Dignity and respect during pregnancy and childbirth: a survey of the experience of disabled women

Experiences of women with physical disabilities in labor and delivery assistance

OBJECTIVE

To understand the meaning attributed by women with physical disabilities to the health care received and expected during labor and delivery.

METHODS

Qualitative study, based on Social Network Theory, conducted through an online workshop in April 2022, with the participation of six women with physical disabilities. Data, collected through the focus group technique, underwent thematic content analysis with the assistance of the IRaMuTeQ tool.

RESULTS

Three thematic categories emerged: Challenges experienced during pregnancy; The experience within the maternity ward; and, The importance of social networks. The assistance provided by healthcare professionals sometimes differed between what was expected and what was received by women with physical disabilities during labor and delivery.

FINAL CONSIDERATIONS

Experiences were predominantly negative, resulting from inappropriate professional conduct due to ableist attitudes. Support from members of social networks is crucial for preventing stressors.

Autistic People's Perinatal Experiences I: A Survey of Pregnancy Experiences

Qualitative studies of autistic people's pregnancy experiences have indicated sensory and communication related barriers to accessing adequate prenatal healthcare. However, quantitative work on the topic is scarce. This online survey study explored pregnancy experiences among 417 autistic and 524 non-autistic people. Compared with non-autistic people, autistic people reported heightened sensory and physical experiences during pregnancy and were more likely to experience prenatal depression and anxiety. Autistic people experienced lower satisfaction with prenatal healthcare, including having lower perceptions of their relationships with healthcare professionals and greater difficulties with antenatal classes. This study identifies key adjustments that can be made to prenatal healthcare, including sensory and communication adjustments. The findings highlight the need for greater autism understanding and awareness among professionals.

Understanding the Mechanisms of Change in the Supportive and Respectful Maternity Care Intervention in Sindh, Pakistan: Provider Perspectives

INTRODUCTION

We conducted this qualitative investigation to explore the mechanisms of change in providing respectful care resulting from the supportive and respectful maternity care intervention (S-RMC) in Sindh, Pakistan.

METHODS

We applied the principles of realist evaluation methodology with a descriptive explanatory research design. We conducted in-depth interviews with 36 maternity care providers at secondary-level public health facilities where S-RMC was implemented for 6 months. The S-RMC broad components included capacity-building of maternity teams and systemic changes for improvements in governance and accountability within public health facilities. Data were analyzed using a deductive content analysis approach.

RESULTS

We identified mechanisms of change, categorized by the S-RMC components: (1) S-RMC training: insight into women's feelings and rights, realization of the value that nonclinical staff can play, understanding of team coordination, orientation in psychosocial components of maternity care; (2) assessment of women's psychosocial vulnerabilities: identification of women's differential needs beyond routine care to provide woman-centered care; (3) psychosocial support: effective engagement with women and within maternity teams and the customization of woman- and companion-focused care; (4) care coordination: improved coordination among clinical and nonclinical staff to provide personalized care and psychosocial support and proper handover to ensure continuity of care; (5) assessment of quality of care: identification of service gaps from women's feedback; and (6) performance review and accountability: monthly performance review meetings to establish team member communication, systematic awareness of the maternity team's performance and challenges, and implementation of collective corrective actions.

CONCLUSION

Our findings pointed to S-RMC working along multiple pathways-and concertedly with various health system components-to enable positive processes and behavioral change in maternity teams.

The Power of Language in Hospital Care for Pregnant and Birthing People: A Vision for Change

Language is commonly defined as the principal method of human communication made up of words and conveyed by writing, speech, or nonverbal expression. In the context of clinical care, language has power and meaning and reflects priorities, beliefs, values, and culture. Stigmatizing language can communicate unintended meanings that perpetuate socially constructed power dynamics and result in bias. This bias may harm pregnant and birthing people by centering positions of power and privilege and by reflecting cultural priorities in the United States, including judgments of demographic and reproductive health characteristics. This commentary builds on relationship-centered care and reproductive justice frameworks to analyze the role and use of language in pregnancy and birth care in the United States, particularly regarding people with marginalized identities. We describe the use of language in written documentation, verbal communication, and behaviors associated with caring for pregnant people. We also present recommendations for change, including alternative language at the individual, clinician, hospital, health systems, and policy levels. We define birth as the emergence of a new individual from the body of its parent, no matter what intervention or pathology may be involved. Thus, we propose a cultural shift in hospital-based care for birthing people that centers the birthing person and reconceptualizes all births as physiologic events, approached with a spirit of care, partnership, and support.

