scholarly journals Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

2020 ◽  
Author(s):  
Rodrigo de Jesús Garcia-Cerde ◽  
Maria del Pilar Torres-Pereda ◽  
Marisela Olvera-Garcia ◽  
Jennifer Meghan Hulme
Keyword(s):  
Qualitative Study ◽  
Maternity Care ◽  
Medical Personnel ◽  
Respectful Maternity Care ◽  
Structured Interviews ◽  
Post Intervention ◽  
Care Workers ◽  
Before And After ◽  
Effective Prophylaxis ◽  
The Moment

Abstract Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how health personal, at four community hospitals in Mexico, perceive episiotomy, both before and after training in respectful maternity care, obstetric and neonatal emergencies. Methods This is a descriptive and interpretative qualitative study. We conducted Fifty-three pre and post-intervention (PRONTO© Program) semi-structured interviews with generalists, specialists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into six major themes surrounding their perceptions of episiotomy: as a predictable practice, as a prophylactic intervention, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of medical personnel. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this and other harmful obstetrical practices.

scholarly journals Midwives' Perspectives of Respectful Maternity Care during Childbirth: A Qualitative Study

2019 ◽  
Author(s):  
Maryam Moridi ◽  
Farzaneh Pazandeh ◽  
Sepideh Hajian ◽  
Abbas Ebadi ◽  
Barbara Potrata
Keyword(s):  
Qualitative Study ◽  
Maternity Care ◽  
Work Experience ◽  
Public Hospitals ◽  
Respectful Maternity Care ◽  
Structured Interviews ◽  
Effective Strategies ◽  
Centered Care ◽  
One Year ◽  
Evidence Based Care

Abstract Background: The adoption of respectful maternity care during labour and birth is complex process which needs both scientific and interpersonal skills of providers. In this regard, identifying the potential barriers and applying effective strategies for implementing respectful maternity care are essential. This study aimed to explore the perceptions of Iranian midwives regarding respectful maternity care during labour and childbirth. Methods: This was a qualitative study which was conducted from September-December 2018 in two non-teaching public hospitals in Tehran, Iran. Twenty four semi-structured interviews were conducted with midwives, who had more than one year work experience in labor and childbirth units, through a purposive sampling method. The data was analyzed using conventional content analysis approach and managed by MAX QDA 10 software. Results: Three themes were extracted including showing empathy, women-centered care and protecting rights. Showing empathy reflects that establishing a friendly relationship and being with women. Women-centered care indicated keeping women safe and participating in decision making. Protecting rights reflected a need for safeguarding dignity as well as giving equal care and preparing appropriate environment. Conclusions: Iranian midwives considered respectful maternity care a broader concept rather than preventing mistreatment. Providing supportive care through friendly interaction with women was the first step for providing respectful maternity care. Promoting respectful care also should be through performing safe care by implementing evidence-based care and women’s involvement in their care as well as appropriate environment for women, families and caregivers.

scholarly journals Health care workers’ perceptions of episiotomy in the era of respectful maternity care: a qualitative study of an obstetric training program in Mexico

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Rodrigo Garcia-Cerde ◽  
Pilar Torres-Pereda ◽  
Marisela Olvera-Garcia ◽  
Jennifer Hulme
Keyword(s):  
Health Care ◽  
Qualitative Study ◽  
Training Program ◽  
Health Care Providers ◽  
Preventive Measure ◽  
Respectful Maternity Care ◽  
Care Providers ◽  
Structured Interviews ◽  
Post Intervention ◽  
General Physician

