Caring behaviours by midwives: Jordanian women's perceptions during childbirth

Assessing the Gap Between Women's Expectations and Perceptions of the Quality of Intrapartum Care in Jordan: A Two-Stage Study Using the SERVQUAL Model

INTRODUCTION

Although Jordan has made significant progress toward expanding the utilization of facility-based intrapartum care, prior research highlights that poor service quality is still persistent. This study aimed to identify quality gaps between women's expectations and perceptions of the actual intrapartum care received, while exploring the contributing factors.

METHODS

Utilizing a pre-post design, quality gaps in intrapartum care were assessed among 959 women pre- and postchildbirth at a prominent tertiary hospital in northern Jordan. Data were gathered using the SERVQUAL scale, measuring service quality across reliability, responsiveness, tangibles, assurance, and empathy dimensions.

RESULTS

The overall mean gap score between women's expectations and perceptions of the quality of intrapartum care was -0.60 (±0.56). The lowest and highest mean gap scores were found to be related to tangibles and assurance dimensions, -0.24 (±0.39) and -0.88 (±0.35), respectively. Significant negative quality gaps were identified in the dimensions of assurance, empathy, and responsiveness, as well as overall service quality (p < 0.001). The MLR analyses highlighted education (β = 0.61), mode of birth (β = -0.60), admission timing (β = -0.41), continuity of midwifery care (β = -0.43), physician's gender (β = -0.62), active labour duration (β = 0.37), and pain management (β = -0.33) to be the key determinants of the overall quality gap in intrapartum care.

CONCLUSION

Our findings underscore the importance of fostering a labour environment that prioritizes enhancing caregivers' empathetic, reassuring, and responsive skills to minimize service quality gaps and enhance the overall childbirth experience for women in Jordan.

PATIENT OR PUBLIC CONTRIBUTION

This paper is a collaborative effort involving women with lived experiences of childbirth, midwives, and obstetrics and gynaecologist physicians. The original idea, conceptualization, data generation, and coproduction, including manuscript editing, were shaped by the valuable contributions of stakeholders with unique perspectives on intrapartum care in Jordan.

Midwives' and women's experiences with respectful maternity care around the globe: A meta-synthesis

BACKGROUND

All women have the right to the highest attainable standards of health, including the right to respectful maternity care (RMC). A qualitative body of knowledge describing midwives' and women's experiences of the value and importance of RMC exists. However, no qualitative synthesis exists about midwives' and women's views of respectful care.

AIM

This review aims to present a qualitative synthesis of global perceptions and experiences of midwives and women regarding RMC.

METHODS

A systematic search was conducted in October 2021 and updated in March 2023 on Science Direct, EBSCO host, PubMed, Nexus and ProQuest databases. The synthesis included qualitative studies published between 2010 and 2023. Qualified midwives and pregnant and postnatal women were the samples of the review. The studies' screening and selection for inclusion in the review are presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow chart, and the quality of the included studies was appraised using the Critical Appraisal Screening Programme (CASP) tool. Thematic analysis was conducted.

FINDINGS

Fifteen studies met the review inclusion criteria involving 266 women and 147 midwives. Five themes were identified from the data: commitment to women's rights; excellence in midwifery knowledge and skills; a facilitative built environment; optimising the interpersonal dimension; and the development of women's resourcefulness and resilience.

CONCLUSION

Maternity care is collaborative, and midwives and women are partners in the process. Midwives play a significant role in promoting women's rights, fostering interpersonal working and client relationships, and addressing women's rights and needs.

The Turkish version of the students' perceptions of respectful maternity care scale: An assessment of psychometric properties

AIM

The aim of the research was to evaluate the psychometric properties of the Turkish validity and reliability of the Students' Perceptions of Respectful Maternity Care (SP-RMC) scale.

BACKGROUND

Respectful maternity care is an important contributor to intrapartum care quality and maternal birth satisfaction. Determining students' perceptions of respectful maternity care can identify knowledge gaps and inform their future practice.

