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Khalil M, Carasso KB, Kabakian-Khasholian T. Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth. Front Glob Womens Health 2022; 3:850796. [PMID: 35547827 PMCID: PMC9082810 DOI: 10.3389/fgwh.2022.850796] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region. Aim This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC. Methods A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR. Findings and Discussion This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV. Conclusion In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
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Affiliation(s)
- Merette Khalil
- Your Egyptian Doula, Cairo, Egypt
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
- *Correspondence: Merette Khalil
| | - Kashi Barbara Carasso
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Haghdoost S, Abdi F, Amirian A. Iranian midwives' awareness and performance of respectful maternity care during labor and childbirth. Eur J Midwifery 2021; 5:59. [PMID: 35083427 PMCID: PMC8711250 DOI: 10.18332/ejm/143873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Midwives' perceptions of Respectful Maternity Care (RMC) play an important role in promoting quality of care. This study aimed to explore the awareness and performance of Iranian midwives of RMC during childbirth. METHODS A cross-sectional study was carried out from November to December 2020 to evaluate 130 midwives' awareness and performance of RMC during childbirth at four public hospitals in Urmia province, Iran. Participants were midwives who were working in the labor unit and had at least one year of work experience. The Midwives' Knowledge and Practice Scale on Respectful Maternity Care was used to assess midwives' awareness and performance. The quality assessment of questionnaires was based on the mean for each item. A multivariate linear regression approach was developed to evaluate the relationship between midwives' age, academic education level plus occupational information and their awareness and performance of RMC. RESULTS This study revealed that Iranian midwives had good awareness but fair performance of RMC. The mean scores of the overall awareness and performance of RMC were 36.07±10.13 and 75.47±35.4, respectively. Midwives' performance on two domains was fair including 'Giving emotional support' and 'Providing safe care'. The results of multivariate linear regression analysis showed a significant negative relationship between job satisfaction and midwives' performance on RMC. Also work experience plus a Master's degree in midwifery had positive significant effects on midwives' awareness along with performance on RMC (p<0.05). CONCLUSIONS Promoting respectful maternity care requires essential interpersonal and communication skills and supportive attitudes from midwives.
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Affiliation(s)
- Simin Haghdoost
- Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdi
- School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Azam Amirian
- Department of Midwifery, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
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Safari K, McKenna L, Davis J. Midwifery in Middle Eastern and North African countries: A scoping review. Women Birth 2021; 34:503-513. [PMID: 33199188 DOI: 10.1016/j.wombi.2020.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/14/2020] [Accepted: 11/07/2020] [Indexed: 11/13/2022]
Abstract
BACKGROUND While midwives are positioned as critical providers for improving sexual, reproductive, maternal and newborn health outcomes in the Middle East and North African (MENA) countries, the standards of midwifery have not been explored systematically in this region. AIM The purpose of this scoping review was to provide an overview of existing literature on midwifery practice, education, and regulation in MENA countries in the context of ICM standards. METHODS A search was conducted inclusive of English and Persian written studies published between 2000 and 2019 in CINAHL plus; Ovid MEDLINE; PubMed; Scopus; and grey literature. Title and abstract and full-text review were performed in Covidence, and data extraction and synthesis performed using NVivo 12. RESULTS The initial search identified 7,994 articles. Overall, 139 studies were included in the review. Although, the primary concept of most included studies was "midwifery practice", "midwifery regulation" was addressed in limited way. Approximately 90% were from Middle Eastern countries. Forty-two per cent of studies used cross-sectional designs, and most originated from Iran, Jordan, and Palestine. Diversity was found in midwifery education, practice and regulation across the MENA countries. Midwives from different nations had uneven levels of proficiency, scope of practice, and education. Midwifery curricula were aligned with ICM competencies in some countries. Most countries had midwifery associations and were members of ICM. Some countries had regulations recognising midwifery as an autonomous profession. CONCLUSION Midwifery practice, education and regulation in MENA countries were not always comparable with ICM standards, although some progress was evident.