Abstract Background Episiotomy in Mexico is highly prevalent and often routine - performed in up to 95% of births to primiparous women. The WHO suggests that episiotomy be used in selective cases, with an expected prevalence of 15%. Training programs to date have been unsuccessful in changing this practice. This research aims to understand how and why this practice persists despite shifts in knowledge and attitudes facilitated by the implementation of an obstetric training program. Methods This is a descriptive and interpretative qualitative study. We conducted 53 pre and post-intervention (PRONTO© Program) semi-structured interviews with general physician, gynecologists and nurses (N = 32, 56% women). Thematic analysis was carried out using Atlas-ti© software to iteratively organize codes. Through interpretive triangulation, the team found theoretical saturation and explanatory depth on key analytical categories. Results Themes fell into five major themes surrounding their perceptions of episiotomy: as a preventive measure, as a procedure that resolves problems in the moment, as a practice that gives the clinician control, as a risky practice, and the role of social norms in practicing it. Results show contradictory discourses among professionals. Despite the growing support for the selective use of episiotomy, it remains positively perceived as an effective prophylaxis for the complications of childbirth while maintaining control in the hands of health care providers. Conclusions Perceptions of episiotomy shed light on how and why routine episiotomy persists, and provides insight into the multi-faceted approaches that will be required to affect this harmful obstetrical practice.

scholarly journals Mitigating the mistreatment of childbearing women: evaluation of respectful maternity care intervention in Ethiopian hospitals

BMJ Open ◽  
2020 ◽  
Vol 10 (9) ◽  
pp. e038871
Author(s):  
Anteneh Asefa ◽  
Alison Morgan ◽  
Samson Gebremedhin ◽  
Ephrem Tekle ◽  
Sintayehu Abebe ◽  
...  
Keyword(s):  
Maternity Care ◽  
Intervention Group ◽  
Vaginal Birth ◽  
Outcome Variable ◽  
Respectful Maternity Care ◽  
Post Intervention ◽  
Caesarean Birth ◽  
Care Intervention ◽  
Before And After ◽  
Childbearing Women

ObjectivesThere is a lack of evidence on approaches to mitigating mistreatment during facility-based childbirth. This study compares the experiences of mistreatment reported by childbearing women before and after implementation of a respectful maternity care intervention.DesignA pre–post study design was undertaken to quantify changes in women’s experiences of mistreatment during facility-based childbirth before and after the respectful maternity care intervention.InterventionA respectful maternity care intervention was implemented in three hospitals in southern Ethiopia between December 2017 and September 2018 and it included training of service providers, placement of wall posters in labour rooms and post-training supportive visits for quality improvement.Outcome measuresA 25-item questionnaire asking women about mistreatment experiences was administered to 388 women (198 in the pre-intervention, 190 in the post-intervention). The outcome variable was the number of mistreatment components experienced by women, expressed as a score out of 25. Multilevel mixed-effects Poisson modelling was used to assess the change in mistreatment score from pre-intervention to post-intervention periods.ResultsThe number of mistreatment components experienced by women was reduced by 18% when the post-intervention group was compared with the pre-intervention group (adjusted regression coefficient (Aβ)=0.82, 95% CI 0.74 to 0.91). Women who had a complication during pregnancy (Aβ=1.17, 95% CI 1.01 to 1.34) and childbirth (Aβ=1.16, 95% CI 1.03 to 1.32) experienced a greater number of mistreatment components. On the other hand, women who gave birth by caesarean birth after trial of vaginal birth (Aβ=0.76, 95% CI 0.63 to 0.92) and caesarean birth without trial of vaginal birth (Aβ=0.68, 95% CI 0.47 to 0.98) experienced a lesser number of mistreatment components compared with those who had vaginal birth.ConclusionsWomen reported significantly fewer mistreatment experiences during childbirth following implementation of the intervention. Given the variety of factors that lead to mistreatment in health facilities, interventions designed to mitigate mistreatment need to involve structural changes.

scholarly journals Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Jana Smith ◽  
Rachel Banay ◽  
Emily Zimmerman ◽  
Vivien Caetano ◽  
Maurice Musheke ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Maternity Care ◽  
Design Methodology ◽  
Behavioral Science ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Disrespectful Care ◽  
Behavioral Design ◽  
Behavioral Barriers ◽  
Respectful Care

