentive health professionals focused on prevention, restoring dignity for the parturient woman, freedom to eat and drink, massages and relaxation, the same cannot be said about the freedom of choice for birth positions and companionship. DISCUSSION The contrasting viewpoints as to the acceptability of humanized childbirth can be explained by the perception of risk and lack of experience with free birthing positions, as well as structural and cultural barriers surrounding the notion of companionship. CONCLUSION Education and awareness of the benefits of free birthing positions and companionship would be required among Senegalese women to enable a cultural shift in maternity wards in Senegal.
Collapse
|
155
|
Kuipers YJ, Thomson G, Goberna-Tricas J, Zurera A, Hresanová E, Temesgenová N, Waldner I, Leinweber J. The social conception of space of birth narrated by women with negative and traumatic birth experiences. Women Birth 2023; 36:e78-e85. [PMID: 35514007 DOI: 10.1016/j.wombi.2022.04.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/14/2022] [Accepted: 04/18/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth. AIM To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth. METHODS A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic. FINDINGS Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror. DISCUSSION/CONCLUSION The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.
Collapse
Affiliation(s)
- Yvonne J Kuipers
- Artesis Plantijn University College, Noorderplaats 2, 2000 Antwerp, Belgium; Edinburgh Napier University, School of Health and Social Care, Sighthill Court, Edinburgh EH11 4BN, Scotland, United Kingdom.
| | - Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston, United Kingdom.
| | - Josefina Goberna-Tricas
- University of Barcelona, Faculty of Medicine and Health Sciences, Bellvitge Health Sciences Campus, Carrer de la Feixa Llarga, s/n. 08907 L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Alba Zurera
- University of Barcelona, Faculty of Law, Avinguda Diagonal, 684, 08028 Barcelona, Spain.
| | - Ema Hresanová
- Charles University, Faculty of Social Sciences, U Krize 8, 158 00 Prague, Czech Republic.
| | - Natálie Temesgenová
- Charles University, Faculty of Social Sciences, U Krize 8, 158 00 Prague, Czech Republic.
| | - Irmgard Waldner
- Universitätsklinik Graz, Auenbruggerplatz 14, 8036 Graz, Austria.
| | - Julia Leinweber
- Institute for Midwifery, Charite Universitätsmedizin Berlin, Berlin, Germany.
| |
Collapse
|
156
|
Schaaf M, Jaffe M, Tunçalp Ö, Freedman L. A critical interpretive synthesis of power and mistreatment of women in maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000616. [PMID: 36962936 PMCID: PMC10021192 DOI: 10.1371/journal.pgph.0000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
Collapse
Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, United States of America
| | - Maayan Jaffe
- Independent Consultant, Brooklyn, New York, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lynn Freedman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
| |
Collapse
|
157
|
Hameed S, Mureed S, Chaudhri R, Khan SA, Khan MS. Postnatal women's perception on person-centered maternity care in twin cities of Rawalpindi and Islamabad: a descriptive study. BMC Pregnancy Childbirth 2023; 23:52. [PMID: 36681786 PMCID: PMC9862516 DOI: 10.1186/s12884-023-05362-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 01/09/2023] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Person-Centered Maternity Care (PCMC) is known as one of the most important components of maternal care. Every woman has the ultimate right of respectful health care. Previous research documents that lack of supportive care and respectful behavior experienced by pregnant women can act as a barrier to the utilization of health care services. Few studies have used PCMC tool to document this phenomenon. The objective of this descriptive study was to assess the women's perception of PCMC in Pakistan. METHODS Three hundred and seventy-seven (377) postnatal women of ages 18-49 years participated in the research. The study sites were secondary and tertiary care hospitals located in the twin cities of Rawalpindi and Islamabad. The PCMC tool used in this study is a validated scale with three sub-domains of i) communication and autonomy, ii) supportive care, and iii) dignity and respect. Data was analyzed using SPSS version 16, and descriptive and bivariate analysis was undertaken. RESULTS The PCMC mean score was 54 ± [10.7] out of 90. About half (55%) of women had good perception of PCMC. Sub-domain of supportive care scored the lowest as compared to the other two domains. Overall, 36% women reported physical abuse while 22% reported verbal abuse at the hands of the healthcare providers. Most of the women (88%) said that health providers did not introduce themselves. About 30% women claimed that health care providers never asked for permission before doing any medical procedures and 20% of women claimed that doctors did not describe the purpose of examination while 178 (47%) of women said that health provider explained the purpose of medications all the time, additionally, about 14% were never given the choice to ask questions. CONCLUSION The study concluded that the majority of postnatal women perceived that they were not getting optimum Person-Centered Maternity Care. Some core aspects in supportive care domain were missing. In order to improve the quality of hospital-based childbirths, efforts are needed to improve the quality of care.
Collapse
Affiliation(s)
- Sumbal Hameed
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan
| | - Sheh Mureed
- Health Section, Ministry of Planning Development and Special Initiatives, Islamabad, Pakistan
| | - Rizwana Chaudhri
- grid.414319.a0000 0004 0401 3810Obstetrics and Gynecology Department, Holy Family Hospital, Rawalpindi, Pakistan
| | - Shahzad Ali Khan
- grid.413930.c0000 0004 0606 8575Vice Chancellor, Health Services Academy, Islamabad, Pakistan
| | - Mohsin Saeed Khan
- grid.413930.c0000 0004 0606 8575Health Services Academy, Islamabad, Pakistan ,grid.4714.60000 0004 1937 0626Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| |
Collapse
|
158
|
Vogel JP, Pingray V, Althabe F, Gibbons L, Berrueta M, Pujar Y, Somannavar M, Vernekar SS, Ciganda A, Rodriguez R, Welling SA, Revankar A, Bendigeri S, Kumar JA, Patil SB, Karinagannanavar A, Anteen RR, Pavithra MR, Shetty S, Latha B, Megha HM, Gaddi SS, Chikkagowdra S, Raghavendra B, Armari E, Scott N, Eddy K, Homer CSE, Goudar SS. Implementing the WHO Labour Care Guide to reduce the use of Caesarean section in four hospitals in India: protocol and statistical analysis plan for a pragmatic, stepped-wedge, cluster-randomized pilot trial. Reprod Health 2023; 20:18. [PMID: 36670438 PMCID: PMC9862839 DOI: 10.1186/s12978-022-01525-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 11/08/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The World Health Organization (WHO) Labour Care Guide (LCG) is a paper-based labour monitoring tool designed to facilitate the implementation of WHO's latest guidelines for effective, respectful care during labour and childbirth. Implementing the LCG into routine intrapartum care requires a strategy that improves healthcare provider practices during labour and childbirth. Such a strategy might optimize the use of Caesarean section (CS), along with potential benefits on the use of other obstetric interventions, maternal and perinatal health outcomes, and women's experience of care. However, the effects of a strategy to implement the LCG have not been evaluated in a randomised trial. This study aims to: (1) develop and optimise a strategy for implementing the LCG (formative phase); and (2) To evaluate the implementation of the LCG strategy compared with usual care (trial phase). METHODS In the formative phase, we will co-design the LCG strategy with key stakeholders informed by facility assessments and provider surveys, which will be field tested in one hospital. The LCG strategy includes a LCG training program, ongoing supportive supervision from senior clinical staff, and audit and feedback using the Robson Classification. We will then conduct a stepped-wedge, cluster-randomized pilot trial in four public hospitals in India, to evaluate the effect of the LCG strategy intervention compared to usual care (simplified WHO partograph). The primary outcome is the CS rate in nulliparous women with singleton, term, cephalic pregnancies in spontaneous labour (Robson Group 1). Secondary outcomes include clinical and process of care outcomes, as well as women's experience of care outcomes. We will also conduct a process evaluation during the trial, using standardized facility assessments, in-depth interviews and surveys with providers, audits of completed LCGs, labour ward observations and document reviews. An economic evaluation will consider implementation costs and cost-effectiveness. DISCUSSION Findings of this trial will guide clinicians, administrators and policymakers on how to effectively implement the LCG, and what (if any) effects the LCG strategy has on process of care, health and experience outcomes. The trial findings will inform the rollout of LCG internationally. TRIAL REGISTRATION CTRI/2021/01/030695 (Protocol version 1.4, 25 April 2022).
Collapse
Affiliation(s)
- Joshua P. Vogel
- grid.1056.20000 0001 2224 8486Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC Australia
| | - Veronica Pingray
- grid.414661.00000 0004 0439 4692Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Fernando Althabe
- grid.414661.00000 0004 0439 4692Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Luz Gibbons
- grid.414661.00000 0004 0439 4692Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Mabel Berrueta
- grid.414661.00000 0004 0439 4692Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Yeshita Pujar
- grid.414956.b0000 0004 1765 8386Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka India
| | - Manjunath Somannavar
- grid.414956.b0000 0004 1765 8386Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka India
| | - Sunil S. Vernekar
- grid.414956.b0000 0004 1765 8386Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka India
| | - Alvaro Ciganda
- grid.414661.00000 0004 0439 4692Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Rocio Rodriguez
- grid.414661.00000 0004 0439 4692Instituto de Efectividad Clínica y Sanitaria (IECS-CONICET), Buenos Aires, Argentina
| | - Saraswati A. Welling
- grid.414956.b0000 0004 1765 8386Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka India
| | - Amit Revankar
- grid.414956.b0000 0004 1765 8386Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka India
| | - Savitri Bendigeri
- grid.414956.b0000 0004 1765 8386Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka India
| | | | | | | | | | | | - Shukla Shetty
- grid.418280.70000 0004 1794 3160JJM Medical College, Davangere, Karnataka India
| | - B. Latha
- grid.418280.70000 0004 1794 3160JJM Medical College, Davangere, Karnataka India
| | - H. M. Megha
- grid.418280.70000 0004 1794 3160JJM Medical College, Davangere, Karnataka India
| | - Suman S. Gaddi
- grid.416866.b0000 0004 0556 696XVijayanagar Institute of Medical Sciences (VIMS), Ballari, Karnataka India
| | - Shaila Chikkagowdra
- grid.416866.b0000 0004 0556 696XVijayanagar Institute of Medical Sciences (VIMS), Ballari, Karnataka India
| | - Bellara Raghavendra
- grid.416866.b0000 0004 0556 696XVijayanagar Institute of Medical Sciences (VIMS), Ballari, Karnataka India
| | - Elizabeth Armari
- grid.1056.20000 0001 2224 8486Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC Australia
| | - Nick Scott
- grid.1056.20000 0001 2224 8486Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC Australia
| | - Katherine Eddy
- grid.1056.20000 0001 2224 8486Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC Australia
| | - Caroline S. E. Homer
- grid.1056.20000 0001 2224 8486Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC Australia
| | - Shivaprasad S. Goudar
- grid.414956.b0000 0004 1765 8386Women’s and Children’s Health Research Unit, Jawaharlal Nehru Medical College, KLE Academy of Higher Education and Research, Belgaum, Karnataka India
| |
Collapse
|
159
|
Sialubanje C, Kaiser JL, Ngoma T, Mwananyanda L, Fong RM, Hamer DH, Scott NA. Postnatal care services in rural Zambia: a qualitative exploration of user, provider, and community perspectives on quality of care. BMC Pregnancy Childbirth 2023; 23:39. [PMID: 36653751 PMCID: PMC9847069 DOI: 10.1186/s12884-023-05350-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/05/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Postnatal care (PNC) is an important set of services offered to the mother and her newborn baby immediately after birth for the first six weeks to prevent maternal and neonatal complications and death. This qualitative study explored user and provider perspectives on quality of PNC services in the selected health facilities within the context of the Maternity Homes Access in Zambia project in the Saving Mothers Giving Life districts in rural Zambia. METHODS Between October 2018 and February 2019, forty focus group discussions (FGDs) (n = 160 participants) and twelve in-depth interviews (IDIs) were conducted in four districts in Southern and Eastern provinces. FGDs comprised women who delivered within the last year, fathers, community elders, and volunteers. IDIs comprised health workers at facility, district, and provincial levels. Data were analysed using content analysis guided by the international quality of care domains derived from the World Health Organization quality of care framework. Findings were triangulated to understand perceptions. RESULTS Overall, study participants perceived PNC services to be beneficial. Nevertheless, respondents had mixed feelings on the quality of PNC services and expressed a stark difference in their perception of factors affecting service quality. Service users described challenges arising from ineffective communication about the new PNC guidelines, and non-adherence of service providers to quality standards regarding respect, preservation of dignity and emotional support. Other factors were long waiting hours, small examination rooms providing inadequate privacy, and low levels of confidentiality. In contrast, service providers attributed poor service quality to various health system-related factors including low staffing levels, dysfunctional referral services, low supply of essential medicines, supplies, vaccines and equipment for optimal routine emergency obstetric and newborn care and management of complications. CONCLUSION These findings highlight important intervention opportunities to improve quality of PNC services in Zambia through better communication and raising awareness on PNC guidelines, respect, preservation of dignity and emotional support to mothers. Interventions should also focus on addressing contextual health system challenges including staffing levels, supply chain for essential medicines and commodities, shortening waiting time, and ensuring functional referral system.
