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Amoakoh HB, De Kok BC, Yevoo LL, Olde Loohuis KM, Srofenyoh EK, Arhinful DK, Koi-Larbi K, Adu-Bonsaffoh K, Amoakoh-Coleman M, Browne JL. Co-creation of a toolkit to assist risk communication and clinical decision-making in severe preeclampsia: SPOT-Impact study design. Glob Health Action 2024; 17:2336314. [PMID: 38717819 PMCID: PMC11080670 DOI: 10.1080/16549716.2024.2336314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 03/25/2024] [Indexed: 05/12/2024] Open
Abstract
Globally, the incidence of hypertensive disorders of pregnancy, especially preeclampsia, remains high, particularly in low- and middle-income countries. The burden of adverse maternal and perinatal outcomes is particularly high for women who develop a hypertensive disorder remote from term (<34 weeks). In parallel, many women have a suboptimal experience of care. To improve the quality of care in terms of provision and experience, there is a need to support the communication of risks and making of treatment decision in ways that promote respectful maternity care. Our study objective is to co-create a tool(kit) to support clinical decision-making, communication of risks and shared decision-making in preeclampsia with relevant stakeholders, incorporating respectful maternity care, justice, and equity principles. This qualitative study detailing the exploratory phase of co-creation takes place over 17 months (Nov 2021-March 2024) in the Greater Accra and Eastern Regions of Ghana. Informed by ethnographic observations of care interactions, in-depth interviews and focus group and group discussions, the tool(kit) will be developed with survivors and women with hypertensive disorders of pregnancy and their families, health professionals, policy makers, and researchers. The tool(kit) will consist of three components: quantitative predicted risk (based on external validated risk models or absolute risk of adverse outcomes), risk communication, and shared decision-making support. We expect to co-create a user-friendly tool(kit) to improve the quality of care for women with preeclampsia remote from term which will contribute to better maternal and perinatal health outcomes as well as better maternity care experience for women in Ghana.
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Affiliation(s)
- Hannah Brown Amoakoh
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Bregje C. De Kok
- Anthropology Department, University of Amsterdam, Amsterdam, Netherlands
| | - Linda Lucy Yevoo
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Klaartje M. Olde Loohuis
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Emmanuel K. Srofenyoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, Greater Accra Regional Hospital, Accra, Ghana
| | - Daniel K. Arhinful
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | | | - Kwame Adu-Bonsaffoh
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Accra, Ghana
| | - Mary Amoakoh-Coleman
- Department of Epidemiology, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Joyce L. Browne
- Department of Global Health and Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
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Gurung R, Bask M. Does mistreatment during institutional childbirth increase the likelihood of experiencing postpartum depressive symptoms? A prospective cohort study in Nepal. Glob Health Action 2024; 17:2381312. [PMID: 39081240 PMCID: PMC11293266 DOI: 10.1080/16549716.2024.2381312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 07/12/2024] [Indexed: 08/03/2024] Open
Abstract
BACKGROUND Postpartum depression is associated with low socioeconomic status, adverse birthing processes, and life stress. Increasing evidence of mistreatment during childbirth, negative birth experiences, and poor quality of maternal care is of global concern. OBJECTIVE To assess the risk of experiencing depressive symptoms among postpartum women exposed to mistreatment during institutional birthing in Nepal. METHOD We conducted a prospective cohort study from 29 March to 19 August 2022. Of 1629 women who gave birth in a hospital in Nepal, 1222 were assessed for mistreatment during childbirth and depressive symptoms using the Edinburgh Postnatal Depression Scale. We used binomial generalized linear mixed model to examine the risk ratio of postpartum depressive symptoms in women exposed to mistreatment during childbirth. RESULTS The prevalence of postpartum depressive symptoms was 4.4%. Women exposed to mistreatment during childbirth were almost fifty percent more likely to have postpartum depressive symptoms (cRR 1.47; 95% CI 1.14, 1.89; p = 0.003) compared with the unexposed group. Furthermore, adolescent mothers exposed to mistreatment during childbirth had a seventy percent increased risk of depressive symptoms (aRR 1.72; 95% CI 1.23, 2.41; p = 0.002). Similarly, women who gave birth to female infants were thirty percent more likely to experience postpartum depressive symptoms (aRR 1.32; 95% CI 1.01-1.74; p = 0.039). CONCLUSION We observed an association between postpartum depressive symptoms and mistreatment during institutional births in Nepal. The implementation of appropriate respectful maternity care during childbirth and also routine screening for depressive symptoms is critical to improving perinatal mental health and well-being.
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Affiliation(s)
- Rejina Gurung
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
- Research Division, Golden Community, Lalitpur, Nepal
| | - Miia Bask
- Department of Sociology, Uppsala University, Uppsala, Sweden
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González-Mesa E, González-Cazorla A, González-Cazorla E, Mozas-Moreno J, Gokce Isbir G, Abreu W, Lubián-López D. Contribution of the abbreviated CAVE-st questionnaire in Spanish: the attitudes toward childbirth experiences. J Psychosom Obstet Gynaecol 2024; 45:2380860. [PMID: 39044401 DOI: 10.1080/0167482x.2024.2380860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 07/11/2024] [Indexed: 07/25/2024] Open
Abstract
There are several factors that influence women's childbirth experience, and personal interactions with health professionals are of particular significance. The main objective of this study was to present the validation of an abbreviated form of an existing questionnaire on attitudes about childbirth in medical and nursing students. We used a sample of 512 perinatal medicine and nursing students who received the original 52-item CAVE-st questionnaire to obtain a shorter version with proper psychometric properties. We used Cronbach's alpha coefficient to evaluate the new version's internal consistency. The Kaiser- Meyer-Olkin test and the Barlett sphericity test were performed to assess the suitability of exploratory factor analysis (EFA). Subsequently, confirmatory factor analysis (CFA) was performed using structural equation models in a second sample of 139 medical students. We obtained a 15-item version with a Cronbach's alpha of 0.82. The EFA revealed a four-dimensional structure, similar to the full 52-item version. In the CFA the adjustment indexes showed good model fitness, RMSEA= 0.046 [CI 0.00-0.07]; CFI = 0.978. We can conclude that the 15-item version is a valid tool for evaluating the attitude of students toward childbirth, pointing out the matters that should be improved in their training to avoid obstetric trauma by the promotion of a positive experience in women during childbirth.
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Affiliation(s)
- Ernesto González-Mesa
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
- Grupo de investigación en Medicina Materno-fetal, epigenética, enfermedades de la mujer y salud reproductiva, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain
- UGC Obstetricia y Ginecología, Hospital Regional Universitario de Málaga, Málaga, Spain
| | - Ana González-Cazorla
- School of Medicine, Obstetrics and Gynecology Department, University of Malaga, Málaga, Spain
| | | | - Juan Mozas-Moreno
- School of Medicine, Obstetrics and Gynecology Department, University of Granada, Granada, Spain
| | | | - Wilson Abreu
- Psychology School, Centro de Investigacao en Tecnologias y Servicios de Saude, Porto University, Porto, Portugal
| | - Daniel Lubián-López
- Obstetrics and Gynecology Department, University Hospital of Jerez de la Frontera, Cádiz, Spain
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Jacques M, Chantry AA, Evrard A, Lelong N, Le Ray C. Consent for interventions during childbirth: A national population-based study. Int J Gynaecol Obstet 2024. [PMID: 39092580 DOI: 10.1002/ijgo.15830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 05/15/2024] [Accepted: 07/15/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVE To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. METHODS The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. RESULTS Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). CONCLUSION Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.
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Affiliation(s)
- Marianne Jacques
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Anne Alice Chantry
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
- Midwifery University Department, Université Paris Cité, Paris, France
| | - Anne Evrard
- Collectif Interassociatif Autour de la Naissance (CIANE), Paris, France
| | - Nathalie Lelong
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
| | - Camille Le Ray
- Université Paris Cité, Inserm, Center for Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), Paris, France
- Maternité Port Royal, Hôpital Cochin Port Royal, Assistance Publique-Hôpitaux de Paris, Université Paris Cité, Paris, France
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Fors M, Falcón K, Brandao T, López M, Mena-Tudela D. Investigating Obstetric Violence in Ecuador: A Cross-Sectional Study Spanning the Last Several Years. Healthcare (Basel) 2024; 12:1480. [PMID: 39120183 PMCID: PMC11311404 DOI: 10.3390/healthcare12151480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 07/01/2024] [Accepted: 07/09/2024] [Indexed: 08/10/2024] Open
Abstract
This pilot cross-sectional study was designed to determine the profile of obstetric violence in Ecuador in recent years. An online survey was conducted between March 2022 and April 2022, including women over 18 years who granted their informed consent to participate (n = 1598). We used non-probabilistic sampling to obtain our sample. Fisher's exact test was performed to assess the association between violence and type of birth, healthcare facility, and education level. Out of the women who participated in the study, 89.2% (n = 1426) identified themselves as Mestiza. Additionally, 88.3% (n = 1411) had completed university-level education. The majority of the participants, specifically 63.6% (n = 1017), received their care in public institutions, and 98.2% (n = 1569) reported structural negligence, while 74.5% (n = 1190) reported violation of their right to information. The entire sample affirmed to have experienced violation of the right of presence. This report shows that obstetric violence is present in Ecuador in different ways and that women experience negligence and violation of their right to receive ethical healthcare during childbirth.
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Affiliation(s)
- Martha Fors
- Medical School, Universidad de Las Américas, Quito 170503, Ecuador
| | - Kirsten Falcón
- Facultad de Ciencias Médicas, Universidad de Las Américas, Quito 170503, Ecuador;
| | - Thais Brandao
- Departamento de Psicología, Universidad de Las Américas, Quito 170503, Ecuador;
| | - Maria López
- Departamento de Enfermería, Universidad de Las Américas, Quito 170503, Ecuador;
| | - Desirée Mena-Tudela
- Departamento de Enfermería, Universidad Jaume I, 12006 Castelló de la Plana, Spain;
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Thomson G, Balaam MC. Researchers' perspectives of self-agency within a context of violence and harm in maternity care. Midwifery 2024; 137:104120. [PMID: 39089175 DOI: 10.1016/j.midw.2024.104120] [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: 03/08/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/03/2024]
Abstract
PROBLEM There is an increasing awareness of the prevalence of obstetric violence within maternity care and that some women and birthing people are at greater risk of experiencing violence and harm. BACKGROUND Supporting self-agency for women and birthing people in maternity care may be a way of addressing the disparities in vulnerability to violence and harm. AIM To explore researchers' perspectives of self-agency for women from different backgrounds, what inhibits and prevents self-agency, and how self-agency can be enabled. METHODS A qualitative research design was undertaken underpinned by a reproductive justice framework. Group interviews were held with researchers working with perinatal women/birthing people with histories and experiences of violence and abuse. Reflexive thematic analysis using Bronfenbrenner's ecological systems theory was undertaken. FINDINGS 12 participants took part in two group interviews. Two themes were developed: 'defining self-agency' and 'ecological influences on self-agency'. DISCUSSION The findings identify how self-agency should not be perceived as an intrinsic attribute, but rather is underpinned by exogenous and endogenous influences. Whether and how self-agency is enacted is determined by interacting factors that operate on a micro, meso and macro level perspective. Self-agency is undermined by factors including immigration policies and sociocultural perspectives that can lead to under-resourced and judgemental care, other intersectional factors can also lead to some individuals being more vulnerable to violence and harm. CONCLUSION Implications from this work include strategies that emphasise woman-centred care, staff training and meaningful organisational change to optimise positive health and wellbeing.
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Affiliation(s)
- Gill Thomson
- MAINN research unit, School of Nursing and Midwifery, University of Central Lancashire, Preston PR2 1SG, UK.
| | - Marie-Clare Balaam
- ReaCH unit, School of Nursing and Midwifery, University of Central Lancashire, Preston, UK
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Chervenak FA, Grünebaum A. Rethinking "Obstetric violence": a misnomer indeed. Am J Obstet Gynecol 2024:S0002-9378(24)00756-7. [PMID: 39009330 DOI: 10.1016/j.ajog.2024.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 07/09/2024] [Indexed: 07/17/2024]
Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
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8
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Collins EC, Burns ES, Dahlen HG. 'It was horrible to watch, horrible to be a part of': Midwives' perspectives of obstetric violence. Women Birth 2024; 37:101631. [PMID: 38861852 DOI: 10.1016/j.wombi.2024.101631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 05/02/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND Obstetric violence, including unconsented interventions, coercion and disrespect, violates human rights; impacting the physical and psychosocial health of women. The perspective and experience of midwives related to obstetric violence have been explored in low and middle-income countries, with limited research into the experience of midwives in high income nations. AIM To explore Australian midwives' perspectives of obstetric violence. METHODS Thematic analysis of qualitative in-depth interviews with 15 midwives experienced in supporting women during birth. Critical feminist theory underpinned each stage of the research. FINDINGS Interviews with 15 Australian midwives from diverse care settings were analysed thematically. Four key themes were developed from the data: 'the operationalisation of obstetric violence', 'the impact of obstetric violence' 'the historical and situational context' and 'hope for the future'. Midwives considered entrenched patriarchal structures and gender inequity as fundamental to the occurrence of obstetric violence. This societal scaffold is intensified within health care systems where power imbalances facilitate maternal mistreatment through coercion and grooming women for compliance in the antenatal period. Fragmented care models expose women to mistreatment with continuity models being protective only to a point. Midwives experience their own trauma, as a result of what they have witnessed, and due to the lack of support they receive when advocating for women. CONCLUSIONS Obstetric violence occurs in Australian maternity systems with unconsented interventions, overmedicalisation, coercion, and disrespect observed by midwives. Care-related trauma impacts on the mental health of midwives, raising workforce concerns for policy makers, consumer advocates and professional bodies.