Abstract Background Recently, a growing body of literature has established that disrespect and abuse during delivery is prevalent around the world. This complex issue has not been well studied through the lens of behavioral science, which could shed light on the psychological dimensions of health worker behavior and how their micro-level context may be triggering abuse. Our research focuses on the behavioral drivers of disrespect and abuse in Zambia to develop solutions with health workers and women that improve the experience of care during delivery. Methods A qualitative study based on the behavioral design methodology was conducted in Chipata District, Eastern Province. Study participants included postpartum women, providers (staff who attend deliveries), supervisors and mentors, health volunteers, and birth companions. Observations were conducted of client-provider interactions on labor wards at two urban health centers and a district hospital. In-depth interviews were audio recorded and English interpretation from these recordings was transcribed verbatim. Data was analyzed using thematic analysis and findings were synthesized following the behavioral design methodology. Results Five key behavioral barriers were identified: 1) providers do not consider the decision to provide respectful care because they believe they are doing what they are expected to do, 2) providers do not consider the decision to provide respectful care explicitly since abuse and violence are normalized and therefore the default, 3) providers may decide that the costs of providing respectful care outweigh the gains, 4) providers believe they do not need to provide respectful care, and 5) providers may change their mind about the quality of care they will provide when they believe that disrespectful care will assist their clinical objectives. We identified features of providers’ context – the environment in which they live and work, and their past experiences – which contribute to each barrier, including supervisory systems, visual cues, social constructs, clinical processes, and other features. Conclusions Client experience of disrespectful care during labor and delivery in Chipata, Zambia is prevalent. Providers experience several behavioral barriers to providing respectful maternity care. Each of these barriers is triggered by one or more addressable features in a provider’s environment. By applying the behavioral design methodology to the challenge of respectful maternity care, we have identified specific and concrete contextual cues that targeted solutions could address in order to facilitate respectful maternity care.

scholarly journals Midwives’ perspectives of respectful maternity care during childbirth: A qualitative study

PLoS ONE ◽  
2020 ◽  
Vol 15 (3) ◽  
pp. e0229941 ◽  
Author(s):  
Maryam Moridi ◽  
Farzaneh Pazandeh ◽  
Sepideh Hajian ◽  
Barbara Potrata
Keyword(s):  
Qualitative Study ◽  
Maternity Care ◽  
Respectful Maternity Care

scholarly journals An exploration of patient-provider dynamics and childbirth experiences in rural and urban Peru: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brianna Vargas ◽  
Paola Louzado-Feliciano ◽  
Nicole Santos ◽  
Shannon Fuller ◽  
Sopiko Jimsheleishvili ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Neonatal Mortality ◽  
Maternity Care ◽  
Respectful Maternity Care ◽  
Attitudes And Beliefs ◽  
Framework Analysis ◽  
Health Seeking ◽  
Birth Attendance ◽  
Rural And Urban ◽  
Childbirth Experiences

Abstract Background Between 2006 and 2013, Peru implemented national programs which drastically decreased rates of maternal and neonatal mortality. However, since 2013, maternal and neonatal mortality in Peru have increased. Additionally, discrimination, abuse, and violence against women persists globally and impacts birthing experiences and mental health. This qualitative study sought to better understand the attitudes and beliefs regarding childbirth among women and providers in Southern Peru. This study also explores how these beliefs influence utilization of skilled care, patient-provider dynamics, and childbirth experiences and identifies factors that impact providers’ provision of care. Methods Thirty semi-structured interviews were conducted with 15 participants from rural Colca Canyon and 15 participants from urban Arequipa between April and May 2018. In each region, 10 women who had experienced recent births and five providers were interviewed. Provider participants predominantly identified as female and were mostly midwives. All interviews were conducted, transcribed, and coded in Spanish. A framework analysis was followed, and data were charted into two separate thematic frameworks using contextual and evaluative categories of conceptualization of childbirth. Results All recent births discussed were facility-based births. Four domains emerged: women’s current birth experiences, provision of childbirth care, beliefs about childbirth among women and providers, and future health-seeking behavior. Findings suggest that women’s feelings of helplessness and frustration were exacerbated by their unmet desire for respectful maternity care and patient advocacy or companionship. Providers attributed strain to perceived patient characteristics and insufficient support, including resources and staff. Conclusions Our findings suggest current childbirth experiences placed strain on the patient-provider dynamic and influenced women’s attitudes and beliefs about future experiences. Currently, the technical quality of safe childbirth is the main driver of skilled birth attendance and facility-based births for women regardless of negative experiences. However, lack of respectful maternity care has been shown to have major long-term implications for women and subsequently, their children. This is one of the first studies to describe the nuances of patient-provider relationships and women’s childbirth experiences in rural and urban Peru.