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Affiliation(s)
- Kolsoom Safari
- School of Nursing and Midwifery, La Trobe University, Australia.
| | - Lisa McKenna
- School of Nursing and Midwifery, La Trobe University, Australia
| | - Jenny Davis
- School of Nursing and Midwifery, La Trobe University, Australia
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Khalife‐Ghaderi F, Amiri‐Farahani L, Haghani S, Hasanpoor‐Azghady SB. Examining the experience of childbirth and its predictors among women who have recently given birth. Nurs Open 2021; 8:63-71. [PMID: 33318813 PMCID: PMC7729799 DOI: 10.1002/nop2.603] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022] Open
Abstract
Aims The aim of this study is to examine the experience of childbirth and its predictors among women who have recently given birth. Design This is a cross-sectional study. Methods This study was conducted on 225 women at 22 Bahman Hospital in Khaf City, Iran. The samples were selected by the continuous sampling method from August to November 2018. Data were collected by demographic questionnaire, fertility information, pregnancy experience scale, satisfaction from birth environment inventory and the childbirth experience questionnaire. Results The mean score of childbirth experience was 55.73. According to the regression model, the husband's education, receiving regular care during pregnancy, the person giving birth, presence of a companion, receiving spinal anaesthesia, perineal conditions, being uplifted and hassled about the pregnancy and satisfaction with the birth environment were the predictors of childbirth experience. The regression model showed 39.8% of the change in outcome variable was predicted by independent variables.
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Affiliation(s)
- Faeze Khalife‐Ghaderi
- Department of Reproductive Health and MidwiferySchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Leila Amiri‐Farahani
- Department of Reproductive Health and MidwiferyNursing Care Research CenterSchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Shima Haghani
- Department of BiostatisticsNursing Care Research CenterIran University of Medical SciencesTehranIran
| | - Syedeh Batool Hasanpoor‐Azghady
- Department of Reproductive Health and MidwiferyNursing Care Research CenterSchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
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Anderson G, Zega M, D'Agostino F, Rega ML, Colaceci S, Damiani G, Alvaro R, Cocchieri A. Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals. J Obstet Gynecol Neonatal Nurs 2020; 50:6-19. [PMID: 33217368 DOI: 10.1016/j.jogn.2020.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To identify and meta-synthesize results of qualitative studies on the needs of women cared for by midwives during childbirth in hospitals. DATA SOURCES MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Cochrane Library. STUDY SELECTION We restricted the bibliographic search to articles published in English to July 31, 2020. The initial search yielded 6,407 articles, and after 2,504 duplicates were removed, we screened the titles and abstracts of 3,903 articles. We conducted a full-text review of 89 articles and included 13 qualitative studies about the needs of women who were hospitalized during childbirth and had midwives as their primary maternity care providers. DATA EXTRACTION We extracted data (e.g., authors, publication date, type of study, sample size, results, and quotes) from the full text of each article into a standardized table. Two authors reviewed all articles using the Critical Appraisal Skills Programme tool to assess study quality and to independently score each study. DATA SYNTHESIS We analyzed the findings of each study and synthesized them to develop themes. We found 14 major themes that reflected the needs of women during hospitalization for childbirth: Nutrition, Hygiene, Privacy, Information, Bodily Respect, Respect for Social Role, Family Intimacy, Shelter, Pain Management, Partnership, Movement, Reassurance, Support, and Empowerment. We categorized these themes in Maslow's hierarchy of needs to better understand the phenomenon. CONCLUSION We identified 14 needs that midwives and nurses can meet when they care for women in hospitals during childbirth. Standardized methods to assess these needs and to link them to specific interventions can be used by midwives and nurses, which will likely affect women's satisfaction with their experience and overall quality of care.