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Affiliation(s)
- Emma C Collins
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2715, Australia.
| | - Elaine S Burns
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2715, Australia
| | - Hannah G Dahlen
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2715, Australia
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Kruk ME, Sabwa S, Lewis TP, Aniebo I, Arsenault C, Carai S, Garcia PJ, Garcia-Elorrio E, Fink G, Kassa M, Mohan S, Moshabela M, Oh J, Pate MA, Nzinga J. Population assessment of health system performance in 16 countries. Bull World Health Organ 2024; 102:486-497B. [PMID: 38933481 PMCID: PMC11197641 DOI: 10.2471/blt.23.291184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 03/06/2024] [Accepted: 03/21/2024] [Indexed: 06/28/2024] Open
Abstract
Objective To demonstrate how the new internationally comparable instrument, the People's Voice Survey, can be used to contribute the perspective of the population in assessing health system performance in countries of all levels of income. Methods We surveyed representative samples of populations in 16 low-, middle- and high-income countries on health-care utilization, experience and confidence during 2022-2023. We summarized and visualized data corresponding to the key domains of the World Health Organization universal health coverage framework for health system performance assessment. We examined correlation with per capita health spending by calculating Pearson coefficients, and within-country income-based inequities using the slope index of inequality. Findings In the domain of care effectiveness, we found major gaps in health screenings and endorsement of public primary care. Only one in three respondents reported very good user experience during health visits, with lower proportions in low-income countries. Access to health care was rated highest of all domains; however, only half of the populations felt secure that they could access and afford high-quality care if they became ill. Populations rated the quality of private health systems higher than that of public health systems in most countries. Only half of respondents felt involved in decision-making (less in high-income countries). Within countries, we found statistically significant pro-rich inequalities across many indicators. Conclusion Populations can provide vital information about the real-world function of health systems, complementing other system performance metrics. Population-wide surveys such as the People's Voice Survey should become part of regular health system performance assessments.
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Affiliation(s)
- Margaret E Kruk
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Shalom Sabwa
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Todd P Lewis
- Harvard TH Chan School of Public Health, 665 Huntington Ave, Boston, MA02115, United States of America (USA)
| | - Ifeyinwa Aniebo
- Ministry of Health and Social Welfare of Nigeria, Abuja, Nigeria
| | - Catherine Arsenault
- Milken Institute School of Public Health, George Washington University, WashingtonDC, USA
| | - Susanne Carai
- WHO Office on Quality of Care and Patient Safety, Athens, Greece
| | | | | | - Günther Fink
- University of Basel and Swiss Tropical and Public Health Institute, Allschwil, Switzerland
| | | | | | - Mosa Moshabela
- College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Juhwan Oh
- Seoul National University College of Medicine, Seoul, Republic of Korea
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Patel SJ, Truong S, DeAndrade S, Jacober J, Medina M, Diouf K, Meadows A, Nour N, Schantz-Dunn J. Respectful Maternity Care in the United States-Characterizing Inequities Experienced by Birthing People. Matern Child Health J 2024; 28:1133-1147. [PMID: 38409453 DOI: 10.1007/s10995-023-03893-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 02/28/2024]
Abstract
OBJECTIVE The purpose of this study is to understand experiences of respectful maternity care (RMC) from the perspective of birthing people in the United States from 2013 to 2018. METHODS We conducted an online cross-sectional survey of United States birthing people ages 18-50 in April 2018 using SurveyMonkey Audience. Quantitative survey data consisted of demographics and responses to RMC indicators. Qualitative data consisted of comments from individuals regarding their birth experiences. RESULTS 1036 birthing people participated in the survey. Most births (95%) occurred in hospitals. 16.3% of Black or African American participants reported discrimination compared to 5.5% of participants who did not identify as Black or African American (p < 0.001). Participants who speak a language other than English were also more likely to report discrimination. 19.5% of all respondents felt neglected during their birth experience. Most prevalent experiences of disrespect and mistreatment were related to neglect (most commonly in postpartum phase of care), poor interpersonal communication, lack of respect for patient wishes, negative experience with breastfeeding services, peripartum complications, and discrimination. CONCLUSION FOR PRACTICE Birthing people in the United States experience many forms of mistreatment, particularly those who identify as Black or African American or speak a language other than English. Patients described experiencing neglect most commonly after birth-an opportunity to improve the provision of RMC postpartum. Strategies to improve quality of maternal health care in the United States should include the provision of RMC as part of a larger effort to reduce inequities in maternal health experiences and outcomes.
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Affiliation(s)
- Suha J Patel
- Department of Obstetrics and Gynecology, Kaiser Permanente Hawaii, Honolulu, HI, 96814, USA
| | - Samantha Truong
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA.
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, 02114, USA.
| | - Samantha DeAndrade
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, 02114, USA
| | - Julianne Jacober
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Matthew Medina
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Khady Diouf
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Audra Meadows
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Nawal Nour
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Julianna Schantz-Dunn
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston, MA, 02115, USA
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11
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Nabirye RC, Mbalinda SN, Epuitai J, Nawagi F, Namyalo S, Nove A, Bazirete O, Hughes K, Lopes SC, Turkmani S, Forrester M, Homer CSE. Perceptions of quality of care in Midwife-led Birth Centres (MLBCs) in Uganda: Why do women choose MLBCs over other options? Women Birth 2024; 37:101612. [PMID: 38615515 PMCID: PMC11266915 DOI: 10.1016/j.wombi.2024.101612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Midwife-led birth centres (MLBCs) are associated with reduced childbirth interventions, higher satisfaction rates, and improved birth outcomes. The evidence on quality of care in MLBCs from low and middle-income countries (LMIC) is limited. AIM This study aimed to explore the perceptions of women and midwives regarding the quality of care in four MLBCs in Uganda. METHODS A qualitative study was conducted in four MLBCs in Uganda. We conducted interviews with women and midwives in the MLBCs to explore their perceptions and experiences related to care in the MLBCs. The study obtained ethical approval. Deductive thematic analysis was used for data analysis. RESULTS Three key themes were identified regarding the perceptions of women and midwives about the quality of care in the MLBCs: providing respectful, and dignified care; a focus on woman-centred care; and reasons for choosing care in the MLBC. Women valued the respectful and humane care characterised by dignified and non-discriminatory care, non-abandonment, privacy, and consented care. The woman-centred care in the MLBC involved individualised holistic care, providing autonomy and empowerment, continuity of care, promoting positive birth experience, confidence in the woman's own abilities, and responsive providers. Women chose MLBCs because the services were perceived to be available, accessible, affordable, with comprehensive and effective referral mechanisms. CONCLUSION Women perceived care to be respectful, woman-centred, and of good quality. Global attention should be directed to scaling up the establishment of MLBCs, especially in LMIC, to improve the positive childbirth experience and increase access to care.
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Affiliation(s)
| | | | | | | | - Sarah Namyalo
- Uganda Private Midwives Association, Kampala, Uganda
| | | | - Oliva Bazirete
- Novametrics Ltd, Duffield, United Kingdom; University of Rwanda, Kigali, Rwanda
| | | | | | - Sabera Turkmani
- Faculty of Health, University of Technology Sydney, Sydney, Australia; Burnet Institute, Melbourne, Australia
| | - Mandy Forrester
- International Confederation of Midwives, The Hague, Netherlands
| | - Caroline S E Homer
- Faculty of Health, University of Technology Sydney, Sydney, Australia; Burnet Institute, Melbourne, Australia
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12
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Yalley AA, Jarašiūnaitė-Fedosejeva G, Kömürcü-Akik B, de Abreu L. Addressing obstetric violence: a scoping review of interventions in healthcare and their impact on maternal care quality. Front Public Health 2024; 12:1388858. [PMID: 38979044 PMCID: PMC11228167 DOI: 10.3389/fpubh.2024.1388858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 06/10/2024] [Indexed: 07/10/2024] Open
Abstract
Background The mistreatment and abuse of women during childbirth have been recognized as a major global health challenge, impeding facility-based delivery and contributing to the high maternal mortalities globally. The World Health Organization has specifically called for interventions to deal with obstetric violence. This scoping review consolidates the existing literature on interventions aimed at reducing obstetric violence and synthesizes existing knowledge on their impact in promoting respectful maternity care. Methodology Thirteen electronic databases were searched for relevant articles from January 2001 to March 2023. A total of 863 records were identified, and 72 full-text articles were retrieved for further screening. The review includes 16 studies, particularly from low- and middle-income countries, with interventions implemented at medical facilities and involving both women and healthcare providers. Eight of the studies were quantitative, three were qualitative and five used a mixed-methods approach. Findings The results reveal a promising trend in reducing obstetric violence through various interventions. Ten different types of interventions were identified, highlighting strategies to improve the quality of maternity care and enhance patient-centered care. Improved patient-provider communication skills, increased privacy measures, and reduced abuse and mistreatment emerged as common themes. Enhanced communication skills, including open discussions and the right to be informed, were crucial in reducing obstetric violence. Privacy measures, such as separate rooms, curtains, and birth companions effectively decreased incidents of non-confidential care. General abuse and mistreatment, including physical abuse and neglect, were also reduced, leading to improved perceptions of respectful care during childbirth. Conclusion Overall, the interventions had a favorable impact on obstetric violence reduction and women's childbirth experiences. However, despite promising results, obstetric violence remains prevalent worldwide, necessitating more efforts to implement effective interventions. To the best of our knowledge, this is the first scoping review on obstetric violence interventions, providing a comprehensive overview of the state of the art. We suggest that further research is needed to explore new interventions, particularly gender-sensitive interventions, to contribute to a growing body of knowledge on the prevention of obstetric violence.
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Affiliation(s)
- Abena Asefuaba Yalley
- Zukunftskolleg, University of Konstanz, Konstanz, Germany
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
| | | | | | - Liliana de Abreu
- Department of Politics and Public Administration, University of Konstanz, Konstanz, Germany
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Häggsgård C, Rubertsson C, Teleman P, Edqvist M. Informed consent to midwifery practices and interventions during the second stage of labor-An observational study within the Oneplus trial. PLoS One 2024; 19:e0304418. [PMID: 38865296 PMCID: PMC11168622 DOI: 10.1371/journal.pone.0304418] [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: 07/29/2023] [Accepted: 05/12/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and experiences of these practices and interventions and women's experiences of the second stage of labor. METHODS This study uses an observational design with data from a follow-up questionnaire sent to women one month after giving birth spontaneously in the Oneplus trial, a study aimed at evaluating collegial midwifery assistance to reduce severe perineal trauma. The trial was conducted between 2018-2020 at five Swedish maternity wards and trial registered at clinicaltrials.gov, no NCT03770962. The follow-up questionnaire contained questions about experiences of the second stage of labor, practices and interventions used and whether the women had provided informed consent. Evaluated practices and interventions were the use of warm compresses held at the perineum, manual perineal protection, vaginal examinations, perineal massage, levator pressure, intermittent catheterization of the bladder, fundal pressure, and episiotomy. Associations between informed consent and women's experiences were assessed by univariate and multivariable logistic regression. FINDINGS Of the 3049 women participating in the trial, 2849 consented to receive the questionnaire. Informed consent was reported by less than one in five women and was associated with feelings of being safe, strong, and in control. Informed consent was further associated with more positive experiences of clinical practices and interventions, and with less discomfort and pain from interventions involving physical penetration of the genital area. CONCLUSION The findings indicate that informed consent during the second stage is associated with feelings of safety and of being in control. With less than one in five women reporting informed consent to all practices and interventions performed by midwives, the results emphasize the need for further action to enhance midwives' knowledge and motivation in obtaining informed consent prior to performance of interventions.
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Affiliation(s)
- Cecilia Häggsgård
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden
| | - Christine Rubertsson
- Department of Health Sciences, Medical Faculty, Lund University, Lund, Sweden
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden
| | - Pia Teleman
- Department of Obstetrics and Gynecology, Skane University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Malin Edqvist
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Women´s Health and Health Professions, Karolinska University Hospital, Stockholm, Sweden
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Thorgaard-Rasmussen K, Alvesson HM, Pembe AB, Mselle LT, Unkels R, Metta E, Alwy Al-Beity FM. Women's and maternity care providers' perceptions of pain management during childbirth in hospitals in Southern Tanzania. BMC Pregnancy Childbirth 2024; 24:417. [PMID: 38858626 PMCID: PMC11163787 DOI: 10.1186/s12884-024-06606-9] [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: 01/10/2023] [Accepted: 05/26/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND The majority of women experience pain during childbirth. Offering and supporting women to use different methods for coping with pain is an essential competency for maternity care providers globally. Research suggests a gap between what women desire for pain management and what is available and provided in many low-and middle-income settings. The study aimed to understand how pain management is perceived by those involved: women experiencing childbirth and maternity care providers. METHODS Individual semi-structured interviews with women (n = 23), maternity care providers (n = 17) and focus group discussions (n = 4) with both providers and women were conducted in two hospitals in Southern Tanzania in 2021. Transcribed interviews were analysed using reflexive thematic analysis. Coding and analysis were supported by the software MAXQDA. RESULTS Three main themes were generated from the data. The first, 'pain management is multifaceted', describes how some providers and women perceived pain management as entailing various methods to manage pain. Providers perceived themselves as having a role in utilization of pain management to varying degree. The second theme 'pain management is primarily a woman's task' highlights a perception of pain management as unnecessary, which appeared to link with some providers' perceptions of pain as natural and necessary for successful childbirth. Few women explicitly shared this perception. The third theme 'practice of pain management can be improved' illustrates how women and maternity care providers perceived current practices of pain management as suboptimal. According to providers, this is primarily due to contextual factors such as shortage of staff and poor ward infrastructure. CONCLUSION Women's and maternity care providers' perceptions ranged from perceiving pain management as involving a combination of physiological, psychological and social aspects to perceive it as related with limited to no pain relief and/or support. While some women and providers had similar perceptions about pain management, other women also reported a dissonance between what they experienced and what they would have preferred. Efforts should be made to increase women's access to respectful pain management in Tanzania.