scholarly journals Midwives’ Perceptions of Barriers to Respectful Maternity Care for Adolescent Mothers in Jamaica: A Qualitative Study

2018 ◽  
Vol 8 (1) ◽  
pp. 18-34
Author(s):  
Karline Wilson-Mitchell ◽  
Amy Marowitz ◽  
Jody R. Lori
Keyword(s):  
Qualitative Study ◽  
Adolescent Mothers ◽  
Maternity Care ◽  
Work Experience ◽  
Care Delivery ◽  
World Health ◽  
Respectful Maternity Care ◽  
Rural And Urban ◽  
Health Organization ◽  
Respectful Care

Background:Few studies have examined respectful maternity care (RMC) of adolescent mothers in the Caribbean. The researchers’ objective was to explore the perceptions of midwives who provide care for adolescent mothers in Jamaica. Design: A pilot qualitative study was conducted in 2015. Participants were 12 community or nurse-midwives who practiced in rural and urban regions of Jamaica attended a nursing and midwifery conference.Method:Semistructured focus groups and interviews of Jamaican midwives were conducted. The World Health Organization (WHO) definitions of respectful care in relationship to sexual and reproductive health rights, and data were examined using a poststructural feminist version of Denzin’s interpretive interactionism theory. Braun and Clark’s method of reiterative content analysis was employed. Findings:Participants shared their work experience with adolescent mothers and explained that restrictive public and institutional policies culture, personal beliefs, and the location of care delivery hindered them from providing respectful care which allows for shared decision-making, informed consent, and allowing for a desired labour companion. They perceived their roles as advocates, educators, expert helpers, and worker activists. Conclusions:Out of hospital environments appeared to facilitate the advocacy role. Policies and attitudes had the potential to hinder or to promote RMC. These findings may be used to inform a national midwifery survey, educational modules, health systems change to allow for less restrictive policies and spaces.

scholarly journals Implementation of RMC at Tertiary Care Centre in South India

2021 ◽  
Author(s):  
Papa Dasari ◽  
Mahalakshmy Thulasingam
Keyword(s):  
Health Care ◽  
Health Care Workers ◽  
Maternity Care ◽  
Tertiary Care ◽  
Respectful Maternity Care ◽  
Disrespect And Abuse ◽  
Care Centre ◽  
Tertiary Care Centre ◽  
Care Workers ◽  
Birth Companion

Title: Implementation of RMC at Tertiary Care Centre in South IndiaAbstract:Background: Disrespect and abuse experienced during childbirth has been reported by women to various sections of health care workers. The objective was to abolish Disrespect and Abuse and to bring about a policy change in labour room practices and to implement Respectful Maternity Care (RMC) in a high-volume tertiary care teaching hospital in South India.Methods: A Workshop and Continuous Medical Education Programme involving RMC experts were conducted in Phase I with defined objectives. These targeted health care workers were nurses, resident doctors, consultants, medical nursing students involved in giving care during pregnancy and labour. In Phase II the Govt. of India Policy on Birth Companion was presented in a meeting discussing on the National guidelines of “LaQshya”. Consent forms for birth companions were introduced and a dedicated public health nurse was trained to train the birth companions regarding their role in maternal support. The change of policy was officially intimated to the hospital administration. A qualitative assessment was done whether the Residents and Nurses practiced RMC as demonstrated in the Workshop. The operationalization of the birth companion policy was followed on daily observations, enquiries and onsite surprise visits over one year period.Results: The practice of RMC was followed only by few health care workers and certain cadre of women who laboured, received RMC and disrespect and abuse still prevailed. The bottle necks identified were low socioeconomic status of women, the in-charge consultants not insisting on presence of birth companions, the residents and nurses not promoting birth companion policy.Conclusions: : Implementation of Respectful Maternity Care needs change of attitudes of personnel who render care during child birth and it can only be successful unless it forms an integral part of Medical and Nursing curriculum.