DESIGN

A descriptive, methodological and cross-sectional design was used.

METHODS

This study was conducted with 226 undergraduate nursing and midwifery students in the western region of Turkey. Data were collected between May and December 2022 from students who completed their birth courses (theory and clinical practicum). Data included sociodemographic details and the Students' Perceptions of Respectful Maternity Care scale (Turkish version). Factor analysis, Cronbach's alpha and item-total score analyses were conducted.

RESULTS

The mean age of the students was 21.88 (SD 1.39). The average number of births observed was 2.57 (SD 3.16). The scale comprised 18 items including three subdimensions. In both exploratory and confirmatory factor tests, the overall factor loading was greater than 0.30, and the total explained variance was 64.89%. The Cronbach's alpha coefficient of the scale was 0.91, with Cronbach's alpha values ranging between 0.80 and 0.91 for the subscales. Pearson correlation coefficients of all the items ranged between 0.42 and 0.78.

CONCLUSIONS

The SP-RMC (Turkish version) is a valid and reliable measure, with 18 items and three dimensions. In this regard, measuring and reporting respectful maternity care perceptions and intrapartum care experiences of students, who are future members of the profession, could contribute to the improvement of the quality of care and the development of educational interventions for behavioral changes.

Perception of caring behavior and associated factors among nurses and midwives working in public hospitals in Southern Ethiopia

Objective

This study aimed to assess the perception of caring behaviors and associated factors among nurses and midwives who provided maternal health care services at Sidama region public hospitals, Hawassa, Ethiopia.

Methods

An institutional-based cross-sectional study design was used on a sample of 269 nurses and midwives working in maternity wards in Sidama region public hospitals. A self-administered questionnaire was used to collect data. Bivariate and multivariable logistic regression analysis was used to identify factors associated with nurses' and midwives' perceptions of caring behaviors.

Results

Totally 261 nurses and midwives participated the survey. Based on the mean score, participants' perception of caring behavior was classified as higher and lower. According to this study, 75.1% (196/261) of nurses and midwives demonstrated a higher perception of caring behavior. Respondents' age, professional satisfaction, personal satisfaction, midwife/nurse-doctor relationship and workload were significantly associated with their perception of caring behavior.

Conclusions

Assessing the nurses' and midwives' perception of caring behavior and related factors is crucial for providing high-quality nursing and midwifery interventions. It is suggested to create a positive and conducive caring behavior in the organization by reducing excessive workload of nurses and midwives, as well as enhancing nurse/midwife-doctor relationship, and increasing their job satisfaction by providing recognition and reward will improve nurses' and midwives' caring behavior.

Midwifery and nursing students' perceptions of respectful maternity care and witnessing of disrespect and abuse: A comparative study from Nepal and Jordan

OBJECTIVES

To compare Nepalese and Jordanian midwifery and nursing students' perceptions of respectful maternity care (RMC) and witnessing of disrespect and abuse; and determine factors that predict scores on a scale measuring perceptions of RMC.

DESIGN

A descriptive, comparative design was used.

SETTING

Recruitment took place from two medical colleges in Nepal and one University in Jordan.

METHODS

A convenience sample of students (n = 276) enrolled in a Bachelor or Diploma level midwifery or nursing degree who were undertaking or had recently completed their midwifery clinical placement were recruited. The online or hard copy survey included the Students' Perceptions of Respectful Maternity Care (SPRMC) Scale and nine questions on witnessing different types of disrespect and abuse.