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Affiliation(s)
| | | | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lilian T Mselle
- Department of Clinical Nursing, School of Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Regine Unkels
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden
| | - Emmy Metta
- Department of Behavioural Sciences, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fadhlun M Alwy Al-Beity
- Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden.
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Barabara ML, Cohen SR, Masenga G, Minja LM, Mlay PS, Stephens MJ, Olomi GA, Mlay J, Marchand V, Weglarz A, Hanson O, Mmbaga BT, Watt MH. Factors associated with respectful maternity care and influence of HIV status among women giving birth in Kilimanjaro, Tanzania. Birth 2024; 51:307-318. [PMID: 37902177 PMCID: PMC11058110 DOI: 10.1111/birt.12787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/25/2023] [Accepted: 09/26/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND Respectful maternity care (RMC) is a rights-based approach to childbirth that centers the dignity, autonomy, and well-being of birthing women. This study aimed to examine factors associated with RMC among women giving birth in Tanzania and to examine whether HIV status was associated with self-reported RMC. METHODS We enrolled 229 postpartum women in six clinics in the Kilimanjaro Region; of them, 103 were living with HIV. Participants completed a survey within 48 h after birth before being discharged. RMC was measured using a 30-item scale with three subscales (dignity and respect; supportive care; communication and autonomy), each standardized from 0 to 100. Univariable and multivariable regression models examined factors associated with RMC. RESULTS The median score of the full RMC score was 74, differing slightly by subscale: 83 for dignity and respect, 76 for supportive care, and 67 for communication and autonomy. RMC did not differ by HIV status (median 67.0 vs. 67.0, p = 0.89). In multivariable linear regression, women who would not recommend the birth facility to their friends and who did not receive breastfeeding education had significantly lower RMC scores on the full RMC scale. In the dignity and respect subscale, variables associated with significantly lower RMC scores were not being able to read and write, delivering in a public facility, and delivering vaginally. CONCLUSIONS Although self-reported RMC was generally high, we identified areas for improvement. Practitioners need ongoing training on RMC principles and the delivery of equitable care.
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Affiliation(s)
- Mariam L. Barabara
- Kilimanjaro Christian Medical University College, Tanzania - PhD candidate
| | - Susanna R. Cohen
- University of Utah, Department of Obstetrics and Gynecology, Utah – Research Associate Professor
| | - Gileard Masenga
- Kilimanjaro Christian Medical Center Consultant Hospital, Tanzania – Executive Director
| | - Linda M. Minja
- Kilimanjaro Clinical Research Institute, Moshi, Tanzania – Statistician
| | - Pendo S. Mlay
- Kilimanjaro Christian Medical Center, Department of Obstetrics and Gynecology, Tanzania – Chair and Consultant Obstetric and Gynaecologist
| | - Maya J. Stephens
- University of Utah, Department of Population Health Sciences, Utah – Research Coordinator
| | - Gaudensia A. Olomi
- Kilimanjaro Regional Secretary’s Office – Health Management Department, Tanzania – Regional Nursing Officer and Regional Research Director
| | - Janeth Mlay
- Kilimanjaro Clinical Research Institute, Tanzania – Research Assistant
| | | | - Anya Weglarz
- University of Utah, Department of Population Health Sciences, Utah – Research Assistant
| | - Olivia Hanson
- University of Utah, Department of Population Health Sciences, Utah – Research Assistant
| | | | - Melissa H. Watt
- University of Utah, Department of Population Health Sciences, Utah - Research Associate Professor
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Hijazi H, Al-Yateem N, Al Abdi R, Baniissa W, Alameddine M, Al-Sharman A, AlMarzooqi A, Subu MA, Ahmed FR, Hossain A, Sindiani A, Hayajneh Y. 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. Health Expect 2024; 27:e14103. [PMID: 38872450 PMCID: PMC11176592 DOI: 10.1111/hex.14103] [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: 11/23/2023] [Revised: 04/16/2024] [Accepted: 05/26/2024] [Indexed: 06/15/2024] Open
Abstract
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.
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Affiliation(s)
- Heba Hijazi
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Nabeel Al-Yateem
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Rabah Al Abdi
- Department of Electrical, Computer, and Biomedical Engineering, College of Engineering, Abu Dhabi University, Abu Dhabi, UAE
- Department of Biomedical Engineering, Faculty of Engineering, Jordan University of Science and Technology, Irbid, Jordan
| | - Wegdan Baniissa
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Mohamad Alameddine
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Alham Al-Sharman
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Rehabilitation Sciences Department, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Alounoud AlMarzooqi
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Muhammad Arsyad Subu
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Fatma Refaat Ahmed
- Nursing Department, College of Health Sciences, University of Sharjah, Sharjah, UAE
- Critical Care and Emergency Nursing Department, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Ahmed Hossain
- Department of Health Care Management, College of Health Sciences, University of Sharjah, Sharjah, UAE
| | - Amer Sindiani
- Department of Obstetrics and Gynsecology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Yaseen Hayajneh
- Ancell School of Business, Western Connecticut State University, Danbury, Connecticut, USA
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Khan Z, Lanceley A, Maslowski K, Hutton L, Nicholls J. Consent in pregnancy: A qualitative study of the experiences of ethnic minority women. PATIENT EDUCATION AND COUNSELING 2024; 123:108234. [PMID: 38479037 DOI: 10.1016/j.pec.2024.108234] [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: 05/19/2023] [Revised: 02/23/2024] [Accepted: 02/28/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE Consent in ante-natal and birthing contexts is often challenging, controversial and poorly understood. Increasing evidence indicates that ethnic minority women's overall experiences of ante-natal care are unsatisfactory, but little is known about their involvement in the consent process. This study aims to explore the views and experiences of ethnic minority women when making decisions requiring their consent. DESIGN Qualitative interview study SETTING: A national study conducted in the UK SAMPLE: Seventeen self-selecting ethnic minority women who had given birth in a UK hospital in the previous 12 months. METHODS In-depth telephone interviews with seventeen women. A thematic analysis was conducted with a focus on women's experiences of the consent process. RESULTS Three themes were identified. 1. Compromised choice: women experienced limited choice; some women were not asked for their consent at all, or consent was presumed. 2. Pressured consent and silencing: women reported feeling undermined and 'othered' based on their ethnicity. 3. Impersonal consent: discussions were impersonal and not tailored to women as individuals; some women suggested that healthcare professionals ignored cultural concerns which were important to them. PRACTICE IMPLICATIONS There is an urgent need for healthcare professionals to be supported in actively facilitating consent consultations which enable women from ethnic minority backgrounds to freely voice their concerns and priorities without censure. CONCLUSIONS This exploratory study is a first step towards understanding how consent is experienced by ethnic minority women. Many women's experiences reflected failure of healthcare professionals to support genuine choice-making which was perceived to be further undermined by negativity related to women's ethnicity and cultural identity. There is a need for further research focusing on the consent experiences of specific ethnic minority groups.
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Affiliation(s)
- Zahra Khan
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK
| | - Anne Lanceley
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK
| | - Katherine Maslowski
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK
| | - Lily Hutton
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK
| | - Jacqueline Nicholls
- EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, Medical School Building, 74 Huntley Street, London WC1E 6AU, UK.
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Kabale WD, Bekele GG, Gonfa DN, Yami AT. Person-centered maternity care during childbirth and associated factors at public hospitals in central Ethiopia. SAGE Open Med 2024; 12:20503121241257790. [PMID: 38826831 PMCID: PMC11143871 DOI: 10.1177/20503121241257790] [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: 11/09/2023] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Abstract
Objectives Person-centered maternity care during childbirth is crucial for improving maternal and newborn health outcomes. Therefore, this study was aimed at assessing the determinants of person-centered maternity care in Central Ethiopia. Methods An institutional-based cross-sectional study was conducted in public hospitals in Central Ethiopia from 30 January to 1 March 2023. A systematic random sampling technique was employed to enroll the study participants. Data were collected through face-to-face interviews using a structured questionnaire. After data collection, it was checked for completeness and consistency, then coded and entered into Epi Data version 4.4.2 and exported to SPSS version 26 for analysis. Both bivariate and multivariable logistic regressions were used to identify associated factors. Results In this study, a total of 565 participants were involved, resulting in a response rate of 98.77%. The respondents mean score for person-centered maternity care was 60.2, with a 95% CI of (59.1, 62.3). No formal education (β = -2.00, 95% CI: -4.36, -0.69), fewer than four antenatal contacts (β = -4.3, 95% CI: -5.46, -2.37), being delivered at night (β = 2.20, 95% CI: 1.56, 6.45), and complications during delivery (β = -6.00, 95% CI: -9.2, -0.79) were factors significantly associated with lower person-centered maternity care. Conclusion This study revealed that person-centered maternity care is low compared with other studies. Consequently, it is imperative to prioritize initiatives aimed at enhancing awareness among healthcare providers regarding the benchmarks and classifications of person-centered maternity care. Moreover, efforts should be directed toward fostering improved communication between care providers and clients, along with the implementation of robust monitoring and accountability mechanisms for healthcare workers to prevent instances of mistreatment during labor and childbirth.
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Affiliation(s)
- Wogene Daro Kabale
- Department of Midwifery, College of Health Science and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Gemechu Gelan Bekele
- Department of Midwifery, College of Health Science and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Dajane Negesse Gonfa
- Department of Midwifery, College of Health Science and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Amare Tesfaye Yami
- Department of Midwifery, College of Health Science and Referral Hospital, Ambo University, Ambo, Ethiopia
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Abderhalden-Zellweger A, de Labrusse C, Gemperle M, Grylka-Baeschlin S, Pfund A, Mueller AN, Mariani I, Pessa Valente E, Lazzerini M. Women's experiences of disrespect and abuse in Swiss facilities during the COVID-19 pandemic: a qualitative analysis of an open-ended question in the IMAgiNE EURO study. BMC Pregnancy Childbirth 2024; 24:402. [PMID: 38822258 PMCID: PMC11143635 DOI: 10.1186/s12884-024-06598-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 05/21/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in over 20 countries, including Switzerland. AIM This study aims to understand women's experiences of disrespect and abuse in Swiss health facilities during the COVID-19 pandemic. METHODS Data were collected via an anonymous online survey on REDCap®. Women who gave birth between March 2020 and March 2022 and answered an open-ended question in the IMAgiNE EURO questionnaire were included in the study. A qualitative thematic analysis of the women's comments was conducted using the International Confederation of Midwives' RESPECT toolkit as a framework for analysis. FINDINGS The data source for this study consisted of 199 comments provided by women in response to the open-ended question in the IMAgiNE EURO questionnaire. Analysis of these comments revealed clear patterns of disrespect and abuse in health facilities during the COVID-19 pandemic. These patterns include non-consensual care, with disregard for women's choices and birth preferences; undignified care, characterised by disrespectful attitudes and a lack of empathy from healthcare professionals; and feelings of abandonment and neglect, including denial of companionship during childbirth and separation from newborns. Insufficient organisational and human resources in health facilities were identified as contributing factors to disrespectful care. Empathic relationships with healthcare professionals were reported to be the cornerstone of positive experiences. DISCUSSION Swiss healthcare facilities showed shortcomings related to disrespect and abuse in maternal care. The pandemic context may have brought new challenges that compromised certain aspects of respectful care. The COVID-19 crisis also acted as a magnifying glass, potentially revealing and exacerbating pre-existing gaps and structural weaknesses within the healthcare system, including understaffing. CONCLUSIONS These findings should guide advocacy efforts, urging policy makers and health facilities to allocate adequate resources to ensure respectful and high-quality maternal care during pandemics and beyond.