scholarly journals Parents’ expectations and experiences of the 6-week baby check: a qualitative study in primary care

BJGP Open ◽  
2020 ◽  
Vol 4 (5) ◽  
pp. bjgpopen20X101110
Author(s):  
Gill Gilworth ◽  
Sarah Milton ◽  
Angel Chater ◽  
Irwin Nazareth ◽  
Andreas Roposch ◽  
...  
Keyword(s):  
Primary Care ◽  
Qualitative Study ◽  
Maternity Care ◽  
Normal Development ◽  
Screening Programme ◽  
Structured Interviews ◽  
Care Policy ◽  
Comprehensive Health ◽  
Health And Development ◽  
Important Milestone

BackgroundThe Newborn and Infant Physical Examination (NIPE) programme requires all babies to have a comprehensive health check at 6–8 weeks of age. These are typically completed by GPs. Although person-centred care has achieved prominence in maternity care policy in recent years, there is limited empirical evidence on what parents and/or carers expect from the check, and how far experiences meet their needs.Aim To explore the expectations and experiences of parents attending their GP for a baby check.Design & settingA qualitative study was undertaken in primary care in London.MethodContent analysis was undertaken of transcripts of semi-structured interviews. Interviews were conducted with a total of 16 participants (14 mothers and two fathers) who had recently attended for a 6-week check for their baby.ResultsDespite the availability of plentiful sources of general advice on infants’ health and development, a thorough check by a trusted GP was an important milestone for most parents. They had few specific expectations of the check in terms of what examinations were undertaken, but even experienced parents anticipated reassurance about their baby’s normal development. Many also hoped for reassurance about their own parenting. Parents appreciated GPs who explained what they were doing during the examination; space to raise any concerns; and combined mother and baby checks. Referrals to secondary care were generally experienced as reassuring rather than a source of anxiety.ConclusionThe baby check meets needs beyond those of the NIPE screening programme. Protecting the time for a thorough consultation is important for parents at what can be a vulnerable time.

Improving well-being in dementia care for clients and carers

2020 ◽  
Vol 19 (4) ◽  
pp. 321-326
Author(s):  
Rhonda Riachi ◽  
Sally Markwell
Keyword(s):  
Qualitative Study ◽  
Well Being ◽  
Dementia Care ◽  
Theory Approach ◽  
Structured Interviews ◽  
Content Type ◽  
Beneficial Effects ◽  
Communication Techniques ◽  
People With Dementia ◽  
Care Workers

Purpose This paper aims to highlight the results and emerging themes from a study concerning the effect of communication techniques that were tailored to each client in relation to the extent of their dementia. Dementia was viewed by the care workers primarily as a memory disability. Design/methodology/approach A short qualitative study of the communication techniques of care workers in England, who had received training in dementia care and some training in the SPECAL® method (Specialised Early Care for Alzheimer’s),was conducted through semi-structured interviews. Resulting data were analysed using a constructivist grounded theory approach. Findings Continued application of the SPECAL techniques appeared to reinforced clients’ sense of well-being and produced benefits for care workers’ own well-being. Research limitations/implications This small qualitative study suggests there can be beneficial effects for both clients and the care team when care workers tailor their communication behaviour to the needs of people with dementia. Further research on communication techniques in dementia care is needed and how these benefits might be translated into institutional settings. Originality/value Few research studies have been made of the SPECAL dementia care method, and this study was the first to look explicitly at the communication techniques that the care workers used with clients. Public health professionals are less likely to be aware of the SPECAL method.

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