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Biondi HS, Barlem ELD, Pinho ECD, Tavares DH, Kerber NPDC, Tomaschewski-Barlem JG. MORAL SUFFERING IN ASSISTANCE TO CHILDBIRTH: SITUATIONS PRESENT IN THE WORK OF NURSES OF OBSTETRIC CENTERS AND MATERNITIES. TEXTO & CONTEXTO ENFERMAGEM 2019. [DOI: 10.1590/1980-265x-tce-2018-0052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to know the situations found in the work of nurses working in maternity hospitals and obstetric centers that can lead to moral suffering. Method: qualitative, exploratory and descriptive study, developed with 14 nurses working in bstetric centers and maternities of two hospitals in southern Brazil. Data were collected from October 2015 to January 2016, through a semi-structured interview, analyzed based on Content Analysis. Results: there was an occurrence of moral distress related to the activities that supplanted nurses’ execution capacity, leading them to prioritize administrative and managerial activities, for which they are charged by the institutions, failing to participate directly in the care, an aspect enhanced by the quantitative nursing professionals. Asymmetric relations of power and conflicting interactions compose an atmosphere of toleration for the autonomy of the nurses, preventing them from acting in harmony with their knowledge and moral values. The fruitless attempts to change the dehumanizing context through advocacy and the visualization of disrespectful, interventionist and violent behaviors against women, generate moral suffering. Conclusion: the plurality of nurse actions, reduced autonomy, disrespect for their practice and the visualization of dehumanizing behaviors generate moral suffering. It is important to seek alternatives so that nurses may act and advocate in line with their moral knowledge and values, in an autonomous and empowered way, aiming to provide a dignified and safe childbirth assistance, and an environment that respects the woman and her autonomy.
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Affiliation(s)
- Heitor Silva Biondi
- Universidade Federal do Rio Grande, Brasil; Universidade Federal do Rio Grande, Brasil
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Ghobadi M, Ziaee T, Mirhaghjo N, Pazandeh F, Kazemnejad lili E. Evaluation of Satisfaction with Natural Delivery Experience and its Related Factors in Rasht Women. ACTA ACUST UNITED AC 2018. [DOI: 10.29252/jhc.20.3.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Begley C, Guilliland K, Dixon L, Reilly M, Keegan C, McCann C, Smith V. A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women Birth 2018; 32:87-97. [PMID: 29730096 DOI: 10.1016/j.wombi.2018.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/29/2018] [Accepted: 04/18/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The perineum stretches during birth to allow passage of the baby, but 85% of women sustain some degree of perineal trauma during childbirth, which is painful post-partum. Episiotomy rates vary significantly, with some countries having rates of >60%. Recent Irish and New Zealand studies showed lower severe perineal trauma and episiotomy rates than other countries. AIM To explore expert Irish and New Zealand midwives' views of the skills that they employ in preserving the perineum intact during spontaneous vaginal birth. METHODS Following ethical approval a qualitative, descriptive study was undertaken. Semi-structured, recorded, interviews were transcribed and analysed using the constant comparative method. Expert midwives employed in New Zealand and one setting in Ireland, were invited to join the study. "Expert" was defined as achieving, in the preceding 3.5 years, an episiotomy rate for nulliparous women of <11.8%, a 'no suture' rate of 40% or greater, and a severe perineal tear rate of <3.2%. Twenty-one midwives consented to join the study. RESULTS Four core themes emerged: 'Calm, controlled birth', 'Position and techniques in early second stage', 'Hands on or off?' and 'Slow, blow and breathe the baby out.' Using the techniques described enabled these midwives to achieve rates, in nulliparous women, of 3.91% for episiotomy, 59.24% for 'no sutures', and 1.08% for serious lacerations. CONCLUSIONS This study provides further understanding of the techniques used by expert midwives at birth. These findings, combined with existing quantitative research, increases the evidence on how to preserve the perineum intact during spontaneous birth.
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Affiliation(s)
- C Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - K Guilliland
- New Zealand College of Midwives, Christchurch, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - M Reilly
- Midwife-Led Unit, Cavan General Hospital, Cavan, Ireland
| | - C Keegan
- Midwife-Led Unit, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - C McCann
- Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - V Smith
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
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