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Affiliation(s)
- Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland.
| | - Claire de Labrusse
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland
| | - Michael Gemperle
- Research Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Susanne Grylka-Baeschlin
- Research Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Anouck Pfund
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Avenue de Beaumont 21, 1011, Lausanne, Switzerland
| | - Antonia N Mueller
- Research Institute of Midwifery and Reproductive Health, ZHAW Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child Health, Institute for Maternaland , Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child Health, Institute for Maternaland , Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child Health, Institute for Maternaland , Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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Ferede WY, Berihun Erega B, Yehuala ED, Yimer TS. An assessment of the provision of women-friendly care and its associated factors among mothers who gave birth at public health institutions in South Gondar Zone, Northwest Ethiopia. Front Glob Womens Health 2024; 5:1368388. [PMID: 38860180 PMCID: PMC11163033 DOI: 10.3389/fgwh.2024.1368388] [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: 02/27/2024] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
Introduction "Women-friendly care" is one of the categories of respectful maternal care and is a method of providing care that improves women's access to safe parenting and to reproductive health services by creating a friendly environment at all levels. Improving service use is crucial, particularly in situations where it is low. There is limited data on women-friendly care during childbirth in Ethiopia. Objective This study aimed to assess the provision of women-friendly care and its associated factors among mothers who gave birth at health institutions in the South Gondar zone, Northwest Ethiopia. Methods A multicenter institutional-based cross-sectional study design was conducted among mothers who gave birth at South Gondar Zone public health institutions, from February 01 to March 30/2021. Three hundred forty-eight study participants were selected by using systematic random sampling. A validated questionnaire was used for data collection. For analysis, the data were imported into Epi-Data version 4.6 and exported to SPSS version 25. A multivariable logistic regression analysis was performed to identify factors associated with the outcome variable. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance. Results The study had 344 participants in total, with a response rate of 98.85%. The study revealed that a full 73% [95%; CI: 68.6, 77.3%] its participants received women-friendly care. Having antenatal care follow-up [AOR: 3.02, 95% CI: 2.16-11.68], being a primipara [AOR = 2.30 95% CI: 1.23-5.49], not experiencing complications during childbirth [AOR: 2.13, 95% CI: 1.17-12.4], stays at health care facilities, specifically between 13 and 24 h [AOR: 0.25, 95% CI: 0.09-0.67], place for delivery [AOR: 2.01, 95% CI: 1.29-6.09] and delivering during daytime hours [AOR = 2.17, 95% CI: 1.08-5.65] were significantly associated with the provision of women-friendly care. Conclusions Only two-thirds of the study participants received Women's-friendly care during childbirth. It was found to be low in our study area in contrast with the majority of the previous findings. Our own findings also suggest the importance of minimizing elective induction of labor during night, of providing comprehensive counseling on antenatal care follow-up, of ensuring mothers remain at health care facilities until the recommended duration, and of implementing early prevention and management of childbirth complications to ensure that mothers receive women-friendly care.
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Polavarapu M, Odems DS, Banks S, Singh S. Role of Obstetric Violence and Patient Choice: Factors Associated With Episiotomy. J Midwifery Womens Health 2024. [PMID: 38794803 DOI: 10.1111/jmwh.13655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/07/2024] [Indexed: 05/26/2024]
Abstract
INTRODUCTION In the United States, 1 in 6 women reports obstetric violence in the form of physical and verbal abuse, coercion, and lack of informed consent. Despite recommendations against routine episiotomy, its use in the United States remains notable and varies considerably. This study aimed to analyze the various forms of obstetric violence associated with undergoing an episiotomy and having a choice in undergoing an episiotomy. METHODS Data from the cross-sectional Listening to Mothers in California survey were analyzed using weighted sample. Logistic regression models were conducted to compute adjusted odds ratios (aORs) and 95% CIs for undergoing episiotomy and having a choice in it. RESULTS Overall, 21% of the respondents reported undergoing an episiotomy, and 75% of them reported not having a choice in undergoing this procedure. After adjusting for covariates, feeling pressured to induce labor (aOR, 1.31; 95% CI, 1.28-1.35) and to use an epidural analgesia (aOR, 1.82; 95% CI, 1.77-1.88) increased the odds of undergoing an episiotomy. Having a midwife during childbirth significantly reduced the odds of an episiotomy. Respondents who indicated being handled roughly by health care providers were 95% less likely to have a choice in receiving an episiotomy (aOR, 0.05; 95% CI, 0.04-0.06). DISCUSSION This is the first study to examine other forms of obstetric violence as correlates of episiotomy and having a choice in it. Standardized institutional measures against obstetric violence, patients' ability to make autonomous decisions through informed consent, and engaging midwives could decrease medically unnecessary labor procedures and associated complications.
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Affiliation(s)
| | - Dorian S Odems
- Department of Population Health, The University of Toledo, Toledo, Ohio
- Department of Human Ecology, University of California, Davis, California
| | - Sativa Banks
- Department of Population Health, The University of Toledo, Toledo, Ohio
| | - Shipra Singh
- Department of Population Health, The University of Toledo, Toledo, Ohio
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Belay DM, Erku D, Bayih WA, Kassie YT, Minuye Birhane B, Assefa Y. Improving the quality of neonatal health care in Ethiopia: a systematic review. Front Med (Lausanne) 2024; 11:1293473. [PMID: 38841585 PMCID: PMC11150606 DOI: 10.3389/fmed.2024.1293473] [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: 10/10/2023] [Accepted: 04/19/2024] [Indexed: 06/07/2024] Open
Abstract
Background Ensuring high-quality healthcare for newborns is essential for improving their chances of survival within Ethiopia's healthcare system. Although various intervention approaches have been implemented, neonatal mortality rates remain stable. Therefore, the present review seeks to identify initiatives for enhancing healthcare quality, their effects on neonatal wellbeing, and the factors hindering or supporting these Quality Improvement (QI) efforts' success in Ethiopia. Methods We searched for original research studies up to June 23, 2023, using PubMed/Medline, WHO-Global Health Library, Cochrane, Clinical Trials.gov, and Hinari. After selecting eligible studies, we assessed their quality using a mixed-method appraisal tool. Quality of care refers to how healthcare services effectively improve desired outcomes for individuals and patient populations. It encompasses vital principles such as safety, effectiveness, timeliness, efficiency, equity, and patient-centeredness. Results We found 3,027 publication records and included 13 studies during our search. All these interventions primarily aimed to provide safe healthcare, with a strong focus on Domain One, which deals with the evidence-based routine upkeep and handling of complications, and Domain Seven, which revolves around ensuring staff competency, emerged as a frequent target for intervention. Many interventions aimed at improving quality also concentrate on essential quality measure elements such as processes, focusing on the activities that occur during care delivery, and quality planning, involving distributing resources, such as basic medicine and equipment, and improving infrastructure. Moreover, little about the facilitators and barriers to QI interventions is investigated. Conclusions This review highlights the significance of introducing QI initiatives in Ethiopia, enhancing the healthcare system's capabilities, engaging the community, offering financial incentives, and leveraging mobile health technologies. Implementing QI interventions in Ethiopia poses difficulties due to resource constraints, insufficient infrastructure, and medical equipment and supplies shortages. It necessitates persistent endeavors to improve neonatal care quality, involving ongoing training, infrastructure enhancement, the establishment of standardized protocols, and continuous outcome monitoring. These efforts are crucial to achieving the optimal outcomes for newborns and their families.
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Affiliation(s)
- Demeke Mesfin Belay
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Menzies School of Health Research, Charles Darwin University, Darwin, NT, Australia
| | - Daniel Erku
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
- Centre for Applied Health Economics, Griffith University, Nathan, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
- Addis Consortium for Health Economics and Outcomes Research (AnCHOR)
| | - Wubet Alebachew Bayih
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
| | | | - Binyam Minuye Birhane
- College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
- School of Public Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Yibeltal Assefa
- School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD, Australia
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Ganapathy D, Tzeli M, Vivilaki V. Midwives: Essential guardians in the climate crisis journey. Eur J Midwifery 2024; 8:EJM-8-22. [PMID: 38779537 PMCID: PMC11110073 DOI: 10.18332/ejm/188196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Affiliation(s)
- Deepti Ganapathy
- Centre for Management Communication, Indian Institute of Management, Bangalore, India
| | - Maria Tzeli
- Midwifery Department, School of Health and Care Sciences, University of West Attica, Athens, Greece
| | - Victoria Vivilaki
- Department of Midwifery, School of Health and Care Sciences, University of West Attica, Athens, Greece
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Yohannes E, Moti G, Gelan G, Creedy DK, Gabriel L, Hastie C. Impact of disrespectful maternity care on childbirth complications: a multicentre cross-sectional study in Ethiopia. BMC Pregnancy Childbirth 2024; 24:380. [PMID: 38773395 PMCID: PMC11110437 DOI: 10.1186/s12884-024-06574-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Globally, disrespectful, and abusive childbirth practices negatively impact women's health, create barriers to accessing health facilities, and contribute to poor birth experiences and adverse outcomes for both mothers and newborns. However, the degree to which disrespectful maternity care is associated with complications during childbirth is poorly understood, particularly in Ethiopia. AIM To determine the extent to which disrespectful maternity care is associated with maternal and neonatal-related complications in central Ethiopia. METHODS A multicentre cross-sectional study was conducted in the West Shewa Zone of Oromia, Ethiopia. The sample size was determined using the single population proportion formula. Participants (n = 440) were selected with a simple random sampling technique using computer-generated random numbers. Data were collected through face-to-face interviews with a pretested questionnaire and were entered into Epidata and subsequently exported to STATA version 17 for the final analysis. Analyses included descriptive statistics and binary logistic regression, with a 95% confidence interval (CI) and an odds ratio (OR) of 0.05. Co-founders were controlled by adjusting for maternal sociodemographic characteristics. The primary exposure was disrespectful maternity care; the main outcomes were maternal and neonatal-related complications. RESULTS Disrespectful maternity care was reported by 344 women (78.2%) [95% CI: 74-82]. Complications were recorded in one-third of mothers (33.4%) and neonates (30%). Disrespectful maternity care was significantly associated with maternal (AOR = 2.22, 95% CI: 1.29, 3.8) and neonatal-related complications (AOR = 2.78, 95% CI: 1.54, 5.04). CONCLUSION The World Health Organization advocates respectful maternal care during facility-based childbirth to improve the quality of care and outcomes. However, the findings of this study indicated high mistreatment and abuse during childbirth in central Ethiopia and a significant association between such mistreatment and the occurrence of both maternal and neonatal complications during childbirth. Therefore, healthcare professionals ought to prioritise respectful maternity care to achieve improved birth outcomes and alleviate mistreatment and abuse within the healthcare sector.
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Affiliation(s)
- Ephrem Yohannes
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, Australia.
- Midwifery Department, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia.
| | - Gonfa Moti
- Surgery Department, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Gemechu Gelan
- Midwifery Department, College of Health Sciences and Referral Hospital, Ambo University, Ambo, Ethiopia
| | - Debra K Creedy
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, Australia
| | - Laura Gabriel
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, Australia
| | - Carolyn Hastie
- School of Nursing and Midwifery, Griffith University, University Drive, Gold Coast, QLD, 4131, Australia
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Faktor LM, Wilson AN, Melepia P, Babona D, Wapi P, Suruka R, Hezeri P, Kabiu DD, Vallely LM, Kennedy E, Scoullar MJL, Spotswood N, Homer CSE. "If I am alive, I am happy": Defining quality of care from the perspectives of key maternal and newborn health stakeholders in Papua New Guinea. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002548. [PMID: 38771819 PMCID: PMC11108204 DOI: 10.1371/journal.pgph.0002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 04/23/2024] [Indexed: 05/23/2024]
Abstract
Quality maternal and newborn healthcare is essential to improve experiences and health outcomes for mothers and babies. In many low to middle income countries, such as Papua New Guinea, there are initiatives to increase antenatal care attendance and facility births. To develop and implement initiatives that are appropriate, relevant, and contextualised to a community, it is important to understand how quality of care is perceived and defined by different maternal and newborn healthcare stakeholders. The aim of this study was to understand how women, their partners, healthcare professionals, healthcare managers, and provincial health administrators in East New Britain, Papua New Guinea define quality of pregnancy, childbirth, and immediate postnatal care. An exploratory qualitative study underpinned by a partnership-defined quality approach was undertaken. In total, 42 participants from five different healthcare facilities in East New Britain, Papua New Guinea, were interviewed. These included women, partners, healthcare professionals, healthcare managers, and provincial health administrators. Interviews were analysed using thematic analysis, assisted by NVivo computer software. Four themes were identified aligning with the journey a woman takes throughout the health system. These included (I) Ensuring Access: Arriving at the health centre, (II) Experiencing Positive Care: What the staff do, (III) Having the Bare Minimum: Resources available to the service, and (IV) Meeting Expectations: Outcomes of care. Stakeholder groups had significant overlap in how quality of care was defined, however women and partners focussed more on elements relating to experience of care, while clinical stakeholders focussed on elements relating to provision of care. There is a gap in how stakeholders define quality maternal and newborn healthcare, and the quality of the care which is administered and received.