Two Pregnancy Care Models in Poland-A Descriptive-Comparative Study

Care for a pregnant woman can take various organizational forms. The World Health Organization (WHO) recommends leaders increase research into health systems. The aim of this is to manage the healthcare system in such a way as to provide beneficiaries with access to high-quality services with limited financial resources. The study presented in this paper was conducted using a diagnostic survey on a group of 1697 Polish women in the traditional model of care (TM) and 3216 women in the Coordinated Care for Pregnant Women Program (CCP). Two research tools were used in this study. The first is a survey prepared by the National Health Fund, the second is an author's survey. The results indicate that most women (85%) receiving care under the CCP received effective pain management, compared to 67% under the traditional care model (p < 0.001). In the CCP, women were significantly more likely to receive midwife assistance in infant care (90%) than women in the traditional care model (60%) (p < 0.001). Significantly more CCP patients want to return to the same hospital for their subsequent childbirth (74%) than women in the traditional model of care (43%) (p < 0.001). In patients' opinion, the new CCP model is superior in meeting their needs and providing higher-quality services. However, educating women that an obstetrician-gynecologist and a midwife can manage their pregnancy is still necessary. In addition to the CCP program, special attention should be paid to available pain management during childbirth since the use of analgesia is still insufficient in Polish hospitals.

Approaches and geographical locations of respectful maternity care research: A scoping review

BACKGROUND

Peripartum mistreatment of women contributes to maternal mortality across the globe and disproportionately affects vulnerable populations. While traditionally recognized in low/low-middle-income countries, the extent of research on respectful maternity care and the types of mistreatment occurring in high-income countries is not well understood. We conducted a scoping review to 1) map existing respectful maternity care research by location, country income level, and approach, 2) determine if high-income countries have been studied equally when compared to low/low-middle-income countries, and 3) analyze the types of disrespectful care found in high-income countries.

METHODS

A systematic search for published literature up to April 2021 using PubMed/MEDLINE, EMBASE, CINAHL Complete, and the Maternity & Infant Care Database was performed. Studies were included if they were full-length journal articles, published in any language, reporting original data on disrespectful maternal care received from healthcare providers during childbirth. Study location, country income level, types of mistreatment reported, and treatment interventions were extracted. This study was registered on PROSPERO, number CRD42021255337.

RESULTS

A total of 346 included studies were categorized by research approach, including direct labor observation, surveys, interviews, and focus groups. Interviews and surveys were the most common research approaches utilized (47% and 29% of all articles, respectively). Only 61 (17.6%) of these studies were conducted in high-income countries. The most common forms of mistreatment reported in high-income countries were lack of informed consent, emotional mistreatment, and stigma/discrimination.

CONCLUSIONS

Mapping existing research on respectful maternity care by location and country income level reveals limited research in high-income countries and identifies a need for a more global approach. Furthermore, studies of respectful maternity care in high-income countries identify the occurrence of all forms of mistreatment, clashing with biases that suggest respectful maternity care is only an issue in low-income countries and calling for additional research to identify interventions that embrace an equitable, patient-centric empowerment model of maternity care.

Person-centered Maternity Care Among Mothers Who Gave Birth in South Wollo Zone Public Hospitals, Northeastern Ethiopia: A Mixed-method Study

Background

Globally, less attention has been given to the abuse and disrespect observed during maternity care. Person-centered maternity care is providing care that is respectful and responsive to individual women's preferences and needs and that their values guide all clinical decisions during childbirth. In Ethiopia, person-centered health care is one of the factors that increase client satisfaction and health service utilization. Therefore, we aimed to determine the level of person-centered maternity care among mothers who gave birth in health facilities of South Wollo Zone public hospitals, Northeastern, Ethiopia, 2019 using a mixed-method study.