Collapse
Affiliation(s)
- Cephas Sialubanje
- grid.513520.00000 0004 9286 1317School of Public Health, Levy Mwanawasa Medical University, Lusaka, Zambia
| | - Jeanette L. Kaiser
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - Thandiwe Ngoma
- grid.511971.aDepartment of Research, Right to Care Zambia, Lusaka, Zambia
| | | | - Rachel M. Fong
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA
| | - Davidson H. Hamer
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA ,grid.189504.10000 0004 1936 7558Section of Infectious Diseases, Department of Medicine, Boston University School of Medicine, Boston, MA 02118 USA
| | - Nancy A. Scott
- grid.189504.10000 0004 1936 7558Department of Global Health, Boston University School of Public Health, Boston, MA USA
| |
Collapse
|
160
|
Miani C, Leiße A, Wandschneider L, Batram-Zantvoort S. Experiences of giving birth during the COVID-19 pandemic: a qualitative analysis of social media comments through the lens of birth integrity. BMC Pregnancy Childbirth 2023; 23:32. [PMID: 36647019 PMCID: PMC9841489 DOI: 10.1186/s12884-022-05326-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Social media offer women a space to discuss birth-related fears and experiences. This is particularly the case during the COVID-19 pandemic when measures to contain the spread of the virus and high rates of infection have had an impact on the delivery of care, potentially restricting women's rights and increasing the risk of experiencing different forms of mistreatment or violence. Through the lens of birth integrity, we focused on the experiences of women giving birth in Germany as shared on social media, and on what may have sheltered or violated their integrity during birth. METHODS Using thematic analysis, we identified key themes in 127 comments and associated reactions (i.e. "likes", emojis) posted on a Facebook public page in response to the dissemination of a research survey on maternity care in the first year of the COVID-19 pandemic. RESULTS Women contributing to the dataset gave birth during March and December 2020. They were most negatively affected by own mask-wearing -especially during the active phase of labour, not being allowed a birth companion of choice, lack of supportive care, and exclusion of their partner from the hospital. Those topics generated the most reactions, revealing compassion from other women and mixed feelings about health measures, from acceptation to anger. Many women explicitly formulated how inhumane or disrespectful the care was. While some women felt restricted by the tight visiting rules, those were seen as positive by others, who benefited from the relative quiet of maternity wards and opportunities for postpartum healing and bonding. CONCLUSION Exceptional pandemic circumstances have introduced new parameters in maternity care, some of which appear acceptable, necessary, or beneficial to women, and some of which can be considered violations of birth integrity. Our research calls for the investigation of the long-term impact of those violations and the reassessment of the optimal conditions of the delivery of respectful maternity during the pandemic and beyond.
Collapse
Affiliation(s)
- Céline Miani
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany ,grid.77048.3c0000 0001 2286 7412Sexual and Reproductive Health and Rights Research Unit, Ined, France
| | - Antonia Leiße
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany
| | - Lisa Wandschneider
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- grid.7491.b0000 0001 0944 9128Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Universitätstr. 15, 33615 Bielefeld, Germany
| |
Collapse
|
161
|
Ahmed SAE, Mahimbo A, Dawson A. Quality intrapartum care expectations and experiences of women in sub-Saharan African Low and Low Middle-Income Countries: a qualitative meta-synthesis. BMC Pregnancy Childbirth 2023; 23:27. [PMID: 36641424 PMCID: PMC9840253 DOI: 10.1186/s12884-022-05319-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 12/20/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Woman-centred maternity care is respectful and responsive to women's needs, values, and preferences. Women's views and expectations regarding the quality of health services during pregnancy and childbirth vary across settings. Despite the need for context-relevant evidence, to our knowledge, no reviews focus on what women in sub-Saharan African Low and Low Middle-Income Countries (LLMICs) regard as quality intrapartum care that can inform quality guidelines in countries. METHODS We undertook a qualitative meta-synthesis using a framework synthesis to identify the experiences and expectations of women in sub-Saharan African LLMICs with quality intrapartum care. Following a priori protocol, we searched eight databases for primary articles using keywords. We used Covidence to collate citations, remove duplicates, and screen articles using a priori set inclusion and exclusion criteria. Two authors independently screened first the title and abstracts, and the full texts of the papers. Using a data extraction excel sheet, we extracted first-order and second-order constructs relevant to review objectives. The WHO framework for a positive childbirth experience underpinned data analysis. RESULTS Of the 7197 identified citations, 30 articles were included in this review. Women's needs during the intrapartum period resonate with what women want globally, however, priorities regarding the components of quality care for women and the urgency to intervene differed in this context given the socio-cultural norms and available resources. Women received sub-quality intrapartum care and global standards for woman-centred care were often compromised. They were mistreated verbally and physically. Women experienced poor communication with their care providers and non-consensual care and were rarely involved in decisions concerning their care. Women were denied the companion of choice due to cultural and structural factors. CONCLUSION To improve care seeking and satisfaction with health services, woman-centred care is necessary for a positive childbirth experience. Women must be meaningfully engaged in the design of health services, accountability frameworks, and evaluation of maternal services. Research is needed to set minimum indicators for woman-centred outcomes for low-resource settings along with actionable strategies to enhance the quality of maternity care based on women's needs and preferences.
Collapse
Affiliation(s)
- Salma A. E. Ahmed
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Abela Mahimbo
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Angela Dawson
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
162
|
Lusambili AM, Wisofschi S, Wade TJ, Temmerman M, Obure J. A qualitative enquiry of health care workers' narratives on knowledge and sources of information on principles of Respectful Maternity Care (RMC). PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000157. [PMID: 36962732 PMCID: PMC10021807 DOI: 10.1371/journal.pgph.0000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/12/2022] [Indexed: 06/18/2023]
Abstract
Research from sub-Saharan Africa indicate that many women experience varied forms of disrespectful maternity care, which amount to a violation of their rights and dignity. Notably, there is little research that sheds light on health care workers (HCWs) training and knowledge of principles of respectful maternity care (RMC). Formulating appropriate interventional strategies to promote the respectful provision of services for women during pregnancy, childbirth, and postpartum period requires an understanding of the current state of knowledge and sources of information on respectful maternity care among HCWs. This paper reports findings from a qualitative study that examined the knowledge and sources of information on the Respectful Maternity Care Charter among HCWs in rural Kisii and Kilifi counties in Kenya. Between January and March 2020, we conducted 24 in-depth interviews among HCWs in rural Kisii and Kilifi health facilities. Data were analyzed using a mixed deductive and inductive thematic analysis guided by Braun's [2006] six stages of analysis. We found that from the seven globally accepted principles of respectful maternity care, at least half of the HCWs were aware of patients right to consented care, confidentiality and privacy, and the right to non-discriminatory care based on specific attributes. Knowledge of the right to no physical and emotional abuse, abandonment of care, and detentions in the facilities was limited to a minority of health care workers but only after prompting. Sources of information on respectful maternity care were largely limited to continuous medical and professional training and clinical mentorship. The existing gap shows the need for training and mentorship of HCWs on the Respectful Maternity Care Charter as part of pre-service medical and nursing curricula and continuing clinical education to bridge this gap. At the policy level, strategies are necessary to support the integration of respectful maternity care into pre-service training curricula.
Collapse
Affiliation(s)
- Adelaide M. Lusambili
- Institute for Human Development, Aga Khan University, Nairobi, Kenya
- School of Business, African International University, Nairobi, Kenya
| | - Stefania Wisofschi
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| | - Terrance J. Wade
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Health Sciences, Brock University, St. Catharines, Canada
| | - Marleen Temmerman
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
- Department of Obstetrics and Gynaecology, Medical College, Aga Khan University, Nairobi, Kenya
| | - Jerim Obure
- Centre of Excellence in Women and Child Health, Aga Khan University, Nairobi, Kenya
| |
Collapse
|
163
|
Jacobs C, Michelo C, Hyder A. Understanding maternal choices and experiences of care by skilled providers: Voices of mothers who delivered at home in selected communities of Lusaka city, Zambia. Front Glob Womens Health 2023; 3:916826. [PMID: 36683603 PMCID: PMC9852978 DOI: 10.3389/fgwh.2022.916826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 11/22/2022] [Indexed: 01/09/2023] Open
Abstract
Background Significant proportions of women living in urban areas including the capital cities continue to deliver at home. We aimed to understand why mothers in a selected densely populated community of Lusaka city in Zambia deliver from home without assistance from a skilled provider during childbirth. Methods Using a phenomenological case study design, we conducted Focus Group Discussions and In-depth Interviews with mothers who delivered at home without assistance from a skilled provider. The study was conducted between November 2020 and January 2021 among 19 participants. Data were analysed using content analysis. Results Individual-related factors including the belief that childbirth is a natural and easy process that did not require assistance, lack of transport to get to the health facility, influence and preference for care from older women who were perceived to have the experience and better care, failure to afford baby supplies, and waiting for partner to provide the supplies that were required at the health facility influenced mothers' choices to seek care from skilled providers. Health system-related factors included mistreatment and disrespectful care such as verbal and physical abuse by skilled healthcare providers, stigma and discrimination, institutional fines, and guidelines such as need to attend antenatal care with a spouse and need to provide health facility demanded supplies. Conclusion Individual and health system access related factors largely drive the choice to involve skilled providers during childbirth. The socioeconomic position particularly contributes to limited decision-making autonomy of mothers, thus, creating challenges to accessing care in health facilities. The health system-related factors found in this study such as mistreatment and disrespectful care suggests the need for redesigning effective and sustainable urban resource-limited context maternal health strategies that are culturally acceptable, non-discriminatory, and locally responsive and inclusive. Rethinking these strategies this way has the potential to strengthening equitable responsive health systems that could accelerate attainment of sustainable developmental goal (SDG) 3 targets.
Collapse
Affiliation(s)
- Choolwe Jacobs
- School of Public Health, University of Zambia, Lusaka, Zambia,Correspondence: Choolwe Jacobs
| | - Charles Michelo
- Harvest Research Institutes, Harvest University, Lusaka, Zambia
| | - Adnan Hyder
- Milken Institute School of Public Health, George Washington University, Washington, DC, United States
| |
Collapse
|
164
|
Associations between self-reported obstetric complications and experience of care: a secondary analysis of survey data from Ghana, Kenya, and India. Reprod Health 2023; 20:7. [PMID: 36609381 PMCID: PMC9817240 DOI: 10.1186/s12978-022-01546-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 12/08/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Although several indicators have been proposed to measure women's experience of care in health facilities during the intrapartum period, it is unknown if these indicators perform differently in the context of obstetric emergencies. We examined the relationship between experience of care indicators from the Person-Centered Maternity Care (PCMC) scale and obstetric complications. METHODS We used data from four cross-sectional surveys conducted in Kenya (rural: N = 873; urban: N = 531), Ghana (N = 531), and India (N = 2018) between August 2016 and October 2017. The pooled sample included 3953 women aged 15-49 years who gave birth within 9 weeks prior to the survey. Experience of care was measured using the PCMC scale. Univariate, bivariate, and multivariable analyses were conducted to examine the associations between the composite and 31 individual PCMC indicators with (1) obstetric complications; (2) severity of complications; and (3) delivery by cesarean section (c-section). RESULTS 16% (632) of women in the pooled sample reported obstetric complications; and 4% (132) reported having given birth via c-Sect. (10.5% among those with complications). The average standardized PCMC scores (range 0-100) were 63.5 (SD = 14.1) for the full scale, 43.2 (SD = 20.6) for communication and autonomy, 67.8 (SD = 14.1) for supportive care, and 80.1 (SD = 18.2) for dignity and respect sub-scales. Women with complications had higher communication and autonomy scores (45.6 [SD = 20.2]) on average compared to those without complications (42.7 [SD = 20.6]) (p < 0.001), but lower supportive care scores, and about the same scores for dignity and respect and for the overall PCMC. 18 out of 31 experience of care indicators showed statistically significant differences by complications, but the magnitudes of the differences were generally small, and the direction of the associations were inconsistent. In general, women who delivered by c-section reported better experiences. CONCLUSIONS There is insufficient evidence based on our analysis to suggest that women with obstetric complications report consistently better or worse experiences of care than women without. Women with complications appear to experience better care on some indicators and worse care on others. More studies are needed to understand the relationship between obstetric complications and women's experience of care and to explore why women who deliver by c-section may report better experience of care.