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Affiliation(s)
- Lachlan M. Faktor
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Alyce N. Wilson
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Pele Melepia
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Delly Babona
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- St Mary’s Hospital Vunapope, Kokopo, East New Britain Province, Papua New Guinea
| | - Pinip Wapi
- Nonga General Hospital, Rabaul, Papua New Guinea
| | - Rose Suruka
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Priscah Hezeri
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Duk Duk Kabiu
- Healthy Mothers, Healthy Babies Program, Burnet Institute, Kokopo, Papua New Guinea
| | - Lisa M. Vallely
- Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea
- Kirby Institute, University of New South Wales, Kensington, Australia
| | - Elissa Kennedy
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Michelle J. L. Scoullar
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
| | - Naomi Spotswood
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
- Royal Hobart Hospital, Hobart, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Caroline S. E. Homer
- Maternal, Child and Adolescent Health Program, International Development, Burnet Institute, Melbourne, Australia
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Mattar B, Abu-Rmeileh NME, Wahdan Y. Postpartum depression symptoms: prevalence, risk factors, and childbirth experiences in Palestine. BMC Public Health 2024; 24:1357. [PMID: 38769541 PMCID: PMC11107043 DOI: 10.1186/s12889-024-18829-8] [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: 05/22/2023] [Accepted: 05/10/2024] [Indexed: 05/22/2024] Open
Abstract
BACKGROUND Worldwide mothers are suffering from postpartum depression (PPD) which impairs mothers' well-being, children, and families, and leads to adverse outcomes for mothers and their growing newborns. Low and middle-income countries have a higher prevalence of PPD and limited studies about it. This study assessed the percentage of Palestinian mothers experiencing PPD nationally, identified mothers at a higher risk of PPD, and studied the correlation between PPD and mistreatment during childbirth. METHODS The study is based on a secondary data analysis from a cross-sectional study in the occupied Palestinian territory (oPt). A total of 745 telephone-based interviews with mothers were done within 2-4 weeks post-childbirth. The Patient Health Questionnaire (PHQ-9) was used as a screening tool for PPD. The Statistical Package for Social Science (SPSS) was used for analyzing the data. RESULTS In the context of descriptive epidemiology, we observed that 12.6% of the selected Palestinian mothers experienced PPD, with a higher occurrence of PPD among mothers living in the Gaza Strip, a politically and economically unstable region in Palestine, compared to mothers living in the West Bank (Adjusted Odd Ratio (AOD: 2.2, Confidence Interval (CI): 1.4-3.44). Older mothers were two times more likely to develop PPD compared to young mothers (AOR: 2.03, CI: 1.070-3.84). Mothers who experienced disrespectful behaviors represented by any abuse, negligence, abandonment, ineffective communication, or poor pain management in childbirth settings were more likely to report PPD than those who were not exposed to the disrespect. CONCLUSION A notable percentage of Palestinian mothers were identified as experiencing PPD, especially among mothers who experienced mistreatment in childbirth settings. It is essential to support healthcare providers to improve their practices and attitudes to eliminate mistreatment and abusive behaviors of mothers during childbirth.
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Affiliation(s)
- Batoul Mattar
- Institute of Community and Public Health, Birzeit University, P. O. Box 14, Ramallah, West Bank, occupied Palestinian territory.
| | - Niveen M E Abu-Rmeileh
- Institute of Community and Public Health, Birzeit University, P. O. Box 14, Ramallah, West Bank, occupied Palestinian territory
| | - Yasmeen Wahdan
- Institute of Community and Public Health, Birzeit University, P. O. Box 14, Ramallah, West Bank, occupied Palestinian territory
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Daly D, Sedlicka N, Švanderlíková K, Kovařčíková PA, Wilhelmová R, Begley C. An online survey of women's views of respectful and disrespectful pregnancy and early labour care in the Czech Republic. BMC Pregnancy Childbirth 2024; 24:370. [PMID: 38750412 PMCID: PMC11097455 DOI: 10.1186/s12884-024-06448-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/26/2024] [Indexed: 05/18/2024] Open
Abstract
OBJECTIVE To ascertain and explore the views of women and their partners, giving birth in the Czech Republic, of the level of respectful or disrespectful care provided during pregnancy and early labour. DESIGN Ethical approval was granted for a descriptive, online anonymous survey of 65 questions, with quantitative and qualitative responses. SETTING The Czech Republic.The survey was completed by 8,767 women and 69 partners in 2018. MEASUREMENTS AND FINDINGS Descriptive statistics and thematic analysis were used to present results. The majority of women were aged 26-35 years. Most had birthed in one of 93 hospitals, with 1.5% home births. Almost 40% never had an abdominal examination.in pregnancy. Quantitative data analysis revealed that less than half were given information on place of birth, or how to keep labour normal or non-interventionist. Almost 60% did not get information on positions for birth. Most (68%) commenced labour naturally, 25% had labour induced, 40% of them before term, and 7% had an elective caesarean section; 55% stated they had not been given any choice in the decision. Over half of those who had a membrane sweep said permission had not been sought. Half (54%) only had 'checking' visits from the midwife in labour. KEY CONCLUSIONS Findings reveal a lack of information-giving, discussion and shared decision-making from healthcare professionals during pregnancy and early labour. Some practices were non-evidenced-based, and interventions were sometimes made without consent. IMPLICATIONS FOR PRACTICE The examples of disrespectful care described in this study caused women distress during childbirth, which may result in an increased fear of childbirth or an increase in free-birthing.
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Affiliation(s)
- Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, DO2 T283, Ireland.
| | - Natalie Sedlicka
- Association for Birth Houses & Centers (APODAC), Týnská ulička 1064/6, , Prague 1, 11000, Czech Republic
| | - Kateřina Švanderlíková
- Association for Birth Houses & Centers (APODAC), Týnská ulička 1064/6, , Prague 1, 11000, Czech Republic
| | - PetraAnn Ann Kovařčíková
- Association for Birth Houses & Centers (APODAC), Týnská ulička 1064/6, , Prague 1, 11000, Czech Republic
| | - Radka Wilhelmová
- Faculty of Medicine, Department of Health Sciences, Masaryk University, Brno, Czech Republic
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin, DO2 T283, Ireland
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Roemer M, Pasos UER, Wanyama I, Lubambi E, Argenziano A, Weber PL. When addressing resources is not enough: lessons learned from a respectful maternal and neonatal care provider training intervention evaluation in Kenya and Tanzania. BMC Pregnancy Childbirth 2024; 24:359. [PMID: 38745117 PMCID: PMC11094886 DOI: 10.1186/s12884-024-06555-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Respectful Maternal and Neonatal Care (RMNC) maintains and respects a pregnant person's dignity, privacy, informed choice, and confidentiality free from harm and mistreatment. It strives for a positive pregnancy and post-pregnancy care experiences for pregnant people and their families, avoiding any form of obstetric violence. Though RMNC is now widely accepted as a priority in obstetric care, there is a gap in resources and support tools for healthcare wproviders to clearly understand the issue and change long-established practices such as non-humanized caesarean sections. MSI Reproductive Choices (MSI) manages 31 maternities across 7 countries with a zero-tolerance approach towards disrespectful maternity care and obstetric violence. MSI developed and implemented a hybrid training package, which includes an online module and 1-day in-person workshop that allows healthcare providers to explore their beliefs and attitudes towards RMNC. It leverages methodologies used in Values-Clarification-Attitudes-Transformation (VCAT) workshops and behaviour change approaches. METHODS The impact of this training intervention was measured from the healthcare providers' and patients' perspectives. Patient experience of (dis)respectful care was collected from a cross-sectional survey of antenatal and postnatal patients attending MSI maternities in Kenya and Tanzania before and following the RMNC training intervention. Healthcare providers completed pre- and post-workshop surveys at day 1, 90 and 180 to measure any changes in their knowledge, attitudes and perception of intended behaviours regarding RMNC. RESULTS The results demonstrate that healthcare provider knowledge, attitudes and perceived RMNC practices can be improved with this training interventions. Patients also reported a more positive experience of their maternity care following the training. CONCLUSION RMNC is a patient-centred care priority in all MSI maternities. The training bridges the gap in resources currently available to support changes in healthcare wproviders' attitudes and behaviours towards provision of RMNC. Ensuring health system infrastructure supports compassionate obstetric care represents only the first step towards ensuring RMNC. The results from the evaluation of this RMNC provider training intervention demonstrates how healthcare provider knowledge and attitudes may represent a bottleneck to ensuring RMNC that can be overcome using VCAT and behaviour change approaches.
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Affiliation(s)
- Matthea Roemer
- MSI Reproductive Choices, 1 Conway Street, Fitzrovia, London, W1t 6LP, UK.
| | | | | | | | - Angela Argenziano
- MSI Reproductive Choices, 1 Conway Street, Fitzrovia, London, W1t 6LP, UK
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Oyugi B, Audi-Poquillon Z, Kendall S, Peckham S. Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: a mixed-methods study. BMJ Open 2024; 14:e082011. [PMID: 38697765 PMCID: PMC11086406 DOI: 10.1136/bmjopen-2023-082011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/09/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Kenya still faces the challenge of mothers and neonates dying from preventable pregnancy-related complications. The free maternity policy (FMP), implemented in 2013 and expanded in 2017 (Linda Mama Policy (LMP)), sought to address this challenge. This study examines the quality of care (QoC) across the continuum of maternal care under the LMP in Kenya. METHODS We conducted a convergent parallel mixed-methods study across multiple levels of the Kenyan health system, involving key informant interviews with national stakeholders (n=15), in-depth interviews with county officials and healthcare workers (HCWs) (n=21), exit interview survey with mothers (n=553) who utilised the LMP delivery services, and focus group discussions (n=9) with mothers who returned for postnatal visits (at 6, 10 and 14 weeks). Quantitative data were analysed descriptively, while qualitative data were analysed thematically. All the data were triangulated at the analysis and discussion stage using a framework approach guided by the QoC for maternal and newborns. RESULTS The results showed that the expanded FMP enhanced maternal care access: geographical, financial and service utilisation. However, the facilities and HCWs bore the brunt of the increased workload and burnout. There was a longer waiting time for the initial visit by the pregnant women because of the enhanced antenatal care package of the LMP. The availability and standards of equipment, supplies and infrastructure still posed challenges. Nurses were multitasking and motivated despite the human resources challenge. Mothers were happy to have received care information; however, there were challenges regarding respect and dignity they received (inadequate food, over-crowding, bed-sharing and lack of privacy), and they experienced physical, verbal and emotional abuse and a lack of attention/care. CONCLUSIONS Addressing the negative aspects of QoC while strengthening the positives is necessary to achieve the Universal Health Coverage goals through better quality service for every woman.
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Affiliation(s)
- Boniface Oyugi
- Western Heights, The Mint Nairobi, M and E Advisory Group, Nairobi, Kenya
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Zilper Audi-Poquillon
- Department of Health Policy, The London School of Economics and Political Science, London, UK
| | - Sally Kendall
- Centre for Health Services Studies, University of Kent, Canterbury, UK
| | - Stephen Peckham
- Centre for Health Services Studies, University of Kent, Canterbury, UK
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Norris G, Hollins Martin CJ, Moylan A, Greig Y. A qualitative descriptive training needs analysis of midwives perceived continuous professional development in providing intranatal respectful maternal care. NURSE EDUCATION TODAY 2024; 136:106144. [PMID: 38471361 DOI: 10.1016/j.nedt.2024.106144] [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: 10/12/2023] [Revised: 02/07/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND The Vietnam midwifery report acknowledges that while health services are available in Vietnam, there is growing need to increase levels of respectful maternal care provided to women in labour. OBJECTIVE In conjunction with newborns Vietnam charity, our objective was to assess the perceived continuous professional development needs of midwives working in Vietnam to inform development of an intranatal respectful maternal care education resource. METHOD A qualitative exploratory descriptive method was used to conduct a training needs analysis, which identified perceived education requirements of midwives in Vietnam in relation to providing respectful maternal care. PARTICIPANTS A convenience sample of midwives (n = 49) participated in the study. DATA-COLLECTION Eight on-line focus groups were carried out in four hospitals (maternity units) across Vietnam using WebEx, with the interview schedule informed by the World Health Organization guide for delivering intrapartum care for a positive birth experience. DATA-ANALYSIS Data were transcribed into English and analysed using the 6-steps of thematic analysis outlined by Braun and Clark. FINDINGS Three themes and 9 sub-themes were developed from the data. The first theme addressed aspects that contribute towards creating a positive birth experience; the second theme observed barriers to changing practice; and the third theme noted that there are a variety of preferred teaching methods. CONCLUSIONS In response to the training needs analysis, a respectful maternal care education resource has been designed to transform selected areas of intranatal care in Vietnam. Integrating the respectful maternal care educational resource into midwives' continuous professional development in Vietnam is intended to increase women's rights to have safe childbirth, which accommodates choice and control, and promotes a positive birth experience. RECOMMENDATIONS FOR PRACTICE Post-completion and evaluation, we hope that the intranatal respectful maternal care educational resource will be rolled out to all practising midwives in Vietnam.
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Affiliation(s)
- Gail Norris
- School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Caroline J Hollins Martin
- Maternal Health, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Anne Moylan
- Advanced Neonatal Practitioner, School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
| | - Yvonne Greig
- School of Health and Social Care, Edinburgh Napier University (ENU), Sighthill Campus, Edinburgh, Scotland, UK.
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Kasaye H, Scarf V, Sheehy A, Baird K. Health care providers' perspectives on the mistreatment towards women during maternity care: Do perceptions of the working environment and empathy level matter? Women Birth 2024; 37:101601. [PMID: 38518578 DOI: 10.1016/j.wombi.2024.101601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 03/09/2024] [Accepted: 03/09/2024] [Indexed: 03/24/2024]
Abstract
BACKGROUND Mistreatment of women in maternity care violates human rights, erodes trust and disrupts the continuity of maternal healthcare services. Investigating Health Care Providers' (HCPs) perspectives is indispensable in uncovering drivers and designing targeted interventions. AIM To identify the roles of HCPs' perceptions of the working environment and levels of empathy on the mistreatment of women during maternity care. METHODS We conducted a self-administered survey among 148 maternal HCPs practising in ten health centres and four hospitals in the East Wollega Zone, Western Ethiopia, from June to September 2022. FINDINGS Most providers reported seeing other HCPs mistreating women (93.2%), while three-fourths (75.7%) admitted it as their actions. Violation of privacy and confidentiality was the most frequently reported category of mistreatment (44.6%), followed by physical abuse (37.1%) and verbal abuse (35.8%). The likelihood of mistreating women was reduced by 65% (AOR=0.35, 95% CI: [0.14, 0.86]) among individuals with positive perceptions of their working environment compared to those with negative perceptions. A unit increase in providers' empathy also led to a five per cent decrease in mistreatment (AOR=0.95, 95% CI: [0.91, 0.98]. CONCLUSIONS HCPs' perceptions of their working environment and enhanced empathy levels were associated with the reduction of the odds of mistreatment of women. While empathic care should be cultivated as a component of HCPs' competencies, efforts should be made to improve the conditions of the demanding health system to realise a resilient, motivated, competent, and compassionate workforce. The interplay between gender, profession, and mistreatment level requires further investigation.