Methods

An institution-based cross-sectional study was conducted using both qualitative and quantitative data collection methods. Three hundred sixty-nine study participants were selected for the quantitative study using simple random sampling. Twelve study participants were selected for the qualitative study using purposive sampling. The quantitative data was coded and entered into Epi data 4.4 version and the analysis was carried out using Statistical Package for Social Sciences version 23. Descriptive statics was presented using tables and figures. Thematic analysis was used for qualitative data and presented with the quantitative result through triangulation.

Result

The Percentage mean score of the person-centered maternity care scale of the respondents was 64% of the total expected score. Whereas, the percentage means score sub-scales were 81.9%, for dignity and respect, 56.4% for communication and autonomy and 61.6% for supportive care. Most mothers who participated in an in-depth interview reported that there is not enough bed, delivery coach and bedpan in government hospitals.

Conclusion and recommendations

Person-centered maternity care in health facilities of South Wollo Zone public hospitals is low. Therefore, responsible health sectors should work to improve the quality of care through effective communication between clients and providers and a supportive environment is crucial to succeeding in increasing the uptake of high-quality facility-based births.

Experiences of women with physical disabilities accessing prenatal care in low- and middle-income countries

INTRODUCTION

Women with physical disabilities experience barriers to accessing patient-centered and accommodative care during the prenatal and childbirth periods. While there is a growing body of work in high-income countries to address these needs, there is little research detailing specific challenges in low- and middle-income countries (LMICs) where a woman's' burden- and need-is greatest.

METHODS

We conducted an integrative review to synthesize the experiences of women with physical disabilities accessing prenatal care and childbirth services in LMICs. Five databases were searched for systematic reviews, retrospective cohort studies, cross-sectional studies, narrative literature reviews, as well as other evidence types. We used Ediom's EvidenceEngine™, a machine-assisted search engine that uses artificial intelligence to conduct this search using pertinent keywords to identify original research published between January 2009 - September 2018. These results were augmented by hand searching of reference lists. Forty articles were identified using this method and 11 retained after duplicates were removed and inclusion and exclusion criteria applied.

RESULTS

Four types of experiences are described in these 11 studies: (1) limited physical and material resources; (2) health care worker knowledge, attitudes, and skills; (3) pregnant people's knowledge; and (4) public stigma and ignorance.

DISCUSSION

People with physical disabilities face specific challenges during pregnancy and childbirth. Importantly, these findings offer targets for enhanced clinical training for nurses, midwives, traditional birth attendants and public health workers, as well as opportunities for the improved delivery of prenatal care and childbirth services to these vulnerable women.

Dignity in nursing: A bibliometric and visual analysis of scientific publications

BACKGROUND

Dignity-conserved nursing has been widely studied by scholars all over the world; however, there is no clear direction in which this field is trending.

AIM

To conduct a bibliometric analysis that systematically characterises publications on dignity research in the nursing field from 2011 to 2020.

DESIGN

Bibliometric and visual analysis of retrieved articles.

METHODS

The Web of Science Core Collection database was used to retrieve all articles which addressed dignity in nursing from 2011 to 2020. The WoSCC's own analysis tool, CiteSpace and VOSviewer, were used to obtain visual analysis results. Reporting follows the STROBE checklist.

RESULTS

A total of 1429 papers on dignity care are included in this study. We found that the number of papers on this topic increased steadily, and the United States topped the list with 366 articles in total. The institute with the most publications was King's College London, and the most widely published journal was Nursing Ethics. We were able to identify four major research topics, namely dignity in: (a) palliative care, (b) dementia and the elderly, (c) health care and (d) nursing ethics. Terminally ill patient, home, value, rehabilitation and psychological distress were the five keywords with the highest burst strength.

CONCLUSIONS

The interest in dignity care research has been steadily increasing from 2011 and is reflected in the number of published papers. The United States and Western Europe are leading in this field, both having a high number of cutting-edge researchers and high-level scientific research institutions. In the domain of dignity care, several stable and high-yield core author groups have been formed. While the existing research mainly focuses on four hot spots, psychological distress, advanced cancer, maternity care and content analysis may be the research frontiers.

Health Information Seeking by Women with Physical Disabilities: A Qualitative Analysis

BACKGROUND

Health information seeking is critical to medical decision-making and optimal health. Although researchers have begun to explore how people with disabilities search for health information, no studies have investigated health information seeking by women with physical disabilities.