Collapse
|
165
|
Mantula F, Chamisa JA, Nunu WN, Nyanhongo PS. Women's Perspectives on Cultural Sensitivity of Midwives During Intrapartum Care at a Maternity Ward in a National Referral Hospital in Zimbabwe. SAGE Open Nurs 2023; 9:23779608231160476. [PMID: 36875792 PMCID: PMC9974627 DOI: 10.1177/23779608231160476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 02/12/2023] [Indexed: 03/07/2023] Open
Abstract
Introduction Midwives attend intrapartum women of diverse ethnic backgrounds who each bring their cultural beliefs into the labor and delivery rooms. The International Confederation of Midwives has recommended providing culturally appropriate maternity care in its quest to increase skilled birth attendance and subsequently improve maternal and newborn health. Objective This study aimed to examine midwives' cultural sensitivity during intrapartum care from women's perspectives, and how this relates to women's satisfaction with maternity care services. Methods A qualitative phenomenological design was employed. Two focus group discussions were conducted with 16 women who had delivered in the labor ward of the selected national referral maternity unit. An interpretive phenomenological approach was used to analyze the data. Results This study revealed ineffective midwife-woman collaboration that excludes the incorporation of women's cultural beliefs in the design of maternity care plans. Emotional, physical, and informational support in the care provided to women during labor and childbirth was found to be incompetent. This suggests that midwives are not sensitive to cultural norms and do not provide woman-centered intrapartum care. Conclusion Various factors implying midwives' lack of cultural sensitivity in their provision of intrapartum care were identified. Resultantly, women's expectations of labor are not met and this could negatively affect future maternity care-seeking behaviors. This study's findings provide policy makers, midwifery program managers and implementers with better insights for developing targeted interventions to improve cultural sensitivity for the delivery of respectful maternity care. Identifying factors that affect the implementation of culture-sensitive care by midwives could guide the adjustments required in midwifery education and practice.
Collapse
Affiliation(s)
- Fennie Mantula
- Department of Nursing and Midwifery, Faculty of Medicine, National University of Science and Technology, Ascot, Bulawayo, Zimbabwe
| | - Judith Audrey Chamisa
- Department of Nursing and Midwifery, Faculty of Medicine, National University of Science and Technology, Ascot, Bulawayo, Zimbabwe
| | - Wilfred Njabulo Nunu
- Department of Environmental Health, Faculty of Environmental Science, National University of Science and Technology, Ascot, Bulawayo, Zimbabwe
| | - Prisca Sophia Nyanhongo
- Department of Nursing and Midwifery, Faculty of Medicine, National University of Science and Technology, Ascot, Bulawayo, Zimbabwe
| |
Collapse
|
166
|
Pappu NI, Öberg I, Byrskog U, Raha P, Moni R, Akhtar S, Barua P, Das SR, De S, Jyoti HJ, Rahman R, Sinha GR, Erlandsson K. The commitment to a midwifery centre care model in Bangladesh: An interview study with midwives, educators and students. PLoS One 2023; 18:e0271867. [PMID: 37036838 PMCID: PMC10085017 DOI: 10.1371/journal.pone.0271867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Accepted: 03/24/2023] [Indexed: 04/11/2023] Open
Abstract
BACKGROUND Midwifery-led care is a key factor in reducing maternal and new-born mortality globally. In Bangladesh, only a third of births are attended by professionals and almost 70% of births occur outside healthcare facilities. Midwifery is a relatively new profession in Bangladesh and a midwifery centre care model has only recently been introduced. This study aims to explore the willingness within the healthcare system to support a greater role for midwifery centres in maternity services. METHODS Data were collected through individual semi-structured interviews with 55 midwives, midwifery educators and final year midwifery students. Two of the midwifery educators were principals of nursing institutes involved in the government's midwifery leadership and considered as experts in the midwifery care system. The data was analysed using qualitative content analysis. The transcribed interviews comprised 150 pages. The study received ethical approval from the Directorate General of Nursing and Midwifery in Bangladesh. RESULTS One main category emerged from the study: "The foundations of a midwifery centre care model need to be strengthened for the sustainable implementation of midwifery centres in Bangladesh to continue". Five additional categories were identified: 1) The midwifery centre care model is inaccessible for communities, 2) Striving for acceptable standards of care within a midwifery centre care model is not a priority 3) Respectful, woman-centred care is weak, 4) Community engagement with the midwifery centre care model is insufficient, and 5) The midwifery centre care model is not integrated into the healthcare system. These categories were supported by the identification of 11 sub-categories. CONCLUSION The willingness to commit to a midwifery centre care model is not yet in place in Bangladesh. Advocacy, information, and education about the benefits of normal birth assisted by professional midwives is needed at all levels of Bangladeshi society.
Collapse
Affiliation(s)
| | - Ida Öberg
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ulrika Byrskog
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Pronita Raha
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Ratna Moni
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shaheen Akhtar
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Priti Barua
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Sujata Rani Das
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Shipra De
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | | - Rezaur Rahman
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Gita Rani Sinha
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | | |
Collapse
|
167
|
Afrin S, Dogne C, Dudi J, Dogne N, Singh A, Raghunath D, Sakalle S, Chellaiyan V. Perception of beneficiaries regarding quality of care and respectful maternity care being provided in delivery room using LaQshya guidelines. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2023. [DOI: 10.4103/injms.injms_108_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
168
|
Collins B, Hall J, Hundley V, Ireland J. Effective communication: Core to promoting respectful maternity care for disabled women. Midwifery 2023; 116:103525. [PMID: 36401905 DOI: 10.1016/j.midw.2022.103525] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 09/26/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Previous research highlights that disabled women have less choice, control and respect of their dignity during pregnancy, childbirth and parenting. The experience of dignity and respect during pregnancy and childbirth for those with physical and sensory disability in the UK and Ireland is explored. DESIGN, SETTING AND PARTICIPANTS Narrative, semi-structured telephone and Skype interviews were conducted with ten disabled women in the UK and Ireland. Interviews were audio-recorded and transcribed verbatim. Intra- and inter-thematic analysis was undertaken, beginning with a process of open coding. As themes developed, a process of constant comparison was used. FINDINGS The key finding is that effective communication with women was perceived to best respect the women's dignity in childbirth. This meant enabling women to feel heard, enabling women to make informed decisions about their care and providing individualized care. The single most important factor that enabled this communication was continuity of carer. KEY CONCLUSIONS The factor that most promoted maternity care that was perceived to be respectful was effective communication. This is not so different in other parts of the world, or for non-disabled women, however care providers should be particularly careful to enable good communication with disabled women.
Collapse
Affiliation(s)
- Bethan Collins
- Head of Occupational Therapy, School of Health and Society, University of Salford C401 Allerton Building, Frederick Road Campus, Salford M6 6PU, United Kingdom.
| | - Jenny Hall
- Independent midwifery educator and researcher, Formerly Centre for Excellence In Learning, Bournemouth University, United Kingdom
| | - Vanora Hundley
- Professor of Midwifery, Centre for Midwifery, Maternity & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, United Kingdom
| | - Jillian Ireland
- Professional Midwifery Advocate, Poole Hospital NHS Foundation Trust, Dorset, United Kingdom; Visiting Associate, Centre for Midwifery, Maternity & Perinatal Health, Faculty of Health and Social Sciences, Bournemouth University, Poole BH12 5BB, United Kingdom
| |
Collapse
|
169
|
Sanga NE, Joho AA. Intrapartum violence during facility-based childbirth and its determinants: A cross-sectional study among postnatal women in Tanzania. WOMEN'S HEALTH (LONDON, ENGLAND) 2023; 19:17455057231189544. [PMID: 37650373 PMCID: PMC10475265 DOI: 10.1177/17455057231189544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 07/04/2023] [Accepted: 07/04/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND Violence during childbirth indirectly contributes to maternal and neonatal morbidity and mortality. It also causes intrapartum health consequences such as prolonged labor, postpartum hemorrhage, and postpartum psychological problems, including postpartum depression, post-traumatic stress disorder, and other negative feelings that lead to a decreased desire for facility delivery and increase the events of home deliveries which reduce the quality of life. In Tanzania, several efforts have been made to promote respectful maternity care. However, violence during childbirth continues to create a critical barrier for facility-based delivery and is in need of considerable attention throughout the health system. OBJECTIVES This study aimed to assess types of intrapartum violence and its determinants among postnatal women in the Dodoma Region, Tanzania. DESIGN A cross-sectional study using a questionnaire to interview postnatal women at the exit point after being discharged from the health facility to assess intrapartum violence and its determinants. METHODS This study was conducted in Dodoma Region involving 307 postnatal women from April to June 2022. A simple random method was used to select respondents. The Chi-square and Fisher's exact tests were used to assess the association between the categorical variables. The predictors of intrapartum violence were determined using binary logistic regression analysis. Statistical analysis was performed using Statistical Package for Social Science version 25.0. P < 0.05 was considered to be significant. RESULTS Overall, 307 postnatal women participated in the study. Among them, 158 (51.5%) postnatal women experienced at least one form of intrapartum violence. The most common forms of intrapartum violence included breach of confidentiality 205 (66.8%), undignified care/verbal abuse 178 (58%), physical abuse 139 (45.3%), and denial or neglected care by midwives 113 (36.8%). Husband employment, urban residence, and being referred from primary hospitals were significant determinants associated with intrapartum violence (adjusted odds ratio = 0.233, 95% confidence interval = 0.057-0.952, p = 0.043, adjusted odds ratio = 2.67, 95% confidence interval = 1.13-10.93, p = 0.026 and adjusted odds ratio = 3.673, 95% confidence interval = 1.131-11.934, p = 0.030, respectively). CONCLUSION Violence during childbirth was highly prevalent in this study. Understanding the prevalence and types of intrapartum violence is important in order to promote changes in all levels of the health system. This study reveals the need for key interventions to effect change at many levels; including an interventional study to educate women and birth partners on client rights, and strengthening the health system to meet the needs of women during labor and childbirth. Policies and systems that support respectful maternity care are urgently needed in this setting, including universal training of health professionals in respectful maternity care.
Collapse
Affiliation(s)
- Neema Egid Sanga
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Angelina A Joho
- Department of Clinical Nursing, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| |
Collapse
|
170
|
Beaumont E, Berhanu D, Allen E, Schellenberg J, Avan BI. Socioeconomic inequity in coverage and quality of maternal postnatal care in Ethiopia. Trop Med Int Health 2023; 28:25-34. [PMID: 36398859 PMCID: PMC10108216 DOI: 10.1111/tmi.13829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE High-quality postnatal care is vital for improving maternal health. This study examined the relationship between household socioeconomic status and both coverage and quality of postnatal care in Ethiopia. METHOD Cross-sectional household survey data were collected in October-November 2013 from 12 zones in 4 regions of Ethiopia. Women reporting a live birth in the 3-24 months prior to the survey were interviewed about the care they received before, during and after delivery and their demographic characteristics. Using mixed effect logistic and linear regression, the associations between household socioeconomic status and receiving postnatal care, location of postnatal care (health facility vs. non-health facility), cadre of person providing care and the number of seven key services (including physical checks and advice) provided at a postnatal visit, were estimated. RESULTS A total of 16% (358/2189) of women interviewed reported receiving at least one postnatal care visit within 6 weeks of delivery. Receiving a postnatal care visit was strongly associated with socioeconomic status with women from the highest socioeconomic group having twice the odds of receiving postnatal care compared to women in the poorest quintile (OR [95% CI]: 1.98 [1.29, 3.05]). For each increasing socioeconomic status quintile there was a mean increase of 0.24 postnatal care services provided (95% CI: 0.06-0.43, p = 0.009) among women who did not give birth in a facility. There was no evidence that number of postnatal care services was associated with socioeconomic status for women who gave birth in a facility. There was no evidence that socioeconomic status was associated with the provider or location of postnatal care visits. CONCLUSION Postnatal care in Ethiopia shows evidence of socio-economic inequity in both coverage and quality. This demonstrates the need to focus on quality improvement as well as coverage, particularly among the poorest women who did not deliver in a facility.