FINDINGS

Nepalese students were slightly older (mean = 23.68 years) than Jordanian students (mean = 21.36). Mean duration of clinical placement was longer for Jordanian students (11.24 compared to 6.28 weeks). However, mean number of births observed was higher among Nepalese students (19.6 compared to 18.62). Overall, perceptions of RMC were more positive among Jordanian students (t (199.97) = 6.68, p < 0.001). A multiple regression analysis found that duration of clinical placement (beta = 0.22, p < 0.001), witnessing disrespect and abuse (beta = 0.11, p = 0.08) and age (beta = -0.14, p = 0.03) explained 12.2% of variance in SPMRC scores. Compared to students in Nepal, all Jordanian students had observed non-consented care during their clinical practicum. However, Nepalese students were more likely to observe poor adherence to women's privacy and confidentiality.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

This is the first study to compare midwifery and nursing students' perceptions of RMC across two middle-income countries. Although Jordanian students held more positive perceptions of RMC than those in Nepal, more had witnessed different forms of disrespect and abuse. Variations in students' perceptions of RMC and witnessing of abuse across countries highlight the need for assessment of workplace cultures to inform the development of tailored education and practice interventions for students, clinicians, and managers. Future research needs to explore how to best support students to consistently offer RMC and how to improve the experiences of childbearing women.

The experience of giving birth in a hospital in Spain: Humanization versus technification

AIM

To explore and describe the experiences of women giving birth in a tertiary public hospital, with special focus on experiences related to humanized care and women's participation in decision making.

METHOD

This is a qualitative phenomenological study through semi-structured interviews to postpartum women giving birth in a tertiary hospital between January and May 2017. Data were analysed through content analysis.

RESULTS

The two overarching themes emerged were the professional-information dyad and privacy. Subthemes of the first main theme were the therapeutic relationship, decision-making, feeding the baby, procedures, and the time factor. Subthemes of the second topic were the feelings generated by the hospital environment, the delivery room, and the maternity ward.

CONCLUSIONS

If the therapeutic relationship is good, technology is not seen as dehumanising but rather as necessary to ensure continuing safety. "Humanising" material resources are not a priority for women in the birth process and are little used. Privacy was experienced as being a particularly intense need, which women called for throughout the healthcare process.

Improving the perception of respect for and the dignity of inpatients: a systematic review

OBJECTIVES

The aim of this systematic review is to find evidence to determine which strategies are effective for improving hospitalised patients' perception of respect and dignity.

METHODS

A systematic review of the literature was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. The MEDLINE/PubMed, PsycINFO and Cochrane Library databases were searched on 9 March 2021. Observational studies, prospective studies, retrospective studies, controlled trials and randomised controlled trials with interventions focused on improving respect for patients and maintaining their dignity were included. Case reports, editorials, opinion articles, studies <10 subjects, responses/replies to authors, responses/replies to editors and review articles were excluded. The study population included inpatients at any health facility. Two evaluators assessed risk of bias according to the Cochrane Handbook of Systematic Reviews of Interventions criteria: allocation, randomisation, blinding and internal validity. The reviewers were blinded during the selection of studies as well as during the quality appraisal. Disagreements were resolved by consensus.

RESULTS

2515 articles were retrieved from databases and 44 articles were included in this review. We conducted a quality appraisal of the studies (27 qualitative studies, 14 cross-sectional studies, 1 cohort study, 1 quali-quantitative study and 1 convergent parallel mixed-method study).

DISCUSSION

A limitation of this study is that it may not be generalisable to all cultures. Most of the included studies are of good quality according to the quality appraisal. To improve medical and hospital care in most countries, it is necessary to improve the training of doctors and other health professionals.

CONCLUSION

Many strategies could improve the perception of respect for and the dignity of the inpatient. The lack of interventional studies in this field has led to a gap in knowledge to be filled with better designed studies and effect measurements.

PROSPERO REGISTRATION NUMBER

CRD42021241805.

Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth

Background

Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region.

Aim

This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC.

Methods

A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR.

Findings and Discussion

This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV.

Conclusion

In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.

Women's experiences and perceptions of women-centered care and respectful care during facility-based childbirth: A meta-synthesis

AIM

The World Health Organization has recommended intrapartum care for a positive childbirth experience through respectful care based on women-centered care. This study aimed to explore women's experiences of facility-based childbirth to gain insights into their perceptions of women-centered care, including humanized childbirth and respectful maternity care during intrapartum care.