OBJECTIVE

The purpose of this qualitative study was to examine the health information seeking experiences of women with physical disabilities.

METHOD

We conducted a series of semi-structured, online focus group meetings with 21 women with disabilities. Sessions were recorded and transcribed, and data were analyzed using conventional content analysis.

RESULTS

Two broad themes emerged: 1) pathways to information on general health; sexual and reproductive health; as well as bowel, bladder, and other pelvic health issues; and 2) perceived facilitators and barriers to obtaining health information. Information pathways differed by the type of information sought. Internet was a commonly used resource, with a high value placed on social media interaction among peers. Self-advocacy emerged as a prominent facilitator of health information seeking. Barriers identified were lack of disability-related education, limited accessibility, and providers' negative attitudes.

CONCLUSION

This is the first known in-depth qualitative exploration of health information seeking by women with disabilities. Study findings revealed pathways to information commonly used by women with disabilities. The study also identified notable gaps and challenges to health information seeking including the need for improved provider education and training. Findings highlight the importance of the availability and accessibility of high quality, health-related information essential for the health and well-being of women with disabilities.

The maternal health-related issues that matter most to women in Ireland as they transition to motherhood - A qualitative study

BACKGROUND

Many studies on women's maternity care experiences reveal recurring issues that are poor or less than optimal. Women's opinions on the maternal health-related issues that matter most to them are essential if care and services are to be improved.

AIMS

To identify the maternal health-related issues that matter most to women in Ireland, based on their own experiences of maternity care, services and motherhood.

METHODS

A qualitative exploratory study with 24 women. Following university ethical approval, audio-recorded one-to-one telephone interviews were conducted and thematically analysed.

FINDINGS

We identified two themes, each with four subthemes, connected to a central concept of the invisible woman. Pendulum of care, and subthemes Inconsistent services, All about the baby, Induced anxiety and Information seesaw, illustrated the extremes of care and services that women experienced. Magnitude of motherhood, and subthemes Weight of responsibility, Real-time reassurance, Change of identity and Growth into advocacy, depicted the intensity of their new role while transitioning to motherhood.

DISCUSSION

Findings articulate the issues that mattered most to women in Ireland as they transitioned to motherhood. Some women identified specific research topics/areas, but all of the issues identified can be translated into researchable topics that seek to improve local care and service provision.

CONCLUSION

Given the recurring nature of women's less than satisfactory experiences of aspects of maternity care in many countries, it is likely that conducting research on issues that matters most to women will have the greatest impact on their health, wellbeing and lives as they transition to motherhood.

Development of the Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) for evaluating and measuring the impact of physical disability on pregnancy and the management of motherhood: a pilot study

PURPOSE

The aim of this study was to develop a questionnaire that allows researchers to investigate and measure the impact of physical disability on pregnancy and the management of motherhood. Such a questionnaire requires good internal consistency.

METHODS

The tool was developed following a study conducted in 2013 in the United States consisting of a semi-structured interview with open-ended questions. A team of three experts drafted and refined the questions, generating 31 retrospective, self-rated, and predefined questions (answered using a 5-point Likert scale). A statistical analysis of the instrument was also included, to assess its reliability and internal consistency.

RESULTS

The Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) was prepared. It is a self-administered questionnaire consisting of an initial section and three subscales. In this phase of the study, 35 women with different pathologies leading to physical disability were recruited and completed the questionnaire. The PMEQ was found to have a good internal consistency. Cronbach's α was 0.812 (p > 0.05).

CONCLUSION

The PMEQ has proven to be a valid, reliable, and rapid administrative tool useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.IMPLICATION FOR REHABILITATIONThis study provides researchers and clinicians a new tool for the evaluation of motherhood and pregnancy in women with physical disabilities.The PMEQ has proven to be a valid, reliable, and rapid administrative tool (10 min) useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.It is a new tool useful in both clinical and research practice to underline the importance of carrying out preventive and woman-centered assistance interventions.This tool is useful for promoting the autonomous management of pregnancy and motherhood in women with physical disabilities, and improving these women's quality of life and sense of satisfaction and competence in managing maternal tasks.