Collapse
Affiliation(s)
- Emma Beaumont
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Della Berhanu
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK.,Health System and Reproductive Health Research Directorate, Ethiopian Public Health Institute, Addis Ababa, Ethiopia
| | - Elizabeth Allen
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Joanna Schellenberg
- Department of Disease Control, London School of Hygiene and Tropical Medicine, London, UK
| | - Bilal Iqbal Avan
- Department of Population Health, Faculty of Epidemiology and Population Health, London Schoold of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
171
|
Policies and Practices on Out-of-Hospital Birth: a Review of Qualitative Studies in the Time of Coronavirus. CURRENT SEXUAL HEALTH REPORTS 2023; 15:36-48. [PMID: 36530373 PMCID: PMC9735103 DOI: 10.1007/s11930-022-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 12/13/2022]
Abstract
Purpose of Review The purpose of this review is to summarize the current knowledge on out-of-hospital births (at home or in an independent birth center) in high-income countries in the time of coronavirus. Qualitative studies published between 2020 and 2022 providing findings on women's and health providers' perspectives and experiences, as well as policies and practices implemented, are synthetized. Recent Findings During the COVID-19 pandemic, the number of women choosing the home or a birth center to deliver has grown considerably. Main reasons for this choice include fear of contagion in facilities and restrictions during delivery and the post-partum period, especially women's separation from their companion of choice and their newborn. Findings suggest that homebirth within a public model has several advantages in the experience of birth for both women and professionals during the pandemic period, maintaining the benefits of biomedicine when needed. Summary During the COVID-19 pandemic, the interest in out-of-hospital birth increased in high-income countries, and the number of women choosing the home or a birth center to deliver has grown considerably. This review aims to give a more in-depth understanding of women's and health providers' perspectives on and experiences of out-of-hospital birth services during this period. Twenty-five studies in different countries, including the USA, Canada, Australia, Switzerland, the Netherlands, the UK, Spain, Croatia, and Norway, were reviewed. Findings stress that out-of-hospital birth has allowed women to deliver according to their wishes and needs. In addition, the pandemic experience represents an opportunity for policy to better support and integrate out-of-hospital services in the health care system in the future.
Collapse
|
172
|
Werdofa HM, Lindahl AK, Lulseged B, Thoresen L. Women’s perspectives on disrespect and abuse experiences during childbirth in a teaching hospital in Southwest Ethiopia: a qualitative study. Sex Reprod Health Matters 2022; 30:2088058. [PMID: 35848504 PMCID: PMC9302010 DOI: 10.1080/26410397.2022.2088058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
There is evidence that women in Ethiopia often face disrespect and abuse in health care facilities during childbirth. Disrespect and abuse (D&A) violate women’s right to dignified, respectful health care and decrease their trust in health care facilities. There is a need for more insight into women’s perspectives on D&A during childbirth in different contexts. Therefore, this study aimed to explore women’s perspectives on D&A during childbirth in a teaching hospital in South-West Ethiopia. A qualitative study was conducted from November 2017 to February 2018 using in-depth interviews and focus group discussions. Postnatal women were purposively chosen and scheduled for interviews six weeks postpartum. Data saturation occurred once 32 women were interviewed, and four focus group discussions were conducted. A thematic analysis method was used to analyse the data using MAXQDA qualitative analysis software. Three main themes emerged from the data: disrespect and abuse, its contributors, and perceived consequences. The subthemes of D&A include neglected care, non-consented care, physical abuse, lack of privacy, loss of autonomy, objectification, lack of companionship, and verbal abuse. The subthemes of contributors include health care provider-related, health care system-related, and women-related contributors. The subthemes of perceived consequences include the fear of using health care facilities. Women in Ethiopia experienced D&A. Health system factors, such as the teaching environment and scarcity of supplies, contribute the most to the identified D&A. Therefore, providers, administrators, training institutions, and researchers must collaborate to address these health system factors to reduce disrespect and abuse during childbirth in teaching hospitals.
Collapse
Affiliation(s)
- Hirut Megersa Werdofa
- Lecturer, School of Nursing, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia and PhD student at Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anne Karin Lindahl
- Associate Professor, Department of Health Management and Health Economics, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway, and Head of Division of Surgery, Akershus University Hospital, Nordbyhagen, Norway
| | - Belayneh Lulseged
- Senior Lecturer, School of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Lisbeth Thoresen
- Associate Professor, Department of Interdisciplinary Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| |
Collapse
|
173
|
Ochieng Arunda M, Agardh A, Larsson M, Asamoah BO. Survival patterns of neonates born to adolescent mothers and the effect of pregnancy intentions and marital status on newborn survival in Kenya, Uganda, and Tanzania, 2014-2016. Glob Health Action 2022; 15:2101731. [PMID: 36018071 PMCID: PMC9423851 DOI: 10.1080/16549716.2022.2101731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Adolescent pregnancy and associated neonatal mortality are major global health challenges. In low-income settings where 90% of the 21 million global adolescent pregnancies occur, half are unintended and a fifth experience unsafe abortion. In Kenya, Uganda, and Tanzania, the survival patterns of neonates born to adolescents are unclear. Objectives To assess survival patterns among neonates born to adolescents and the effect of pregnancy intentions and marital status on survival in Kenya, Uganda, and Tanzania. Methods Cross-sectional data from demographic and health surveys in Kenya, Uganda, and Tanzania 2014–2016 were used. Kaplan-Meier estimates investigated patterns of neonatal survival among adolescent mothers, aged 15–19 years, compared to mothers aged 20–29 years. Cox proportional hazards regression determined the hazard ratios (HR) for the predictors of neonatal survival. Results About 50% of adolescent pregnancies were unintended and neonatal death rate was twice as high than older mothers (26.6 versus 12.0 deaths/1000 live births). The median survival time was two days for adolescent-born babies and four days among older mothers. The hazard of death for all adolescent-born neonates was about twofold that of 20–29 years-old-mothers, HR 1.80 (95% CI 1.22–2.63). Among married adolescents with unintended newborn pregnancies, the HR was 4-folds higher than corresponding older mothers, HR 4.08 (95% CI 1.62–10.31). Among married, primiparous adolescents with unintended pregnancies, the HR was six times higher than corresponding older mothers. Conclusion Our findings reveal how unintended pregnancies and deaths of neonates born to adolescents contribute substantially to preventable neonatal deaths in East Africa. Full implementation of existing adolescent health policies and utilization of contraceptives should be ensured. Partnership with youths and novel efforts that address sociocultural norms to reduce adolescent pregnancies or marriage should be supported. Regulations requiring adolescents’ obstetric care conducted by only skilled personnel should be introduced and implemented.
Collapse
Affiliation(s)
- Malachi Ochieng Arunda
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Anette Agardh
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Markus Larsson
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Benedict Oppong Asamoah
- Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden
| |
Collapse
|
174
|
Ellis C, Larson CP, Bicaba F, Bicaba A, Nguyen A, Ramdé J, Otis A. Measurement of self-reported, facility-based labour and birth experiences: The Perinatal Experience Assessment Tool (PEAT). J Glob Health 2022; 12:04103. [PMID: 36579597 PMCID: PMC9798243 DOI: 10.7189/jogh.12.04103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background Women and their families make decisions on accessing perinatal care based on their experiences in the health care system and on the experience of others around them. Receiving supportive maternity care which demonstrates respect is an essential part of quality care. Globally, and in low- and middle-income countries in particular, women report receiving mistreatment and a lack of respect during labour, childbirth and the early postnatal period. These experiences, if negative, may influence choices around place of birth, thus hindering the scale-up of facility-based births. Methods We conducted a focussed review of the literature between 2010 and 2019 to identify recent research addressing the assessment of women's experiences during childbirth in low- and middle-income country facilities. The World Health Organization (WHO) and White Ribbon Alliance themes and concepts of respectful maternity care served as a guide. Themes included disrespectful or abusive experiences such as verbal abuse or rudeness, abandonment, corruption, lack of privacy, failure to respect traditional practices, discrimination, and physical or sexual abuse. Experienced midwives in two low-resource countries contributed to the identification of appropriate indicators of respectful, non-abusive care, and eventual agreement as to which to include in an assessment tool monitoring women's experiences. Results Our review of the literature identified 18 publications meeting pre-established criteria. This resulted in the eventual selection of 33 indicators of respectful care sub-grouped under 9 domains: 1) communication/verbal interaction, 2) supportive care, 3) physical abuse, 4) non-consented care, 5) non-confidential care/lack of privacy, 6) stigma and discrimination, 7) abandonment/neglect, 8) detention/inability to pay, and 9) health facility conditions. We converted these indicators into questions to be asked by an interviewer during a short interview following discharge to assess the childbirth experience. Conclusions The Perinatal Experience Assessment Tool (PEAT) may be used to monitor or evaluate the experiences that women report after facility-based childbirth. It can be administered by trained, independent interviewers in the facility following discharge. The PEAT enables maternity leaders to assess the extent to which maternity services are conducted in a respectful, non-abusive manner and modify practices and procedures as feasible and appropriate.
Collapse
Affiliation(s)
- Cathryn Ellis
- Midwifery Program, Department of Family Practice, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles P Larson
- Canadian Coalition for Global Health Research, Ottawa, Ontario, Canada,Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada
| | - Frank Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - Abel Bicaba
- Société d'Études et de Recherche en Santé Publique, Ouagadougou, Burkina Faso
| | - An Nguyen
- HealthBridge Vietnam, Hanoi, Vietnam
| | - Jean Ramdé
- Direction en santé mondiale, Faculté de Médecine, Université Laval, Québec City, Québec, Canada
| | - Alexandra Otis
- Canadian Coalition for Global Health Research, Ottawa, Ontario, Canada
| |
Collapse
|
175
|
Edward MM, Kibanda Z. Obstetric violence: A public health concern. Health Sci Rep 2022; 6:e1026. [PMID: 36589633 PMCID: PMC9795374 DOI: 10.1002/hsr2.1026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Majani M. Edward
- Department of Public HealthSt. Francis University of health and allied SciencesMorogoroTanzania
| | - Zakia Kibanda
- Department of Public HealthSt. Francis University of health and allied SciencesMorogoroTanzania
| |
Collapse
|
176
|
“We Beat Them to Help Them Push”: Midwives’ Perceptions on Obstetric Violence in the Ashante and Western Regions of Ghana. WOMEN 2022. [DOI: 10.3390/women3010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Obstetric violence has been recognized as a major impediment to facility-based delivery, increasing the risk of preventable complications and maternal mortality. In Ghana, studies on women’s birth experiences reveal enormous and brutal acts of violence during delivery; however, inquiries into why midwives abuse women have not been extensively studied. This study explored the perspectives of midwives on the drivers of obstetric violence in the Western and Ashante Regions of Ghana. A qualitative study was conducted involving 30 in-depth interviews with midwives in eight health facilities. The data were analyzed thematically using NVivo 12. The results of the study reveal a normalization of violence in the delivery room and the intensity of violence is heightened during the second stage of labor. Midwives reported perpetrating or witnessing physical violence, abandonment of women, stigmatization of HIV women, verbal abuses such as shouting, and the detention of women in the health facilities. Midwives abuse women as a result of the pressures of the midwifery profession, poor maternal efforts of women, disrespect of midwives, women’s disobedience, and uncooperative attitudes. The culture of acceptability of obstetric violence is a major driver, contributing to its normalization. Midwives do not consider obstetric violence as abuse, but rather, as a delivery strategy which aids a successful delivery. It is therefore justified and viewed as a necessary part of the delivery process. There is a critical need for retraining midwives on alternative birthing strategies devoid of violence.