METHODS

Used the Joanna Briggs Institute method as the framework for this meta-synthesis, we searched the PubMed, EMBASE, CINAHL, PsycINFO, and LILCAS databases, and included qualitative studies and interviews of women's experiences and perceptions of women-centered care during facility-based childbirth published from 1990 to 2020 in English. Study quality was assessed using the Critical Appraisal Skills Programme checklist. NVivo software was used for data extraction and synthesis.

RESULTS

There were 22 studies from 19 countries that met the established inclusion criteria. Five categories of experiences of facility-based childbirth and perceptions of women-centered care from the synthesized voices of women were generated: (i) value of women through childbirth; (ii) overwhelmed by unpleasant childbearing experiences; (iii) a sense of being respected and valued; (iv) a sense of being disrespected and abused; and (v) inadequate systems and resources. Our meta-synthesis indicated that respectful and helpful interaction between women and healthcare providers produced positive perceptions among women.

CONCLUSIONS

This study emphasizes the importance of respectful interactions and intrapersonal experiences. Strong systems and positive environments lead to positive interactions between women and healthcare providers. Future studies need to consider cultural and economic differences in women-centered care and respectful care for childbirth in different contexts.

Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals

OBJECTIVE

To identify and meta-synthesize results of qualitative studies on the needs of women cared for by midwives during childbirth in hospitals.

DATA SOURCES

MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Cochrane Library.

STUDY SELECTION

We restricted the bibliographic search to articles published in English to July 31, 2020. The initial search yielded 6,407 articles, and after 2,504 duplicates were removed, we screened the titles and abstracts of 3,903 articles. We conducted a full-text review of 89 articles and included 13 qualitative studies about the needs of women who were hospitalized during childbirth and had midwives as their primary maternity care providers.

DATA EXTRACTION

We extracted data (e.g., authors, publication date, type of study, sample size, results, and quotes) from the full text of each article into a standardized table. Two authors reviewed all articles using the Critical Appraisal Skills Programme tool to assess study quality and to independently score each study.

DATA SYNTHESIS

We analyzed the findings of each study and synthesized them to develop themes. We found 14 major themes that reflected the needs of women during hospitalization for childbirth: Nutrition, Hygiene, Privacy, Information, Bodily Respect, Respect for Social Role, Family Intimacy, Shelter, Pain Management, Partnership, Movement, Reassurance, Support, and Empowerment. We categorized these themes in Maslow's hierarchy of needs to better understand the phenomenon.

CONCLUSION

We identified 14 needs that midwives and nurses can meet when they care for women in hospitals during childbirth. Standardized methods to assess these needs and to link them to specific interventions can be used by midwives and nurses, which will likely affect women's satisfaction with their experience and overall quality of care.

"Being relieved and puzzled": A qualitative study of first time fathers' experiences postpartum in Jordan

BACKGROUND

Although the transition to fatherhood is a point of attention for researchers, little is known about the first time father's postpartum experience. This study aims to explore the first time fathers postpartum experience in the country of Jordan.

METHODS

An exploratory qualitative design was used. Semi-structured interviews were conducted with a purposive sample consisting of twelve first time fathers. The study was conducted in a public university in Jordan. The data was collected in 2017 and was thematically analysed using the colour and file index method.

RESULTS

The analysis revealed two main themes. The first theme centred around a feeling of relief which can be further divided into two sub-themes of self-actualisation and continuation of the family line. The second theme centred around the feeling of puzzlement, and this can also be further divided into two sub-themes of feeling unable to deal with a newborn baby and struggling to care for a recovering wife. The study identified fathers as willing to engage in the private care of their new babies and recovering wives but at a limited level of engagement. The fathers verbalised the lack of knowledge and exhibited sociocultural stereotypes related to masculinity and the role of the man in the family.

CONCLUSIONS

The first time fathers' experiences ranged from feelings of relief to puzzlement. The fathers experiences were shaped by religion, culture, and masculinity which suggests education during antepartum may enhance the experience.