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Affiliation(s)
- Habtamu Kasaye
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia; Department of Midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia.
| | - Vanessa Scarf
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Annabel Sheehy
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Kathleen Baird
- Collective for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
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Güner S, Gökçe İsbir G, Aydın Beşen M. Midwives' Intercultural Effectiveness Levels and Influencing Factors. J Transcult Nurs 2024; 35:189-198. [PMID: 38380448 DOI: 10.1177/10436596241229479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
INTRODUCTION Due to globalization, countries around the world are starting to notice diversity in their populations. It is crucial that midwives be able to communicate effectively with women from a variety of cultures to provide them with culturally effective health care. METHOD This cross-sectional study was conducted with 394 midwives who work in seven different regions of Türkiye. Data on the intercultural effectiveness and intercultural communication competence of midwives were collected. Data analysis was performed using descriptive statistics, t-tests, analysis of variance, and regression analysis. RESULTS Midwives' intercultural effectiveness was influenced by their foreign language proficiency, experiences abroad, having friends from different cultures, following social media platforms in different languages and cultures, providing care to individuals from diverse cultures, and their willingness to do so. DISCUSSION Findings suggest that exposure to different cultures enhances the level of intercultural effectiveness. Consequently, it is recommended to make plans to support midwives to have positive experiences with different cultures.
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Hameed W, Khan B, Avan BI. Supportive Care-A Missing Piece in the Current Global Efforts of Promoting Respectful Maternity Care. Public Health Rev 2024; 45:1605597. [PMID: 38741751 PMCID: PMC11089184 DOI: 10.3389/phrs.2024.1605597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 04/17/2024] [Indexed: 05/16/2024] Open
Affiliation(s)
- Waqas Hameed
- Department of Community Health Sciences, Aga Khan University, Karachi, Sindh, Pakistan
| | - Bushra Khan
- Department of Psychology, University of Karachi, Karachi, Sindh, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Pablo MC, Ildefonso HA, Elisa CR. Respectful maternity care interventions to address women mistreatment in childbirth: What has been done? BMC Pregnancy Childbirth 2024; 24:322. [PMID: 38671343 PMCID: PMC11046783 DOI: 10.1186/s12884-024-06524-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/16/2024] [Indexed: 04/28/2024] Open
Abstract
INTRODUCTION Over the last decade, there has been an increasing number of studies regarding experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth. These negative experiences during labour have been proven to create a barrier for seeking both facility-based childbirth and postnatal health care, as well as increasing severe postpartum depression among the women who experienced them. This constitutes a serious violation of human rights. However, few studies have carried out specifically designed interventions to reduce these practices. The aim of this scoping review is to synthetise available evidence on this subject, and to identify initiatives that have succeeded in reducing the mistreatment, D&A that women suffer during childbirth in health facilities. METHODS A PubMed search of the published literature was conducted, and all original studies evaluating the efficacy of any type of intervention specifically designed to reduce these negative experiences and promote RMC were selected. RESULTS Ten articles were included in this review. Eight studies were conducted in Africa, one in Mexico, and the other in the U.S. Five carried out a before-and-after study, three used mixed-methods, one was a comparative study between birth centres, and another was a quasi-experimental study. The most common feature was the inclusion of some sort of RMC training for providers at the intervention centre, which led to the conclusion that this training resulted in an improvement in the care received by the women in childbirth. Other strategies explored by a small number of articles were open maternity days, clinical checklists, wall posters and constant user feedback. DISCUSSION These results indicate that there are promising interventions to reduce D&A and promote RMC for women during childbirth in health facilities. RMC training for providers stands as the most proven strategy, and the results suggest that it improves the experiences of care received by women in labour. CONCLUSION The specific types of training and the different initiatives that complement them should be evaluated through further scientific research, and health institutions should implement RMC interventions that apply these strategies to ensure human rights-based maternity care for women giving birth in health facilities around the world.
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Affiliation(s)
- Mira-Catalá Pablo
- Public Health Department, Miguel Hernández University, 03550, Alicante, Spain.
| | - Hernández-Aguado Ildefonso
- Public Health Department, Miguel Hernández University, 03550, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
| | - Chilet-Rosell Elisa
- Public Health Department, Miguel Hernández University, 03550, Alicante, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029, Madrid, Spain
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van der Waal R, van Nistelrooij I. Shroud waving self-determination: A qualitative analysis of the moral and epistemic dimensions of obstetric violence in the Netherlands. PLoS One 2024; 19:e0297968. [PMID: 38648219 PMCID: PMC11034656 DOI: 10.1371/journal.pone.0297968] [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: 08/25/2023] [Accepted: 01/15/2024] [Indexed: 04/25/2024] Open
Abstract
Obstetric violence is an urgent global problem. Recently, several studies have appeared on obstetric violence in the Netherlands, indicating that it is a more widespread phenomenon in Dutch maternity care than commonly thought. At the same time, there has been very little public outrage over these studies. The objective of this qualitative research is to gain insight into the working and normalization of obstetric violence by focusing on the moral and epistemic injustices that both facilitate obstetric violence and make it look acceptable. Following the study design of Responsive Evaluation, interviews, homogenous, and heterogenous focus groups were done in three phases, with thirty-one participants, consisting of ten mothers, eleven midwives, five doulas and five midwives in training. All participants were already critically engaged with the topic, which was a selection criterion to be able to bring the existing depth of knowledge on this topic of people in the field to the fore. Data was analyzed through Thematic Analysis. We elaborate on two groups of results. First, we discuss the forms of obstetric violence most commonly mentioned by the participants, which were vaginal examinations, episiotomies, and pelvic floor support. Second, we demonstrate two major themes that concern practices related to moral and epistemic injustice: 1) 'Playing the dead baby card', with the sub-themes 'shroud waving', 'hidden agenda', and 'normalizing obstetric violence'; and 2) 'Troubling consent', with sub-themes 'not being asked for consent', 'saying "yes"', 'saying "no"', and 'giving up resistance'. While epistemic injustice has been analyzed in relation to obstetric violence, moral injustice has not yet been conceptualized as a fundamental part of both the practice and the justification of obstetric violence. This research hence contributes not only to the better understanding of obstetric violence in the Netherlands, but also to a further theorization of this specific form of gender-based violence.
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Affiliation(s)
- Rodante van der Waal
- Care Ethics Department, University for Humanistic Studies, Utrecht, The Netherlands
| | - Inge van Nistelrooij
- Care Ethics Department, University for Humanistic Studies, Utrecht, The Netherlands
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Glover A, Holman C, Boise P. Patient-centered respectful maternity care: a factor analysis contextualizing marginalized identities, trust, and informed choice. BMC Pregnancy Childbirth 2024; 24:267. [PMID: 38605316 PMCID: PMC11010273 DOI: 10.1186/s12884-024-06491-2] [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: 01/25/2024] [Accepted: 04/07/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Increasing rates of maternal mortality and morbidity, coupled with ever-widening racial health disparities in maternal health outcomes, indicate that radical improvements need to be made in the delivery of maternity care. This study explored the provision of patient-centered maternity care from the perspective of pregnant and postpartum people; experiences of respect and autonomy were examined through the multi-dimensional contexts of identity, relational trust, and protection of informed choices. METHODS We conducted primary data collection among individuals who experienced a pregnancy in the five years preceding the survey (N = 484) using the validated Mothers on Respect Index (MORi) and Mothers Autonomy in Decision Making (MADM) scale. We conducted an exploratory factor analysis (EFA) which produced three factor variables: trust, informed choice, and identity. Using these factor variables as dependent variables, we conducted bivariate and multivariate analysis to examine the relationship between these factor variables and social marginalization, as measured by race, disability, justice-involvement, and other social risk factors, such as food and housing insecurity. RESULTS Results of our bivariate and multivariate models generally confirmed our hypothesis that increased social marginalization would be associated with decreased experiences of maternity care that was perceived as respectful and protective of individual autonomy. Most notably, AI/AN individuals, individuals who are disabled, and individuals who had at least one social risk factor were more likely to report experiencing identity-related disrespect and violations of their autonomy. CONCLUSIONS In light of the findings that emphasize the importance of patient identity in their experience in the healthcare system, patient-centered and respectful maternity care must be provided within a broader social context that recognizes unequal power dynamics between patient and provider, historical trauma, and marginalization. Provider- and facility-level interventions that improve patient experiences and health outcomes will be more effective if they are contextualized and informed by an understanding of how patients' identities and traumas shape their healthcare experience, health-seeking behaviors, and potential to benefit from clinical interventions and therapies.
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Affiliation(s)
- Annie Glover
- University of Montana Rural Institute for Inclusive Communities, Missoula, US.
- University of Montana School of Public & Community Health Sciences, Missoula, US.
| | - Carly Holman
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
| | - Patrick Boise
- University of Montana Rural Institute for Inclusive Communities, Missoula, US
- University of Montana School of Public & Community Health Sciences, Missoula, US
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MacVicar S, Jordan A, Vu H, Tran HN, Greig Y, Thi Tuyet Nguyen H, Norris G, Martin CR, Hollins Martin CJ. Translation and validation of Vietnamese version of the Birth Satisfaction Scale-Revised (BSS-R). J Reprod Infant Psychol 2024:1-14. [PMID: 38591499 DOI: 10.1080/02646838.2024.2338176] [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: 01/30/2024] [Accepted: 03/26/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND The 10-item Birth Satisfaction Scale-Revised (BSS-R) is a quick and easy survey instrument recommended by the International Consortium for Health Outcome Measures as the tool of choice for measuring women's birth satisfaction. AIM To translate and validate a Vietnamese-language version of the BSS-R. METHOD A quantitative cross-sectional method was used to gather data post translation and back-translation of a Vietnamese version of the BSS-R (VN-BSS-R). Data collected were psychometrically evaluated using key indices of validity and reliability. PARTICIPANTS Vietnamese women who were within one month postpartum of birth (N = 383) took part in the study. RESULTS Findings illustrate that a two-factor model offered excellent psychometric properties. With the two-factor VN-BSS-R, five items loaded onto a subscale 'Positive birth experiences' and the other five onto a second subscale 'Negative birth experiences'. This two-factor model offered a fit to data (root mean square error of approximation [RMSEA] = 0.07, 90% confidence interval [CI] [0.05, 0.09], root square mean residual [RMSE] = 0.04 and comparative fit index [CFI] = 0.97). Mean scores for the exploratory factor analysis [EFA]-derived 'positive' and 'negative' sub-scales were 17.12 (SD 2.34) and 8.40 (SD 4.18) respectively. CONCLUSION The translated and validated VN-BSS-R is a psychometrically robust tool for measuring birth satisfaction in Vietnamese postpartum women.The VN-BSS-R is available for use to measure experiences and perceptions of intrapartum care received by Vietnamese women.
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Affiliation(s)
- Sonya MacVicar
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Hien Vu
- Head of Social Work department, Phu San Hanoi Hospital, Hanoi, Vietnam
| | - Hai Ngoc Tran
- Specialist medicine, Tu Du hospital, Ho Chi Minh, Vietnam
| | - Yvonne Greig
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Gail Norris
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Colin R Martin
- Institute for Health and Wellbeing, University of Suffolk, UK
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Abebaw WA, Wolde HF, Tilahun WM, Gebreegziabher ZA, Teshome DF. Quality of childbirth care and its determinants along the continuum of care among pregnant women who gave birth vaginally in Gondar town public health facility, Northwest Ethiopia, 2022: generalised structural equation modelling. BMJ Open 2024; 14:e073199. [PMID: 38580371 PMCID: PMC11002431 DOI: 10.1136/bmjopen-2023-073199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
OBJECTIVE To assess the quality of childbirth care and its determinants along the continuum of care in Gondar town public health facility in Ethiopia. DESIGN An institution-based, cross-sectional study was employed. Completed data were imported to Stata V.16 for cleaning and analysis. A generalised structural equation model was employed to examine the relationships along the continuum of childbirth care and to determine the factors affecting the quality of childbirth care. SETTING AND PARTICIPANTS This study was conducted among a total of 865 women who delivered in the public health facility of Gondar, Ethiopia, from 19 May to 30 June 2022. RESULTS The study revealed the proportion of good-quality childbirth care during admission, intrapartum and immediate postpartum period was 59% (95% CI 55.7, 62.4), 76.8% (95% CI 73.8, 79.5) and 45% (95% CI 41.7, 48.5), respectively. Postsecondary educational status of mothers (β=0.60, 95% CI 0.16, 1.04) and maternal age of 25-35 (β=0.68, 95% CI 0.33, 1.02) were predictors of quality of care at admission. Referral hospital (β=0.43, 95% CI 0.10, 0.76), presence of guidelines (β=1.36, 95% CI 0.72, 1.99) and provider age of 25-35 (β=0.61, 95% CI 0.12, 1.10) affected the quality of care during the intrapartum period. Urban residence (β=0.52, 95% CI 0.12, 0.93), skilled birth attendant experience (β=0.19, 95% CI 0.11, 0.28) and number of delivery couches (β=-0.29, 95% CI -0.44, -0.13) had significant associations with the quality of childbirth care during the immediate postpartum period. CONCLUSIONS Although our study found improvements in the quality of childbirth care along the continuum compared with previous studies, more workers are needed to alleviate the problem of poor-quality service. Different maternal, provider and facility factors were found to be predictors of the quality of childbirth care.