Collapse
|
177
|
Exploring women's experiences during childbirth in health facilities during COVID-19 pandemic in occupied palestinian territory: a cross-sectional community survey. BMC Pregnancy Childbirth 2022; 22:957. [PMID: 36550427 PMCID: PMC9773592 DOI: 10.1186/s12884-022-05265-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION This study aims to assess the prevalence of mistreatment during childbirth in the occupied Palestinian territory and to explore factors associated with mistreatment. METHODS A cross-sectional study of women who gave birth in the West Bank and Gaza Strip health facilities. The survey was administered over the phone to women up to 8 weeks post-partum. Data collection took place between July 2020 and March 2021. RESULTS A total of 745 women participated in the study, 36·25% were from the Gaza Strip and 63·75% from the West Bank. The prevalence of mistreatment was 18·8% in which women reported any verbal abuse, physical abuse, or stigma or discrimination during childbirth, with verbal abuse as the most common form of mistreatment reported. Physical abuse was more likely to be reported by women with no labour companion with them (OR: 3·11, 95%CI: 1·24 - 7·99). Verbal abuse was more likely to be reported by women with less than three live births (OR: 1·71, 95%CI: 1·06 - 2·76, women with no birth companion (OR: 2·72, 95%CI: 1·36 - 3·80) and more likely to be reported if curtains wre not used (OR: 2·55, 95%CI: 1·33 - 4·88). Women with less education were more likely to report long waiting times or delays in receiving services compared to women with higher education (OR: 1·40, 95%CI: 1·06 - 2·10). CONCLUSION For the first time using the World Health Organisation (WHO) tool in the Eastern Mediterranean region, the study findings, show the occurrence of mistreatment and identify areas to be strengthened to ensure that all women have a respectful childbirth experience within health facilities.
Collapse
|
178
|
Mwakawanga DL, Mwilike B, Kaneko M, Shimpuku Y. Local knowledge and derived practices of safety during pregnancy, childbirth and postpartum: a qualitative study among nurse-midwives in urban eastern Tanzania. BMJ Open 2022; 12:e068216. [PMID: 36521900 PMCID: PMC9756159 DOI: 10.1136/bmjopen-2022-068216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Maternal and newborn mortality are still high in low-income and middle-income countries despite global efforts to improve the quality of care by prioritising evidence-based practices and increasing the number of births attended by skilled personnel. During childbirth, women are hesitant to use the health facility services. Concerns about safety and risks during pregnancy, childbirth and postpartum period are deeply rooted in local health practices and beliefs. OBJECTIVE The aim of this study was to explore the perceptions of local health knowledge and derived practices among nurse-midwives in urban eastern Tanzania. METHODS An exploratory qualitative study design was carried out in a district hospital in eastern Tanzania. Twenty-one nurse-midwives participated in two focus group discussions. The data were analysed using qualitative content analysis. RESULTS Based on existing scientific data, local knowledge and derived practices were categorised as potentially beneficial, neither beneficial nor harmful and potentially harmful. Our study identified a wide range of local knowledge and derived practices used by women. These include to refrain from shouting or crying to prevent exhaustion during labour, drinks and foods restrictions during labour and after birth, and use of local herbs to stimulate labour. In addition, midwives reinforced the importance of integrating local knowledge and practices with potential benefits with evidence-based practices. Encouraging and listening to women would offer an opportunity to reduce harmful practices. CONCLUSIONS While non-harmful and beneficial practices for ensuring safety during pregnancy, childbirth and postpartum period should be accepted and supported as a part of our cultural richness, harmful practices should be discouraged. This can be achieved through antenatal health education and afterbirth health messages on hospital discharge to promote positive childbirth health outcomes.
Collapse
Affiliation(s)
- Dorkasi L Mwakawanga
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
- Graduate School of Biomedical and Health Sciences, Department of Global Health Nursing, Hiroshima University, Hiroshima, Japan
| | - Beatrice Mwilike
- Department of Community Health Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Morie Kaneko
- Graduate School of Asian and African Area Studies, Center for African Area Studies, Kyoto University, Kyoto, Japan
| | - Yoko Shimpuku
- Graduate School of Biomedical and Health Sciences, Department of Global Health Nursing, Hiroshima University, Hiroshima, Japan
| |
Collapse
|
179
|
Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia. AJOG GLOBAL REPORTS 2022; 3:100140. [PMID: 36594001 PMCID: PMC9803839 DOI: 10.1016/j.xagr.2022.100140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Effective communication, respect and dignity, and emotional support are critical for a positive childbirth experience that is responsive to the needs and preferences of women. OBJECTIVE This study evaluated the performance of a person-centered maternity care scale in a large, representative household sample of postpartum women, and it describes differences in person-centered maternity care across individuals and communities in Ethiopia. STUDY DESIGN The study used data from 2019 and 2020 from a representative sample of postpartum women in 6 regions of Ethiopia. It measured person-centered maternity care using a scale previously validated in other settings. To assess the scale validity in Ethiopia, we conducted cognitive interviews, measured internal consistency, and evaluated construct validity. Then, we fit univariable and multivariable linear regression models to test for differences in mean person-centered maternity care scores by individual and community characteristics. Lastly, multilevel modeling separated variance in person-centered maternity care scores within and between communities. RESULTS Effective communication and support of women's autonomy scored lowest among person-centered maternity care domains. Of 1575 respondents, 704 (44.7%) were never asked their permission before examinations and most said that providers rarely (n=369; 23.4%) or never (n=633; 40.2%) explained why procedures were done. Person-centered maternity care was significantly higher for women with greater wealth, more formal education, and those aged >20 years. Variation in person-centered maternity care scores between individuals within the same community (τ2=58.3) was nearly 3 times greater than variation between communities (σ2=21.2). CONCLUSION Ethiopian women reported widely varying maternity care experiences, with individuals residing within the same community reporting large differences in how they were treated by providers. Poor patient-provider communication and inadequate support of women's autonomy contributed most to poor person-centered maternity care.
Collapse
|
180
|
Nedberg IH, Vik ES, Kongslien S, Mariani I, Valente EP, Covi B, Lazzerini M, Roda DD, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Vaska A, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Quality of health care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Norway and trends over time. Int J Gynaecol Obstet 2022; 159 Suppl 1:85-96. [PMID: 36530008 PMCID: PMC9877678 DOI: 10.1002/ijgo.14460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. METHODS Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. RESULTS Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83-4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. CONCLUSION Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored.
Collapse
Affiliation(s)
- Ingvild Hersoug Nedberg
- Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Eline Skirnisdottir Vik
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Sigrun Kongslien
- Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
181
|
Costa R, Rodrigues C, Dias H, Covi B, Mariani I, Valente EP, Zaigham M, Vik ES, Grylka‐Baeschlin S, Arendt M, Santos T, Wandschneider L, Drglin Z, Drandić D, Radetic J, Rozée V, Elden H, Mueller AN, Barata C, Miani C, Bohinec A, Ruzicic J, de La Rochebrochard E, Linden K, Geremia S, de Labrusse C, Batram‐Zantvoort S, Ponikvar BM, Sacks E, Lazzerini M. Quality of maternal and newborn care around the time of childbirth for migrant versus nonmigrant women during the COVID-19 pandemic: Results of the IMAgiNE EURO study in 11 countries of the WHO European region. Int J Gynaecol Obstet 2022; 159 Suppl 1:39-53. [PMID: 36530012 PMCID: PMC9877819 DOI: 10.1002/ijgo.14472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the perception of quality of maternal and newborn care (QMNC) around the time of childbirth among migrant and nonmigrant women in Europe. METHODS Women who gave birth at a health facility in 11 countries of the WHO European Region from March 2020 to July 2021 were invited to answer an online questionnaire including demographics and childbirth experience. Data were analyzed and compared for 1781 migrant and 20 653 nonmigrant women. RESULTS Migrant women who experienced labor perceived slightly more difficulties in attending routine antenatal visits (41.2% vs 39.4%; P = 0.001), more barriers in accessing facilities (32.9% vs 29.9%; P = 0.001), lack of timely care (14.7% vs 13.0%; P = 0.025), inadequate room comfort and equipment (9.2% vs 8.5%; P = 0.004), inadequate number of women per room (9.4% vs 8.6%; P = 0.039), being prevented from staying with their baby as they wished (7.8% vs 6.9%; P = 0.011), or suffering abuse (14.5% vs 12.7%; P = 0.022) compared with nonmigrant women. For women who had a prelabor cesarean, migrant women were more likely not to receive pain relief after birth (16.8% vs.13.5%; P = 0.039) and less likely to provide informal payment (1.8% vs 4.4%; P = 0.005) compared with nonmigrant women. Overall, the QMNC index was not significantly different for migrant compared with nonmigrant women. CONCLUSION Gaps in overall QMNC were reported by both migrant and nonmigrant women, with improvements to healthcare necessary for all.
Collapse
Affiliation(s)
- Raquel Costa
- EPIUnit ‐ Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal,Lusófona University/HEI‐Lab: Digital Human‐environment Interaction LabsLisbonPortugal
| | - Carina Rodrigues
- EPIUnit ‐ Instituto de Saúde PúblicaUniversidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal
| | - Heloísa Dias
- Regional Health Administration of the AlgarveLisbonPortugal
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Mehreen Zaigham
- Department of Obstetrics and GynecologyInstitution of Clinical Sciences Lund, Lund University, Lund and Skåne University HospitalMalmöSweden
| | - Eline Skirnisdottir Vik
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Susanne Grylka‐Baeschlin
- Research Institute of Midwifery, School of Health SciencesZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional Association of Lactation Consultants in Luxembourg)LuxembourgLuxembourg
| | - Teresa Santos
- Universidade EuropeiaLisbonPortugal,Plataforma CatólicaMed/Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica PortuguesaLisbonPortugal
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
| | - Zalka Drglin
- National Institute of Public HealthLjubljanaSlovenia
| | | | | | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Helen Elden
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of Obstetrics and Gynecology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Antonia N. Mueller
- Research Institute of Midwifery, School of Health SciencesZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de LisboaLisbonPortugal
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany,Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Anja Bohinec
- National Institute of Public HealthLjubljanaSlovenia
| | | | - Elise de La Rochebrochard
- Sexual and Reproductive Health and Rights Research UnitInstitut National d'Études Démographiques (INED)ParisFrance
| | - Karolina Linden
- Institute of Health and Care Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Sara Geremia
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Claire de Labrusse
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Stephanie Batram‐Zantvoort
- Department of Epidemiology and International Public Health, School of Public HealthBielefeld UniversityBielefeldGermany
| | | | - Emma Sacks
- Department of International HealthJohns Hopkins UniversityBaltimoreMarylandUSA
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | |
Collapse
|
182
|
Mallick LM, Thoma ME, Shenassa ED. The role of doulas in respectful care for communities of color and Medicaid recipients. Birth 2022; 49:823-832. [PMID: 35652195 PMCID: PMC9796025 DOI: 10.1111/birt.12655] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/17/2022] [Accepted: 05/09/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Despite the tenets of rights-based, person-centered maternity care, racialized groups, low-income people, and people who receive Medicaid insurance in the United States experience mistreatment, discrimination, and disrespectful care more often than people with higher income or who identify as white. This study aimed to explore the relationship between the presence of a doula (a person who provides continuous support during childbirth) and respectful care during birth, especially for groups made vulnerable by systemic inequality. METHODS We used data from 1977 women interviewed in the Listening to Mothers in California survey (2018). Respondents who reported high levels of decision making, support, and communication during childbirth were classified as having "high" respectful care. To examine associations between respectful care and self-reported doula support, we conducted multivariable logistic regressions. Interactions by race/ethnicity and private or Medi-Cal (Medicaid) insurance status were assessed. RESULTS Overall, we found higher odds of respectful care among women supported by a doula than those without such support (odds ratios [OR]: 1.4, 95% CI: 1.0-1.8). By race/ethnicity, the association was largest for non-Hispanic Black women (2.7 [1.1-6.7]) and Asian/Pacific Islander women (2.3 [0.9-5.6]). Doula support predicts higher odds of respectful care among women with Medi-Cal (1.8 [1.3-2.5]), but not private insurance. CONCLUSIONS Doula support was associated with high respectful care, particularly for low-income and certain racial/ethnic groups in California. Policies supporting the expansion of doulas for low-income and marginalized groups are consistent with the right to respectful care and may address disparities in maternal experiences.
Collapse
Affiliation(s)
- Lindsay M. Mallick
- Maternal and Child Health ProgramDepartment of Family ScienceUniversity of MarylandCollege ParkMarylandUSA,Maryland Population Research CenterUniversity of MarylandCollege ParkMarylandUSA,Avenir HealthGlastonburyConnecticutUSA
| | - Marie E. Thoma
- Maternal and Child Health ProgramDepartment of Family ScienceUniversity of MarylandCollege ParkMarylandUSA,Maryland Population Research CenterUniversity of MarylandCollege ParkMarylandUSA
| | - Edmond D. Shenassa
- Maternal and Child Health ProgramDepartment of Family ScienceUniversity of MarylandCollege ParkMarylandUSA,Maryland Population Research CenterUniversity of MarylandCollege ParkMarylandUSA,Department of Epidemiology and BiostatisticsSchool of Public Health, University of MarylandCollege ParkMarylandUSA,School of MedicineUniversity of MarylandBaltimoreMarylandUSA,Department of EpidemiologySchool of Public Health, Brown UniversityProvidenceRhode IslandUSA
| |
Collapse
|
183
|
Tsakmakis PL, Akter S, Bohren MA. A qualitative exploration of women’s and their partners’ experiences of birth trauma in Australia, utilising critical feminist theory. Women Birth 2022. [DOI: 10.1016/j.wombi.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
184
|
Logan RG, McLemore MR, Julian Z, Stoll K, Malhotra N, Vedam S. Coercion and non-consent during birth and newborn care in the United States. Birth 2022; 49:749-762. [PMID: 35737547 DOI: 10.1111/birt.12641] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 03/19/2022] [Accepted: 03/31/2022] [Indexed: 12/01/2022]
Abstract
UNLABELLED In the United States, Black, Indigenous, and People of Color (BIPOC) experience more adverse health outcomes and report mistreatment during pregnancy and birth care. The rights to bodily autonomy and consent are core components of high-quality health care. To assess experiences of coercion and nonconsent for procedures during perinatal care among racialized service users in the United States, we analyzed data from the Giving Voice to Mothers (GVtM-US) study. METHODS In a subset analysis of the full sample of 2700, we examined survey responses for participants who described the experience of pressure or nonconsented procedures or intervention during perinatal care. We conducted multivariable logistic regression analyses by racial and ethnic identity for the outcomes: pressure to have perinatal procedures (eg, induction, epidurals, episiotomy, fetal monitoring), nonconsented procedures performed during perinatal care, pressure to have a cesarean birth, and nonconsented procedures during vaginal births. RESULTS Among participants (n = 2490), 34% self-identified as BIPOC, and 37% had a planned hospital birth. Overall, we found significant differences in pressure and nonconsented perinatal procedures by racial and ethnic identity. These inequities persisted even after controlling for contextual factors, such as birthplace, practitioner type, and prenatal care context. For example, more participants with Black racial identity experienced nonconsented procedures during perinatal care (AOR 1.89, 95% CI 1.35-2.64) and vaginal births (AOR 1.87, 95% CI 1.23-2.83) than those identifying as white. In addition, people who identified as other minoritized racial and ethnic identities reported experiencing more pressure to accept perinatal procedures (AOR 1.55, 95% CI 1.08-2.20) than those who were white. DISCUSSION There is a need to address human rights violations in perinatal care for all birthing people with particular attention to the needs of those identifying as BIPOC. By eliminating mistreatment in perinatal care, such as pressure to accept services and nonconsented procedures, we can help mitigate long-standing inequities.
Collapse
Affiliation(s)
| | - Monica R McLemore
- Department of Family Health Care Nursing, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, Oakland, CA, USA
| | - Zoë Julian
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA.,Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kathrin Stoll
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Nisha Malhotra
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | -
- The Birth Place Lab, Vancouver, BC, Canada
| | - Saraswathi Vedam
- Birth Place Lab, Division of Midwifery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
185
|
Wudneh A, Cherinet A, Abebe M, Bayisa Y, Mengistu N, Molla W. Obstetric violence and disability overlaps: obstetric violence during child birth among womens with disabilities: a qualitative study. BMC Womens Health 2022; 22:299. [PMID: 35850722 PMCID: PMC9290254 DOI: 10.1186/s12905-022-01883-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/14/2022] [Indexed: 11/10/2022] Open
Abstract
Introduction Obstetric violence is an invisible wound which is being distorting the quality of obstetric care. Obstetric Violence, which is an issue spoken and amplified currently as a type of sexual violence and is of alarming seriousness and is an evolving field of inquiry despite women’s experience of institutional childbirth, has garnered unprecedented global attention in recent years. Losing on both counts: obstetric violence is a double burden among disabled women.
Aim To explore the experience of disabled women towards obstetric violence during child birth in Gedio zone, South Ethiopia. Methods Twenty-two (22) women with disabilities were interviewed. They were recruited through a nonprobability snowball sampling method. The interviews were conducted using a structured questionnaire in the Gedio zone, south Ethiopia. For coding purposes, NVivo (version 11) software was employed. Using a method known as continuous comparison, we classified the extracted codes based on their similarities and differences. The classes were then arranged in such a way that there was the greatest internal uniformity and the least external mismatch. Results The profile of the study group is predominantly of women between the ages of 21 and 30. Physical abuse, verbal abuse, stigma and discrimination, neglect and abandonment, and violations of privacy were the five major categories emerged during the thematic analysis describing the experience of obstetric violence. Women also observed these forms of obstetric violence among other disabled women during child birth. In addition to the violations of care, some of the participants described positive aspects of their childbirth experiences in one or more obstetric care settings. Conclusion This study concluded that the quality of service was deplorable, with reports of obstetric violence among this vulnerable group of women imposing a double burden on them. The findings suggest that there is a need to improve maternity care for disabled women by implementing comprehensive, culturally sensitive, client-sensitive special services and providing sensitivity training to healthcare providers, ensuring satisfied, equitable, and quality obstetric care.
Collapse
|
186
|
The prevalence of respectful maternity care during childbirth and its determinants in Ethiopia: A systematic review and meta-analysis. PLoS One 2022; 17:e0277889. [PMID: 36417397 PMCID: PMC9683616 DOI: 10.1371/journal.pone.0277889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Respectful maternity care is the provision of woman-centered health care during childbirth that is friendly, abuse-free, timely, and discrimination-free. Although several epidemiological studies on the magnitude and determinants of Respectful maternity care in Ethiopia have been conducted, the results have been inconsistent and varied. This makes drawing equivocal conclusions and evidence at the national level harder. Hence, this systematic review and meta-analysis aimed at estimating the pooled prevalence of respectful maternity care and its determinants in Ethiopia. METHODS Studies conducted from 2013 to June 30, 2022, were searched by using PubMed, Google Scholar, Science Direct, Scopus, ProQuest, Web of Science, Cochrane Library, and Direct of Open Access Journals. Searching was carried out from May 15- June 30, 2022. In total, sixteen studies were considered in the final analysis. The data were extracted using Microsoft Excel and analyzed using STATA 16 software. The methodological quality of included studies was assessed by using Joanna Briggs Institute's critical appraisal checklist for prevalence studies. To estimate the pooled national prevalence of respectful maternity care, a random effect model with a DerSimonian Laird method was used. To assess the heterogeneity of the included studies, the Cochrane Q test statistics and I2 tests were used. To detect the presence of publication bias, a funnel plot and Begg's and Egger's tests were used. RESULTS Sixteen studies were eligible for this systematic review and meta-analysis with a total of 6354 study participants. The overall pooled prevalence of respectful maternity care in Ethiopia was 48.44% (95% CI: 39.02-57.87). Receiving service by CRC-trained health care providers [AOR: 4.09, 95% CI: 1.73, 6.44], having ANC visits [AOR: 2.34, 95% CI: 1.62, 3.06], planning status of the pregnancy [AOR = 4.43, 95% CI: 2.74, 6.12], giving birth during the daytime [AOR: 2.61, 95% CI: 1.92, 3.31], and experiencing an obstetric complication[AOR: 0.46, 95% CI: 0.30, 0.61] were identified as determinants of RMC. CONCLUSION As per this meta-analysis, the prevalence of respectful maternity care in Ethiopia was low. Managers in the health sector should give due emphasis to the provision of Compassionate, Respectful, and Care(CRC) training for healthcare providers, who work at maternity service delivery points. Stakeholders need to work to increase the uptake of prenatal care to improve client-provider relationships across a continuum of care. Human resource managers should assign an adequate number of health care providers to the night-shift duties to reduce the workload on obstetric providers.
Collapse
|
187
|
Britton LE, Tumlinson K, Williams CR, Wambua D, Onyango D, Mantell E, George M. Findings from a mixed-methods journey map study of barriers to family planning in western Kenya. Health Care Women Int 2022; 45:144-160. [PMID: 36394947 PMCID: PMC10188649 DOI: 10.1080/07399332.2022.2135097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 10/09/2022] [Indexed: 11/18/2022]
Abstract
Our objective was to map and prioritize barriers to high-quality family planning care in western Kenya. We conducted key informant interviews (n = 19); focus group discussions with clients (n = 55); mystery client visits (n = 180); unannounced visitors (n = 120); and direct observation of client-provider interactions (n = 256) at public facilities offering family planning. We synthesized the data into a client and a provider journey map, which we used to facilitate client (n = 9) and provider (n = 12) discussions. For both groups, stockouts were frequent, impactful, and important barriers. Clients also reported male partner resistance, insufficient counseling, and informal fees were priority barriers.
Collapse
Affiliation(s)
- Laura E. Britton
- Columbia University School of Nursing, New York City, United States
| | - Katherine Tumlinson
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina, United States
| | - Caitlin R. Williams
- Gillings School of Public Health, University of North Carolina, Chapel Hill, North Carolina, United States
| | | | - Dickens Onyango
- Kisumu County Department of Health, Kisumu, Kenya
- Utrecht University Netherlands and Institute of Tropical Medicine, Antwerp, Netherlands
| | - Elise Mantell
- Columbia University School of Nursing, New York City, United States
| | - Maureen George
- Columbia University School of Nursing, New York City, United States
| |
Collapse
|
188
|
Zhang N, An S. Consistency of Delivery Mode Increases Chinese Mothers' Maternal Satisfaction: The Effect of Perception of Support from Medical Staff and Mothers' Self-Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14904. [PMID: 36429625 PMCID: PMC9689991 DOI: 10.3390/ijerph192214904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/08/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Maternal satisfaction is essential for women. Extant research has focused on how a practical delivery method effects maternal satisfaction. This article tried to explore the effect of the consistency of delivery mode between mothers' expectations and their experience of maternal satisfaction and proposed the mediating effect of the perception of support from medical staff and the moderated mediation effect of maternal self-efficacy. Based on two studies, this article found that the consistency of the delivery mode has a positive effect on maternal satisfaction, and women's perception of support from medical staff mediated the above relationship. The maternal perception of self-efficacy has a moderated mediation effect; specifically, for women with a high level of self-efficacy, the positive effect of the consistency of the delivery mode on maternal satisfaction through perception support from medical staff is stronger. This article highlights the importance of the consistency of the delivery mode between women's expectations and the experience of maternal satisfaction and the psychological mechanisms involved. The results extend the theoretical research on ethics in childbirth and provide implications for improving women's maternal satisfaction from medical staff and themselves.