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Affiliation(s)
| | - Haileab Fekadu Wolde
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
| | - Werkneh Melkie Tilahun
- Department of Public Health, Debre Markos University College of Health Science, Debre Markos, Ethiopia
| | | | - Destaw Fetene Teshome
- Epidemiology and Biostatistics, University of Gondar College of Medicine and Health Sciences, Gondar, Ethiopia
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Spurlock EJ, Pickler RH. Birth Experience Among Black Women in the United States: A Qualitative Meta-Synthesis. J Midwifery Womens Health 2024. [PMID: 38561916 DOI: 10.1111/jmwh.13628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/11/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION There are striking disparities in perinatal health outcomes for Black women in the United States. Although the causes are multifactorial, research findings have increasingly identified social and structural determinants of health as contributors to perinatal disparities. Maltreatment during perinatal care, which is disproportionately experienced by Black women, may be one such contributor. Qualitative researchers have explored Black women's perinatal care experiences, but childbirth experience data has yet to be analyzed in-depth across studies. The aim of this meta-synthesis was to explore the birthing experience of Black women in the United States. METHODS PubMed, Embase, PsycINFO, and CINAHL databases were searched. Inclusion criteria were qualitative research studies that included birth experience data shared by self-identified Black or African American women who had given birth in the United States. Exclusion criteria were reports that did not include rich qualitative data or only included experience data that did not specify the race of the participant (eg, data pooled for women of color). The search began February 2022 and ended June 2022. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to appraise the research. Results were synthesized using content analysis. RESULTS Fifteen studies met inclusion criteria. Main themes included (1) trust: being known and seen; (2) how race influences care; (3) preserving autonomy; and (4) birth as trauma. DISCUSSION Fragmented care resulted in reports of poor birth experiences in several studies. Open communication and feeling known by perinatal care providers was influential in improving childbirth experiences among Black women; these themes are consistent with existing research. Further prospective research exploring relationships among these themes and perinatal outcomes is needed. Limitations of this report include the use of content analysis and meta-synthesis which may lose the granularity of the original reports; however, the aggregation of voices may provide valuable, transferable, actionable insight that can inform future supportive care interventions.
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Affiliation(s)
- Elizabeth J Spurlock
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio
| | - Rita H Pickler
- Martha S. Pitzer Center for Women, Children and Youth, College of Nursing, The Ohio State University, Columbus, Ohio
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Ngarmbatedjimal A, Abdelaziz M, Allambademel VDP, Diarra A, Djerambete V, Kodjimadje T, Luketa S, Madjigoto R, Miangotar Y, Ndingayande A, Tamira S, Varelis T, Vourbane K, Casey SE. Refugee women's and providers' perceptions of person-centered maternity care: a qualitative study in two refugee camps in Chad. BMC Pregnancy Childbirth 2024; 24:225. [PMID: 38561681 PMCID: PMC10983620 DOI: 10.1186/s12884-024-06424-z] [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: 09/08/2023] [Accepted: 03/14/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Globally, mistreatment of women during labor and delivery is a common human rights violation. Person-centered maternity care (PCMC), a critical component of quality of care, is respectful and responsive to an individual's needs and preferences. Factors related to poor PCMC are often exacerbated in humanitarian settings. METHODS We conducted a qualitative study to understand Sudanese refugee women's experiences, including their perceptions of quality of care, during labor and delivery at the maternities in two refugee camps in eastern Chad, as well as maternity health workers' perceptions of PCMC and how they could be better supported to provide this. In-depth interviews were conducted individually with 22 women who delivered in the camp maternities and five trained midwives working in the two maternities; and in six dyads with a total of 11 Sudanese refugee traditional birth attendants and one assistant midwife. In addition, facility assessments were conducted at each maternity to determine their capacity to provide PCMC. RESULTS Overall, women reported positive experiences in the camp maternities during labor and delivery. Providers overwhelmingly defined respectful care as patient-centered and respect as being something fundamental to their role as health workers. While very few reported incidents of disrespect between providers and patients in the maternity, resource constraints, including overwork of the providers and overcrowding, resulted in some women feeling neglected. CONCLUSIONS Despite providers' commitment to offering person-centered care and women's generally positive experiences in this study, one of few that explored PCMC in a refugee camp, conflict and displacement exacerbates the conditions that contribute to mistreatment during labor and delivery. Good PCMC requires organizational emphasis and support, including adequate working conditions and ensuring suitable resources so health workers can effectively perform.
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Affiliation(s)
- Alexis Ngarmbatedjimal
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Mahamat Abdelaziz
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Vincent de Paul Allambademel
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Aminata Diarra
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA
| | - Valentin Djerambete
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Thérèse Kodjimadje
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Samy Luketa
- International Rescue Committee Chad, BP 5208, N'Djaména, Chad
| | - Robert Madjigoto
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Yodé Miangotar
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | | | - Salomon Tamira
- Laboratoire de Sociologie, d'Anthropologie et des Etudes Africaines (LASA), Department of Sociology, College of Humanities and Social Sciences, University of N'Djamena, BP 1117, N'Djaména, Chad
| | - Theodora Varelis
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA
| | | | - Sara E Casey
- RAISE Initiative, Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, 60 Haven Ave, New York, NY, 10032, USA.
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Benyamini Y, Delicate A, Ayers S, Dikmen-Yildiz P, Gouni O, Jonsdottir SS, Karlsdottir SI, Kömürcü Akik B, Leinweber J, Murphy-Tighe S, Pajalic Z, Riklikiene O, Limmer CM. Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies. PLoS One 2024; 19:e0299151. [PMID: 38551936 PMCID: PMC10980232 DOI: 10.1371/journal.pone.0299151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/06/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are. OBJECTIVE To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience. METHODS Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis. FINDINGS Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions. CONCLUSIONS The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.
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Affiliation(s)
- Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Amy Delicate
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Pelin Dikmen-Yildiz
- Department of Psychology, Fen—Edebiyat Fakültesi, Cumhuriyet Mahallesi, Kirklareli University, Kırklareli, Turkey
| | - Olga Gouni
- Cosmoanelixis, Prenatal & Life Sciences Educational Organization, Nea Ionia, Athens, Greece
| | | | | | - Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
| | - Julia Leinweber
- Institute of Midwifery, Charité University of Medicine, Berlin, Germany
| | - Sylvia Murphy-Tighe
- Department of Nursing & Midwifery, Health Sciences Building, University of Limerick, Ireland
| | | | - Olga Riklikiene
- Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Claudia Maria Limmer
- Department of Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
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Fullaondo A, Erreguerena I, Keenoy EDM. Transforming health care systems towards high-performance organizations: qualitative study based on learning from COVID-19 pandemic in the Basque Country (Spain). BMC Health Serv Res 2024; 24:364. [PMID: 38515068 PMCID: PMC10958960 DOI: 10.1186/s12913-024-10810-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 02/29/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND The COVID-19 pandemic is one of the worst health catastrophes of the last century, which caused severe economic, political, and social consequences worldwide. Despite these devastating consequences, lessons learned provide a great opportunity that can drive the reform of health systems to become high-performing, effective, equitable, accessible, and sustainable organisations. This work identifies areas in which changes must be encouraged that will enable health systems to deal effectively with current and future challenges, beyond COVID-19. METHODS A realist design was chosen, based on qualitative data collection techniques, content analysis and triangulation to identify key domains of organizational interventions behind the changes implemented to react to the COVID-19 pandemic in the Basque Country. Twenty key informants were used as an expert source of information. Thematic analysis was done using the Framework Method. RESULTS The analysis of the interviews resulted in the identification of 116 codes, which were reviewed and agreed upon by the researchers. Following the process of methodological analysis, these codes were grouped into domains: seven themes and 23 sub-themes. Specifically, the themes are: responsiveness, telehealth, integration, knowledge management, professional roles, digitisation, and organisational communication. The detailed description of each theme and subtheme is presented. CONCLUSIONS The findings of this work pretend to guide the transformation of health systems into organisations that can improve the health of their populations and provide high quality care. Such a multidimensional and comprehensive reform encompasses both strategic and operational actions in diverse areas and requires a broad and sustained political, technical, and financial commitment.
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Affiliation(s)
- Ane Fullaondo
- Kronikgune Institute for Health Services Research, Barakaldo, Spain.
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Udho S, Clow SE. Experiences, prevalence and drivers of disrespect and abuse of adolescents during facility-based childbirth in sub-Saharan Africa: a scoping review protocol. BMJ Open 2024; 14:e078912. [PMID: 38490663 PMCID: PMC10946369 DOI: 10.1136/bmjopen-2023-078912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 02/15/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION Adolescents are more likely to experience disrespect and abuse (D&A) by skilled health personnel during facility-based childbirth. However, research evidence on the experiences, prevalence and drivers of D&A of adolescents in childbirth is limited. We aim to establish research evidence on the experiences, prevalence and drivers of D&A of adolescents during facility-based childbirth in sub-Saharan Africa and identify gaps in the literature to inform future research. METHODS AND ANALYSIS The protocol is designed using Arksey and O'Malley's methodological framework and will be reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. We will systematically search to retrieve peer-reviewed articles published in English from 2011 to date in PubMed/Medline, EBSCOhost (Africa Wide Information, CINAHL, PsycINFO and SocINDEX), Web of Science (SciELO Citation Index and Web of Science Core Collection) and Scopus. Two independent reviewers will screen the references by titles, abstracts and full texts. Discrepancies in screening results will be resolved through discussions. Key elements of included studies will be charted using a predetermined tool. We will perform numerical analysis and synthesis of narrative accounts of the extent, nature and distribution of review studies. ETHICS AND DISSEMINATION No ethical approval is required since the scoping review will use openly available public data and information. Review findings will be disseminated at conferences and published in peer-reviewed journals. No protocol registration is required.
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Affiliation(s)
- Samson Udho
- Department of Midwifery, Lira University, Lira, Uganda
- Department of Health and Rehabilitation Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Sheila Elizabeth Clow
- Department of Health and Rehabilitation Sciences, University of Cape Town, Rondebosch, Western Cape, South Africa
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Suarez A, Yakupova V. Childbirth experiences of women with a history of physical, sexual, and child abuse: a cross-sectional study of 2,575 Russian women. BMC Pregnancy Childbirth 2024; 24:186. [PMID: 38459457 PMCID: PMC10921683 DOI: 10.1186/s12884-024-06369-3] [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: 10/16/2023] [Accepted: 02/24/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND A substantial number of women who subsequently become pregnant and give birth have a history of physical, sexual, and/or child abuse. This study investigated the associations of these types of traumas and their cumulative effect with childbirth experiences, namely, mode of birth, maternal and child complications during pregnancy/childbirth, preterm birth, medical procedures, and obstetric violence during labour. METHODS A group of Russian women (n = 2,575) who gave birth within the previous 12 months, completed a web-based survey, where they provided demographic information, details about their childbirth experiences, and a history of trauma. RESULTS Women with any type of past abuse were at higher risk for maternal complications during pregnancy/childbirth (exp(β) < 0.73, p < 0.010 for all). More specific to the type of trauma were associations of physical abuse with caesarean birth, child abuse with complications during pregnancy/childbirth for the baby, and physical and child abuse with obstetric violence (exp(β) < 0.54, p < 0.022 for all). There was a cumulative effect of trauma for all the outcomes except for medical procedures during childbirth and preterm birth. CONCLUSION This study provides insights into potential different individual effects of physical, sexual, and/or child abuse as well as their cumulative impact on the childbirth experiences. The robust findings about maternal complications during pregnancy/childbirth and obstetric violence highlight the importance of trauma-informed care, supportive policies, and interventions to create safe and empowering birthing environments that prioritise patient autonomy, dignity, and respectful communication.
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Affiliation(s)
- Anna Suarez
- Department of Psychology, Lomonosov Moscow State University, Mokhovaya St, 11/9, Moscow, 125009, Russia.
| | - Vera Yakupova
- Department of Psychology, Lomonosov Moscow State University, Mokhovaya St, 11/9, Moscow, 125009, Russia
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Širvinskienė G, Forray AI, König-Bachmann M, Blaga OM, Grincevičienė Š, Luegmair K, Pranskevičiūtė-Amoson R, Zenzmaier C. Experiences of childbirth care in Lithuania and Romania: Insights from the European Babies Born Better survey. Birth 2024; 51:121-133. [PMID: 37798932 DOI: 10.1111/birt.12771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 06/14/2023] [Accepted: 08/11/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND Data on experience and satisfaction of users are essential for improvement of health care, especially in the field of childbirth. The aim of this study was to compare childbirth care experiences in Lithuania and Romania. METHODS Data derived from the EU Babies Born Better online survey were analyzed. Parturients from Lithuania (N = 373) and Romania (N = 359) who had given birth within the last 5 years were included. Participants were asked to (1) describe the best things in childbirth care and (2) suggest changes in the care received at their birthplace. Qualitative data were analyzed using a previously developed deductive coding framework. RESULTS In agreement with previous findings from Austria, positive experiences mainly addressed care experienced at an individual level (in particular healthcare practitioners' competence and personality traits) and suggested changes mainly addressed services at birthplace (issues related to infrastructure, information and counseling, and empowerment). Responses not initially included in the coding framework addressed aspects such as informal payment (in both countries), desire for home birth (particularly in Lithuania), or mistreatment of parturients (particularly in Romania). CONCLUSIONS We conclude that similar trends in childbirth care exist in Lithuania and Romania with regard to parturients' personal experiences and psychosocial needs and that addressing the needs of parturients is important for improving service provision.