Collapse
Affiliation(s)
- Nan Zhang
- School of Economics and Management, Beijing Jiaotong University, Beijing 100044, China
| | - Shanshan An
- School of Law, Jiangnan University, Wuxi 214122, China
| |
Collapse
|
189
|
Heys S, Downe S, McKeown M, Thomson G. The design, delivery and evaluation of 'Human Perspectives VR': An immersive educational programme designed to raise awareness of contributory factors for a traumatic childbirth experience and PTSD. PLoS One 2022; 17:e0276263. [PMID: 36322586 PMCID: PMC9629609 DOI: 10.1371/journal.pone.0276263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND A traumatic childbirth experience affects ~30% of women each year, with negative impacts on maternal, infant, and family wellbeing. Women classified as vulnerable or marginalised are those more likely to experience a psychologically traumatising birth. A key contributory factor for a traumatic childbirth experience is women's relationships with maternity care providers. AIMS To develop, design and evaluate an immersive educational programme for maternity care providers to raise awareness of traumatic childbirth experiences amongst vulnerable groups, and ultimately to improve women's experiences of childbirth. METHODS A critical pedagogical approach that utilised virtual reality (VR) underpinned the design and development of the educational programme. This involved: a) collecting vulnerable/disadvantaged women's experiences of birth via interviews; b) analysing data collected to identify key hotspots for traumatic experiences within interpersonal patient-provider relationships to develop a script; c) filming the script with professional actors creating a first person perspective via VR technology; d) using existing literature to inform the theoretical and reflective aspects of the programme; e) conducting an evaluation of the education programme using pre-and post-evaluation questionnaires and a follow-up focus group. FINDINGS Human Perspective VR was very well received. Participants considered the content to have enhanced their reflective practice and increased their knowledge base regarding contributory factors associated with a traumatic childbirth experience. A need for further work to implement learning into practice was highlighted. CONCLUSION While further research is needed to evaluate the impact of the programme, Human Perspective VR programme offers an innovative approach to reflective education and to enhance participants' care practices.
Collapse
Affiliation(s)
- Stephanie Heys
- Maternity Learning and Development Lead, Consultant Midwife, The Northwest Ambulance Service, The University of Central Lancashire, Preston, United Kingdom
- * E-mail:
| | - Soo Downe
- Professor of Midwifery Studies, The University of Central Lancashire, Preston, United Kingdom
| | - Mick McKeown
- Professor of Democratic Mental Health, The University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Professor of Perinatal Health, The University of Central Lancashire, Preston, United Kingdom
| |
Collapse
|
190
|
Umar N, Bhattacharya A, Exley J, Jalingo IB, Shuaibu A, Marchant T. Measurement of respectful maternity care in exit interviews following facility childbirth: a criterion validity assessment in Nigeria. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.38745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Valid methods for assessing women’s experiences of maternity care are essential to the global efforts toward providing positive childbirth environments for all women in all health facilities. Methods This criterion validity study used observation of childbirth as the reference standard compared to exit interviews with women upon discharge with a live baby, usually within 24 hours of childbirth. We investigated eight positive and sixteen negative maternity care experience indicators. Data were collected from ten primary healthcare facilities in Gombe State, northeast Nigeria, in August 2018 and August 2019. Data analysis involved tabulation of demographic characteristics of women and childbirth context, computation of individual level validity metrics including the area under the receiver operating curve (AUC) and estimating population level validity using the inflation factor (IF). Results A total of 724 women were observed and interviewed at the time of discharge (exit) following facility childbirth, 15% of whom were adolescents, 99% were married, 43% had no formal education, and a skilled birth attendant had attended only 12%. The prevalence of positive maternity care experience indicators ranged between 25% and 96% in childbirth observations. For these positive indicators, the agreement between childbirth observations and exit interviews ranged from 55% to 97%. Six of the eight positive maternity care experience indicators had high overall validity, meaning AUC≥0.70 and 0.75<IF<1.25, with high sensitivity (89% to 99%) and moderate to high specificity (44% to 84%). The prevalence of the 16 negative maternity care experience indicators ranged between 0.1% and 18% in childbirth observations. For these negative indicators, agreement ranged from 87% to 99%. Just six of the 16 negative maternity care experience indicators met the criteria for validation analysis; and these showed low to moderate sensitivity (32% to 74%), high specificity (97% to 100%) and moderate (0.60<AUC<0.70) to high (AUC≥0.70) individual-level validity. Conclusions In this high mortality setting with relatively low coverage of skilled attendance at birth, exit interviews with women following facility-based childbirth care provided responses consistent with the observation of childbirth for eight positive and six negative maternity care experience indicators.
Collapse
Affiliation(s)
- Nasir Umar
- London School of Hygiene & Tropical Medicine
| | | | | | - Inuwa B. Jalingo
- Data Research and Mapping Consult Limited, Abuja, Nigeria; National Population Commission, Abuja, Nigeria
| | | | | |
Collapse
|
191
|
Chawla L, Singh M, Sharma KA, Rajaram S, Gaurav A, Khoiwal K, Mundhra R, Bahadur A, M R, Ravichandran N, Chaturvedi J. Implementing the Practice of Birth Companion in Labor During the COVID-19 Pandemic: A Quality Improvement Endeavor in India. Cureus 2022; 14:e30531. [DOI: 10.7759/cureus.30531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2022] [Indexed: 11/05/2022] Open
|
192
|
Dwekat IMM, Ismail TAT, Ibrahim MI, Ghrayeb F, Abbas E. Mistreatment of Women during Childbirth and Associated Factors in Northern West Bank, Palestine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13180. [PMID: 36293759 PMCID: PMC9602547 DOI: 10.3390/ijerph192013180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Mistreatment of women during childbirth is a clear breach of women's rights during childbirth. This study aimed to determine the prevalence and associated factors of mistreatment of women during childbirth in the north of West Bank, Palestine. A cross-sectional study was conducted among 269 women within the first 16 weeks of their last vaginal childbirth to understand the childbirth events by using proportionate stratified random sampling. An Arabic valid questionnaire was used as a study instrument. Simple and multiple logistic regression analyses were conducted to determine the factors associated with each type of mistreatment. The mean age of the women was 26.5 (SD 4.77) years. The overall prevalence of mistreatment was 97.8%. There were six types of mistreatment. Nine factors were significantly associated with the occurrence of one or more types of mistreatment. Delivery at a public childbirth facility was associated with all of the six types (aAdjOR: 2.17-16.77; p-values < 0.001-0.013). Women who lived in villages (aAdjOR 2.33; p-value = 0.047), had low education (aAdjOR 5.09; p-value = 0.004), underwent induction of labour (aAdjOR 3.03; p-value = 0.001), had a long duration of labour (aAdjOR 1.10; p-value = 0.011), did not receive pain killers (aAdjOR: 2.18-3.63; p-values = 0.010-0.020), or had an episiotomy or tear (aAdjOR 5.98; p-value < 0.001) were more likely to experience one or more types of mistreatment. With every one-hour increase in the duration of labor, women were 1.099 times more likely to experience a failure to meet the professional standard of care. Women were less likely to experience mistreatment with increasing age. Women with increasing age (aAdjOR: 0.91-0.92; p-values = 0.003-0.014) and parity (aAdjOR 0.72; p-value = 0.010) were less likely to experience mistreatment. Awareness of women's fundamental rights during childbirth, making the childbirth process as normal as possible, and improving the childbirth facilities' conditions, policies, practices and working environment may decrease mistreatment occurrence.
Collapse
Affiliation(s)
- Ibtesam Medhat Mohamad Dwekat
- Department of Community Medicine, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia
- Faculty of Health Professions, Al-Quds University, Jerusalem 51000, Palestine
| | | | - Mohd Ismail Ibrahim
- Department of Community Medicine, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia
| | - Farid Ghrayeb
- Faculty of Health Professions, Al-Quds University, Jerusalem 51000, Palestine
| | - Eatimad Abbas
- Faculty of Health Professions, Al-Quds University, Jerusalem 51000, Palestine
| |
Collapse
|
193
|
Arias Fuentes FF, Arteaga E, San Sebastián M. Social inequalities in women exposed to obstetric and gyneco-obstetric violence in Ecuador: a cross-sectional study. BMC Womens Health 2022; 22:419. [PMID: 36229808 PMCID: PMC9563786 DOI: 10.1186/s12905-022-01998-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/05/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Obstetric and gyneco-obstetric violence (OV, GOV) is a concerning public health problem, particularly in Latin America. This study aimed to determine the prevalence of OV and GOV and to assess its socio-geographical distribution in Ecuador. METHODS This cross-sectional study used data from a national survey conducted in 2019 (n = 17,211) among women aged 15 years and over. Independent variables included age, marital status, education, ethnicity, place of residence and region. The chosen outcomes were lifetime experience of OV and GOV. Frequency tables were calculated and crude and adjusted regression models estimating prevalence ratios and their 95% confidence intervals were computed. RESULTS Nearly one-third (32.8%) of the participants had experienced OV and two-fifths (41.86%) GOV at least once in their lifetime. Prevalence of OV were particularly common in women 26-35 and 46-55 years old, with primary or middle education and in urban regions. In comparison, GOV had a higher prevalence in women aged > 65 years and with no formal education. Both subtypes of violence were more common among women with current or earlier partners compared with the single ones. Also the two outcomes were more prevalent in the non-white population, OV among the populations of colour (POC), while GOV both, in the POC and Indigenous group. Additionally, women from the Highlands and Amazon reported higher OV and GOV than the Coastal group. CONCLUSION Our study showed that OV and GOV are common in Ecuador and identified an unequal distribution of their prevalence across different socio-geographical groups. Further studies including more social factors and a continuous monitoring of OV and GOV are recommended. Current policies, laws to protect women and guidelines regarding the treatment of women, particularly in health care settings, need to be constantly advocated for and effectively implemented in the country.
Collapse
Affiliation(s)
- Fara Faith Arias Fuentes
- grid.12650.300000 0001 1034 3451Dept. of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| | - Erika Arteaga
- grid.412251.10000 0000 9008 4711Health Sciences College, University of San Francisco de Quito, Quito, Ecuador
| | - Miguel San Sebastián
- grid.12650.300000 0001 1034 3451Dept. of Epidemiology and Global Health, Umeå University, 901 87 Umeå, Sweden
| |
Collapse
|
194
|
Reddy B, Thomas S, Karachiwala B, Sadhu R, Iyer A, Sen G, Mehrtash H, Tunçalp Ö. A scoping review of the impact of organisational factors on providers and related interventions in LMICs: Implications for respectful maternity care. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001134. [PMID: 36962616 PMCID: PMC10021694 DOI: 10.1371/journal.pgph.0001134] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 09/14/2022] [Indexed: 11/05/2022]
Abstract
We have limited understanding of the organisational issues at the health facility-level that impact providers and care as it relates to mistreatment in childbirth, especially in low- and middle-income countries (LMICs). By extension, it is not clear what types of facility-level organisational changes or changes in working environments in LMICs could support and enable respectful maternity care (RMC). While there has been relatively more attention to health system pressures related to shortages of staff and other resources as key barriers, other organisational challenges may be less explored in the context of RMC. This scoping review aims to consolidate evidence to address these gaps. We searched literature published in English between 2000-2021 within Scopus, PubMed, Google Scholar and ScienceDirect databases. Study selection was two-fold. Maternal health articles articulating an organisational issue at the facility- level and impact on providers and/or care in an LMIC setting were included. We also searched for literature on interventions but due to the limited number of related intervention studies in maternity care specifically, we expanded intervention study criteria to include all medical disciplines. Organisational issues captured from the non-intervention, maternal health studies, and solutions offered by intervention studies across disciplines were organised thematically and to establish linkages between problems and solutions. Of 5677 hits, 54 articles were included: 41 non-intervention maternal healthcare studies and 13 intervention studies across all medical disciplines. Key organisational challenges relate to high workload, unbalanced division of work, lack of professional autonomy, low pay, inadequate training, poor feedback and supervision, and workplace violence, and these were differentially influenced by resource shortages. Interventions that respond to these challenges focus on leadership, supportive supervision, peer support, mitigating workplace violence, and planning for shortages. While many of these issues were worsened by resource shortages, medical and professional hierarchies also strongly underpinned a number of organisational problems. Frontline providers, particularly midwives and nurses, suffer disproportionately and need greater attention. Transforming institutional leadership and approaches to supervision may be particularly useful to tackle existing power hierarchies that could in turn support a culture of respectful care.
Collapse
Affiliation(s)
- Bhavya Reddy
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
- School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Sophia Thomas
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Baneen Karachiwala
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Ravi Sadhu
- T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, United States of America
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Hedieh Mehrtash
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
195
|
Kabakian-Khasholian T, Makhoul J, Ghusayni A. "A person who does not have money does not enter": a qualitative study on refugee women's experiences of respectful maternity care. BMC Pregnancy Childbirth 2022; 22:748. [PMID: 36199044 PMCID: PMC9533279 DOI: 10.1186/s12884-022-05083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Women’s childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to seeking care for subsequent births. Research that explores women’s perspectives of the dimensions of disrespect and mistreatment during childbirth in Arab countries is scarce, and there is none pertaining to refugee groups who carry the burden of multiple vulnerabilities and who suffer from discontinued care, especially in fragile health systems. This paper aims at presenting Palestinian, Iraqi and Syrian refugee women’s experiences, understanding and interpretation of disrespect and mistreatment during childbirth in hospitals in Lebanon. Methods This study employed phenomenology, a qualitative research design to generate data through in-depth interviews. Women who were 3 to 6 months postpartum were recruited through the non-governmental organizations (NGOs) that are actively engaged in providing welfare and healthcare services to different populations of refugee women in Lebanon. In total, 24 women were interviewed. All interviews were audio recorded, transcribed verbatim and subjected to thematic analysis. Results Of the 24 women who participated in this study, 9 were Palestinian, 12 were Syrian and 3 were Iraqi. The participants spoke of restricted choices to hospitals, care providers and to types of birth, while revealing adverse experiences during childbirth in healthcare facilities, including verbal and physical abuse, disrespectful verbal and non-verbal communication by healthcare providers. They also reported sub-standard care, denial of birth companions and breaches to their privacy. Our findings exemplify how the coverage of the cost of facility-based births by UN agencies and NGOs increase refugee women’s vulnerability to disrespect and mistreatment during childbirth. Conclusion This study shows how disrespect and mistreatment are intertwined in a complex system which is devised to ensure access to facility-based birth for displaced populations. Implications for programs and policies point to the need for strengthening capacity and for providing resources for the adaptation of global guidelines into context-specific strategies for the provision of quality maternity care during humanitarian crises and beyond. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05083-2.
Collapse
Affiliation(s)
- Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jihad Makhoul
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Aleni Ghusayni
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| |
Collapse
|
196
|
Moridi M, Pazandeh F, Potrata B. Midwives' knowledge and practice of Respectful Maternity Care: a survey from Iran. BMC Pregnancy Childbirth 2022; 22:752. [PMID: 36199103 PMCID: PMC9535863 DOI: 10.1186/s12884-022-05065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the past decade, countries worldwide aimed to evaluate the quality of childbirth care and reduce the high rates of disrespect and abuse during childbirth. Few studies have attempted to identify providers' characteristics associated with respectful maternity care quantitatively. This study aims to evaluate midwives' knowledge and practice of respectful maternity care (RMC). METHODS A cross-sectional study was carried out in 15 teaching and non-teaching hospitals in Tehran, Iran. The hospitals were selected by using a cluster sampling design. Midwives' Knowledge and Practice of Respectful Maternity Care scale (MKP-RMC) was administered to 250 midwives working in maternity units at study hospitals. The data were analysed by statistics package for social science (SPSS, version 21.0, Chicago, IL). RESULTS Findings demonstrated that the mean score for knowledge and practice of midwives were 20.96 ± 3.54 and 101.64 ± 11.49, respectively. Also, in both knowledge and practice scales, midwives had the highest score in "providing safe care' domain and the lowest score in "preventing mistreatment" domain. CONCLUSION Our findings showed that for Iranian midwives, providing care to preserve mothers' and their babies' wellbeing is more critical than preventing maternal mistreatment, resulting from the importance of the care provision in the Iranian healthcare system. Promoting midwives' knowledge and practice through developing a tailored educational program to prevent mistreatment and providing emotional support alongside physical care is recommended.
Collapse
Affiliation(s)
- Maryam Moridi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- School of Health Sciences, University of Nottingham, Nottingham, UK.
| | | |
Collapse
|
197
|
Attanasio LB, Ranchoff BL, Paterno MT, Kjerulff KH. Person-Centered Maternity Care and Health Outcomes at 1 and 6 Months Postpartum. J Womens Health (Larchmt) 2022; 31:1411-1421. [PMID: 36067084 PMCID: PMC9618378 DOI: 10.1089/jwh.2021.0643] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: Person-centered care has been increasingly recognized as an important aspect of health care quality, including in maternity care. Little is known about correlates and outcomes of person-centered care in maternity care in the United States. Materials and Methods: Data were from a prospective cohort of more than 3000 individuals who gave birth to a first baby in a Pennsylvania hospital. Person-centered maternity care was measured via a 13-item rating scale administered 1-month postpartum. Content validity was established through exploratory factor analysis. The resulting scale had scores ranging from 13 to 54, with Cronbach's alpha of 0.86. Using linear and logistic regression models to control for covariates, we examined associations between participants' characteristics and person-centered maternity care and between person-centered maternity care and postpartum outcomes. Results: Participants had a mean total score of 47.80 on the person-centered maternity care scale. Patient factors independently associated with more person-centered maternity care included older age, more positive attitude toward vaginal birth during pregnancy, and spontaneous vaginal birth. In adjusted models, higher person-centered maternity scale scores were strongly associated with many positive physical and mental health outcomes at 1 and 6 months postpartum. Conclusions: Our findings underscore the importance of person-centered maternity not just due to its intrinsic value but also because it may be associated with both mental and physical health outcomes through the postpartum period. Results suggest that policy efforts are necessary to ensure person-centered maternity care, especially for delivery hospitalization experience.
Collapse
Affiliation(s)
- Laura B. Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Brittany L. Ranchoff
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Mary T. Paterno
- Cooley Dickinson ObGyn and Midwifery, Cooley Dickinson Medical Group, Northampton, Massachusetts, USA
| | - Kristen H. Kjerulff
- Department of Public Health Sciences and Penn State College of Medicine, Hershey, Pennsylvania, USA
- Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey, Pennsylvania, USA
| |
Collapse
|
198
|
Ghulaxe Y, Tayade S, Huse S, Chavada J. Advancement in Partograph: WHO's Labor Care Guide. Cureus 2022; 14:e30238. [PMID: 36381845 PMCID: PMC9652267 DOI: 10.7759/cureus.30238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023] Open
Abstract
Worldwide, the partograph, also known as a partogram, is used as a labor monitoring tool to detect difficulties early, allowing for referral, intervention, or closer observations to follow. Despite widespread support from health experts, there are worries that the partograph has not yet fully realized its potential for enhancing therapeutic results. As a result, the instrument has undergone several changes, and numerous studies have been conducted to examine the obstacles and enablers to its use. Nevertheless, the partograph was widely embraced and has been a component of evaluating labor progress. Earlier it was also used as a standard method for monitoring labor progress. Even though it is widely used, there have been reports of usage and accurate execution rates. The WHO Labor Care Guide (LCG) was created so that medical professionals could keep an eye on the health of pregnant women and their unborn children during labor by conducting routine evaluations to spot any abnormalities. The tool intends to enhance women-centered care and encourage collaborative decision-making between women and healthcare professionals. The LCG is designed to be a tool for ensuring high-quality research centered on health, reducing pointless measures, and offering comfort measures.
Collapse
Affiliation(s)
- Yash Ghulaxe
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Surekha Tayade
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Shreyash Huse
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| | - Jay Chavada
- Medical Student, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Wardha, IND
| |
Collapse
|
199
|
Diamond-Smith N, Lin S, Peca E, Walker D. A landscaping review of interventions to promote respectful maternal care in Africa: Opportunities to advance innovation and accountability. Midwifery 2022; 115:103488. [PMID: 36191382 DOI: 10.1016/j.midw.2022.103488] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 08/15/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE In the past decade, global recognition of the need to address disrespect and abuse (also described as mistreatment of women) and promote respectful maternal care in facility-based childbirth has increased. While many studies have documented gaps in respectful maternal care, little is known about the design and implementation of these interventions. Our aim was to summarize and describe respectful maternal care -promoting interventions during childbirth implemented in Africa. DESIGN We identified respectful maternal care -promoting interventions in Africa through a rapid scoping of peer-reviewed articles and gray literature, and a crowdsourcing survey distributed through stakeholder networks. SETTING Africa PARTICIPANTS: NA MEASUREMENTS AND FINDINGS: We identified 43 unique interventions implemented in 16 African countries, gathered from a crowdsourcing survey, gray and published literature between 2010 and 2020. Most interventions were implemented in East Africa (N = 13). The interventions had various targets and were categorized into nine approaches, 60% of interventions focused on training providers about respectful maternal care and practice. About two thirds included multiple intervention approaches, and about two thirds addressed respectful maternal care beyond the period of childbirth. Few publications presented data on the effectiveness of the intervention, and those that did used a wide variety of indicators. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is a reliance on provider training approaches to promote respectful maternal care and there are few examples of either engaging women in the community or adopting social accountability approaches. We encourage implementors to develop interventions targeting multiple approaches beyond provider training and consider delivery across pre-pregnancy, pregnancy, birth, and the postnatal periods. Finally, in order to effectively move from documenting respectful maternal care gaps to action and scale, we need global consensus on common indicators and measures of effectiveness for interventions promoting respectful care across the life course.
Collapse
Affiliation(s)
- Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, United States of America
| | - Sunny Lin
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America.
| | - Emily Peca
- University Research Co., LLC., Chevy Chase, Maryland, United States of America
| | - Dilys Walker
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, United States of America; Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Francisco, San Francisco, CA, United States of America
| |
Collapse
|
200
|
Vedam S, Titoria R, Niles P, Stoll K, Kumar V, Baswal D, Mayra K, Kaur I, Hardtman P. Advancing quality and safety of perinatal services in India: opportunities for effective midwifery integration. Health Policy Plan 2022; 37:1042-1063. [PMID: 35428886 PMCID: PMC9469892 DOI: 10.1093/heapol/czac032] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 03/30/2022] [Accepted: 04/15/2022] [Indexed: 11/12/2022] Open
Abstract
India has made significant progress in improving maternal and child health. However, there are persistent disparities in maternal and child morbidity and mortality in many communities. Mistreatment of women in childbirth and gender-based violence are common and reduce women's sense of safety. Recently, the Government of India committed to establishing a specialized midwifery cadre: Nurse Practitioners in Midwifery (NPMs). Integration of NPMs into the current health system has the potential to increase respectful maternity care, reduce unnecessary interventions, and improve resource allocation, ultimately improving maternal-newborn outcomes. To synthesize the evidence on effective midwifery integration, we conducted a desk review of peer-reviewed articles, reports and regulatory documents describing models of practice, organization of health services and lessons learned from other countries. We also interviewed key informants in India who described the current state of the healthcare system, opportunities, and anticipated challenges to establishing a new cadre of midwives. Using an intersectional feminist theoretical framework, we triangulated the findings from the desk review with interview data to identify levers for change and recommendations. Findings from the desk review highlight that benefits of midwifery on outcomes and experience link to models of midwifery care, and limited scope of practice and prohibitive practice settings are threats to successful integration. Interviews with key informants affirm the importance of meeting global standards for practice, education, inter-professional collaboration and midwifery leadership. Key informants noted that the expansion of respectful maternity care and improved outcomes will depend on the scope and model of practice for the cadre. Domains needing attention include building professional identity; creating a robust, sustainable education system; addressing existing inter-professional issues and strengthening referral and quality monitoring systems. Public and professional education on midwifery roles and scope of practice, improved regulatory conditions and enabling practice environments will be key to successful integration of midwives in India.
Collapse
Affiliation(s)
- Saraswathi Vedam
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Reena Titoria
- Population Health Observatory, Fraser Health Authority, Suite 400, Central City Tower 13450 – 102nd Avenue, Surrey, BC V3T 0H1, Canada
| | - Paulomi Niles
- Rory Meyers College of Nursing, New York University, 433 1st Avenue, New York, NY 10010, USA
| | - Kathrin Stoll
- Department of Family Practice, University of British Columbia, 304-5950 University Blvd, Vancouver, BC V6T 1Z3, Canada
| | - Vishwajeet Kumar
- Community Empowerment Lab, 26/11 Wazir Hasan Road, Gokhale Marg, Lucknow, UP 226001, India
| | - Dinesh Baswal
- MAMTA Health Institute for Mother and Child, B-5, Greater Kailash Enclave-II, New Delhi 110048, India
| | - Kaveri Mayra
- Global Health Research Institute, Faculty of Social Sciences, University of Southampton, University Road, Southampton SO17 1BJ, UK
| | - Inderjeet Kaur
- Fernandez Foundation, Fernandez Hospital, 4-1-120, Bogulkunta, Hyderabad 500001, India
| | - Pandora Hardtman
- Johns Hopkins Program for International Education in Gynecology and Obstetrics, John Hopkins University, 1615 Thames Street, Baltimore, MD 21231, USA
| |
Collapse
|