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Affiliation(s)
- Giedrė Širvinskienė
- Department of Health Psychology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Health Research Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alina Ioana Forray
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Department of Community Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Oana Maria Blaga
- Department of Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
- Center for Health Policy and Public Health, College of Political, Administrative and Communication Sciences, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Švitrigailė Grincevičienė
- Department of Biothermodynamics and Drug Design, Institute of Biotechnology, Life Sciences Centre, Vilnius University, Vilnius, Lithuania
| | - Karolina Luegmair
- Midwifery Department, Health University of Applied Sciences Tyrol, Innsbruck, Austria
- KSH Munich, University of Applied Sciences, Munich, Germany
| | | | - Christoph Zenzmaier
- Midwifery Department, Health University of Applied Sciences Tyrol, Innsbruck, Austria
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Calys-Tagoe BNL, Brownson K, Nsaful J, Dedey F, Tetteh J, Coleman N, Laryea RY, Clegg-Lamptey JN. Satisfaction levels and associated influencing factors among inpatients and outpatients with breast cancer at a tertiary health facility in Ghana. Ghana Med J 2024; 58:7-16. [PMID: 38957283 PMCID: PMC11215237 DOI: 10.4314/gmj.v58i1.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Objectives To uncover variables linked to breast cancer patient satisfaction in order to improve policy choices and actions for breast cancer care in Ghana. Design We employed a cross-sectional design using a quantitative approach. Setting The Radiotherapy, Oncology and Surgery Departments of the Korle Bu Teaching Hospital, Accra. Participants Inpatient and outpatient breast cancer patients. Main outcome measures The level of inpatient and outpatient satisfaction was measured using descriptive and inferential statistical analyses. The Shapiro-Wilk test was employed to assess normality, while the Heckman selection model assessed significance with outcomes of interest. Results A total of 636 participants, with a mean age of 52.64±14.07 years, were recruited. The measured inpatient and outpatient levels of satisfaction out of 100 were 74.06±7.41 and 49.99±1.00 respectively, while the self-reported satisfaction levels out of 5 were 4.22±0.63 and 4.11±0.85 respectively. The level of inpatient satisfaction was significantly influenced by age, marital status, income level, and number of previous facilities visited (p<0.05). Outpatient satisfaction level was significantly associated with place of residence and income level (p<0.05). Conclusions The study offers insight into the satisfaction levels of breast cancer patients receiving inpatient and outpatient services at the largest tertiary referral centre and teaching hospital in Ghana, as well as the factors influencing attendance and satisfaction levels. Understanding and improving breast cancer patients' levels of satisfaction is a way that providers can safeguard their emotional well-being. Improvement in patient satisfaction at our institution among outpatients is an area for future growth. Funding Gardner-Holt Women's Health Grant program, Centre for Global Surgery 2021.
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Affiliation(s)
| | - Kirstyn Brownson
- Huntsman Cancer Institute, University of Utah School of Medicine, Utah, USA
| | - Josephine Nsaful
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
| | - John Tetteh
- Department of Community Health, University of Ghana Medical School, Korle Bu, Accra
| | - Nathaniel Coleman
- Department of Obstetrics and Gynaecology, University of Ghana Medical School, Korle Bu, Accra
| | - Ruth Y Laryea
- Department of Medicine and Therapeutics, University of Ghana Medical School, Korle Bu, Accra
| | - Joe-Nat Clegg-Lamptey
- Department of Surgery, University of Ghana Medical School, College of Health Sciences, Korle Bu, Accra
- Department of Surgery, Korle Bu Teaching Hospital, Accra, Ghana
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Haseli A, Khosravi S, Hajimirzaie SS, Feli R, Rasoal D. Midwifery students' experiences: Violations of dignity during childbirth. Nurs Ethics 2024; 31:296-310. [PMID: 37650382 PMCID: PMC11181724 DOI: 10.1177/09697330231197703] [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] [Indexed: 09/01/2023]
Abstract
BACKGROUND The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. RESEARCH OBJECTIVES The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. RESEARCH DESIGN This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. RESULTS Four key themes described the threats to women's dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. CONCLUSION The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth.
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Affiliation(s)
| | | | | | | | - Dara Rasoal
- School of Health and Welfare, Dalarna University, Sweden
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Ayers S, Horsch A, Garthus-Niegel S, Nieuwenhuijze M, Bogaerts A, Hartmann K, Karlsdottir SI, Oosterman M, Tecirli G, Turner JD, Lalor J. Traumatic birth and childbirth-related post-traumatic stress disorder: International expert consensus recommendations for practice, policy, and research. Women Birth 2024; 37:362-367. [PMID: 38071102 DOI: 10.1016/j.wombi.2023.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/22/2023] [Accepted: 11/23/2023] [Indexed: 03/05/2024]
Abstract
BACKGROUND Research suggests 1 in 3 births are experienced as psychologically traumatic and about 4% of women and 1% of their partners develop post-traumatic stress disorder (PTSD) as a result. AIM To provide expert consensus recommendations for practice, policy, and research and theory. METHOD Two consultations (n = 65 and n = 43) with an international group of expert researchers and clinicians from 33 countries involved in COST Action CA18211; three meetings with CA18211 group leaders and stakeholders; followed by review and feedback from people with lived experience and CA18211 members (n = 238). FINDINGS Recommendations for practice include that care for women and birth partners must be given in ways that minimise negative birth experiences. This includes respecting women's rights before, during, and after childbirth; and preventing maltreatment and obstetric violence. Principles of trauma-informed care need to be integrated across maternity settings. Recommendations for policy include that national and international guidelines are needed to increase awareness of perinatal mental health problems, including traumatic birth and childbirth-related PTSD, and outline evidence-based, practical strategies for detection, prevention, and treatment. Recommendations for research and theory include that birth needs to be understood through a neuro-biopsychosocial framework. Longitudinal studies with representative and global samples are warranted; and research on prevention, intervention and cost to society is essential. CONCLUSION Implementation of these recommendations could potentially reduce traumatic births and childbirth-related PTSD worldwide and improve outcomes for women and families. Recommendations should ideally be incorporated into a comprehensive, holistic approach to mental health support for all involved in the childbirth process.
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Affiliation(s)
- Susan Ayers
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, EC1V 0HB, UK.
| | - Antje Horsch
- Institute of Higher Education and Research in Healthcare, University of Lausanne, Lausanne, Switzerland; Department Woman-Mother-Child, Lausanne University Hospital, Lausanne, Switzerland
| | - Susan Garthus-Niegel
- Institute for Systems Medicine (ISM), Faculty of Medicine, Medical School Hamburg, Hamburg, Germany; Institute and Policlinic of Occupational and Social Medicine, Faculty of Medicine, Technische Universität Dresden, Dresden, Germany; Department of Childhood and Families, Norwegian Institute of Public Health, Oslo, Norway
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; CAPHRI, Maastricht University, 6229 ER Maastricht, the Netherlands
| | - Annick Bogaerts
- REALIFE research group, Research Unit Woman and Child, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | | | | | - Mirjam Oosterman
- Faculty of Behavioral and Movement Sciences, Department of Clinical Child & Family Studies, Vrije Universiteit Amsterdam and Amsterdam Public Health Research Institute, the Netherlands
| | - Gulcan Tecirli
- Health Technology Assessment Department, Republic of Turkiye Ministry of Health, Bilkent, Çankaya, Ankara, Turkiye
| | - Jonathan D Turner
- Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Joan Lalor
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
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Chervenak FA, McLeod-Sordjan R, Pollet SL, De Four Jones M, Gordon MR, Combs A, Bornstein E, Lewis D, Katz A, Warman A, Grünebaum A. Obstetric violence is a misnomer. Am J Obstet Gynecol 2024; 230:S1138-S1145. [PMID: 37806611 DOI: 10.1016/j.ajog.2023.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/01/2023] [Accepted: 10/02/2023] [Indexed: 10/10/2023]
Abstract
The term "obstetric violence" has been used in the legislative language of several countries to protect mothers from abuse during pregnancy. Subsequently, it has been expanded to include a spectrum of obstetric procedures, such as induction of labor, episiotomy, and cesarean delivery, and has surfaced in the peer-reviewed literature. The term "obstetric violence" can be seen as quite strong and emotionally charged, which may lead to misunderstandings or misconceptions. It might be interpreted as implying a deliberate act of violence by healthcare providers when mistreatment can sometimes result from systemic issues, lack of training, or misunderstandings rather than intentional violence. "Obstetric mistreatment" is a more comprehensive term that can encompass a broader range of behaviors and actions. "Violence" generally refers to the intentional use of physical force to cause harm, injury, or damage to another person (eg, physical assault, domestic violence, street fights, or acts of terrorism), whereas "mistreatment" is a more general term and refers to the abuse, harm, or control exerted over another person (such as nonconsensual medical procedures, verbal abuse, disrespect, discrimination and stigmatization, or neglect, to name a few examples). There may be cases where unprofessional personnel may commit mistreatment and violence against pregnant patients, but as obstetrics is dedicated to the health and well-being of pregnant and fetal patients, mistreatment of obstetric patients should never be an intended component of professional obstetric care. It is necessary to move beyond the term "obstetric violence" in discourse and acknowledge and address the structural dimensions of abusive reproductive practices. Similarly, we do not use the term "psychiatric violence" for appropriately used professional procedures in psychiatry, such as electroshock therapy, or use the term "neurosurgical violence" when drilling a burr hole. There is an ongoing need to raise awareness about the potential mistreatment of obstetric patients within the context of abuse against women in general. Using the term "mistreatment in healthcare" instead of the more limited term "obstetric violence" is more appropriate and applies to all specialties when there is unprofessional abuse and mistreatment, such as biased care, neglect, emotional abuse (verbal), or physical abuse, including performing procedures that are unnecessary, unindicated, or without informed patient consent. Healthcare providers must promote unbiased, respectful, and patient-centered professional care; provide an ethical framework for all healthcare personnel; and work toward systemic change to prevent any mistreatment or abuse in our specialty.
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Affiliation(s)
- Frank A Chervenak
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Renee McLeod-Sordjan
- Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra Northwell School of Nursing and Physician Assistant Studies, Northwell Health, New York, NY
| | - Susan L Pollet
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Monique De Four Jones
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Long Island Jewish Hospital, Manhasset, NY
| | | | - Adriann Combs
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY
| | - Eran Bornstein
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Dawnette Lewis
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, South Shore University Hospital, Bay Shore, NY
| | - Adi Katz
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY
| | - Ashley Warman
- Division of Medical Ethics, Department of Medicine, Lenox Hill Hospital, New York, NY
| | - Amos Grünebaum
- Department of Obstetrics and Gynecology, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lenox Hill Hospital, New York, NY.
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Dmowska A, Fielding-Singh P, Halpern J, Prata N. The intersection of traumatic childbirth and obstetric racism: A qualitative study. Birth 2024; 51:209-217. [PMID: 37849421 PMCID: PMC10922554 DOI: 10.1111/birt.12774] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 06/02/2023] [Accepted: 09/12/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Traumatic childbirth experiences are common in the United States - affecting a third to a fourth of mothers - with significant negative impacts on maternal health. Yet most research on traumatic childbirth focuses on white mothers' experiences. Drawing on a racially and ethnically diverse sample of mothers who experienced traumatic childbirth, this exploratory qualitative study examined Black, Latina, and Asian mothers' traumatic birth experiences and the role of obstetric racism in shaping these experiences. METHODS In-depth, semi-structured interviews were conducted in 2019-2020 with 30 mothers who identified as women of color (37% Black, 40% Latina, and 23% Asian) who gave birth in the US and self-identified as having experienced a traumatic childbirth. Data were analyzed using qualitative content analysis. RESULTS Mothers reported obstetric racism as core to their traumatic birth experiences. This racism manifested through practitioners' use of gendered and racialized stereotypes, denying and delegitimizing mothers' needs. Mothers shared key consequences of the obstetric racism they experienced, including postpartum anxiety and depression, increased medical mistrust, and decreased desire for future children. CONCLUSIONS Mothers' reports suggest that obstetric racism played a role in their traumatic birth experiences. Particularly, practitioners' deployment of gendered and racialized stereotypes influenced mothers' treatment during birth. These findings point to opportunities to address obstetric racism during childbirth and improve patients' experiences through enhancing their agency and empowerment. The findings, in addition, highlight the need for increased practitioner training in anti-racist practice and cultural humility.
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Affiliation(s)
- Amelia Dmowska
- Medical Student, University of California Berkeley and University of California San Francisco Joint Medical Program
| | | | - Jodi Halpern
- Professor of Bioethics and Medical Humanities, University of California Berkeley and University of California San Francisco Joint Medical Program
| | - Ndola Prata
- Professor of Maternal, Child and Adolescent Health, University of California Berkeley School of Public Health
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