Search and read at least one article on Respectful Maternity Care and share readings in the by replying in this discussion forum.
We all know that all women deserve a humane, considerate, sensitive, and respectful care in childbirth. This is called the Respectful Maternity Care which is a human right and standard midwifery practice. However, it’s actually sad to say that there still have been general public complaints about lack of respectful behavior by midwives. As long as we want to educate our health practitioners about what impact respectful treatment to pregnant, laboring, and postpartum mothers can have, some care providers still lack compassion and commitment to their responsibilities in ensuring the care needed by these mothers. One study was made to determine clients experience of respectful maternity care and midwives’ caring behavior. The research article is entitled Respectful Maternity Care and Midwives' Caring Behaviours During Childbirth in Two Hospitals In Calabar, Nigeria and is authored by Mildred E John, and Ekpoanwan E Esienumph in 2020. Although the participants—midwives and postnatal women—selected were from hospitals in Calabar, Nigeria, based on the study’s background, there is a resemblance to what is also happening in some hospitals here in the Philippines. It is important that these common acts of disrespectful care experienced by women be identified, so ways of addressing these issues can be made and implemented. With this, appropriate maternity care which is respectful and rights-based will be ensured to all women, enhancing the utilization of maternity services and access to skilled care.
The descriptive study collected data from 83 purposively selected postnatal women who had spontaneous vaginal delivery, and 51 midwives caring for them. Ethical clearance was obtained as well as the informed consent of the participants. Clients and midwives identified respectful maternity care received/practiced from the Respectful Maternity Care (RMC) checklist. According to the data, RMC was reported by 58 clients which composed of 69.9% of participants from the study, while the 25 clients comprising the 30.1% reported lack of it in different categories. What’s interesting about this study is that, this reports different cases of lack of RMC and why it is considered so. This include non-respectful maternity care, reported lack of privacy, lack of information about progress of labor, denying preference and choice of childbirth position, lack of sensitivity towards clients’ pain and culture, verbal abuse, and detention in facility for non-payment of bill. Furthermore, the study also revealed that it is not only the midwives that are incompetent or giving inadequate care to the postnatal participants. Attending midwives confirmed not adequately screening or draping women because of lack of resources. The hospitals do not have enough screens and drapes. They said they restrict women to deliver in the dorsal position and detain them if they cannot pay the bill because of the hospital’s policy. This leaves the midwives, few to no choices to follow the protocols and use the only inadequate resources resulting to non-respectful care to the postnatal women.
These circumstances, although were witnessed and studied in Nigeria, are also present in other countries especially the third world or the developing ones even in the Philippines. According to these studies, which are also incorporated in the article, there has been a general public complaint about lack of respectful behavior by attending midwives, their non-welcoming stance, and non-availability of required materials in nearby healthcare facilities. Moreover, there is an increasing evidence of disrespectful, neglectful, and abusive treatment of women during facility-based childbirth in other countries. In a study conducted in Ethopia, there’s even a 36% mistreatment of postnatal women in the form of physical abuse, verbal abuse, violated privacy, and abandonment. Such disrespect and abuse are reportedly more common in single mothers. Even in India, the 98% of mistreatment of patients during labor and delivery is the verbal abuse which also includes being ‘left without care’, lack of information, and detention or confinement against will.
Poor practice of respectful maternity care may discourage many women from facility based births, make them report to the health facility only as a last resort, and therefore poses a burden to quality healthcare delivery most especially in poor countries. Although in the case from Nigeria, the proportion of women who experience disrespectful maternity care is not generally documented, such mistreatments along with poor quality of care have been cited as barriers to access to skilled care by pregnant women in the country. Moreover, disrespect and abuse during childbirth reflect a lack of value for life, and is a systemic barrier to safe motherhood, as well as a violation of the human rights of the woman. Every woman strives for a positive childbirth experience, and the memories of childbirth experiences tend to stay with the woman for a long time, and may influence future childbirth choices. And this highlights how important the roles of nurses and maternity caregivers are in pregnant, laboring, and postnatal women and their family. The experiences with maternity caregivers have the power to ensure comfort, or to cause lasting damage and emotional trauma that would hinder future utilization of skilled care for childbirth. Disrespectful and abusive behavior by health workers is an important, but little understood component of the poor quality of care experienced by women during childbirth in healthcare facilities. These tend to hinder access and deter utilization of maternity care services and skilled care for childbirth in many third world countries including the Philippines. If a woman does not feel safe and respected during her visit to a maternity center she is less likely to attend other antenatal care appointments or come to the health facility when in labor. Some may delay decision to seek care even when feeling ill. This would result to lack of skilled maternity care coupled with care that does not meet basic respect and dignity standards, and tend to increase the risk of pregnancy and childbirth-related morbidity and mortality.
Improving the quality of care around the time of birth has been identified as the most impactful strategy for reducing maternal and perinatal mortality and morbidity. Respectful maternity care is gaining attention globally and is regarded as the standard midwifery practice no matter the setting. It is believed that it could contribute towards the achievement of the health related Sustainable Development Goals (SDGs) by ensuring an increased proportion of births attended by skilled birth health care givers. The midwives, nurses, and other health practitioners are ethically bound to give patient-centred, culturally-sensitive and respectful care to every woman seen in the course of their practice, no matter the setting. And as revealed in the study, a mix of respectful and disrespectful care are rendered by midwives to the women. This implies a deficit in maternity care because it is not fully rights-based, thus the women are not obtaining optimal care. In response, the women may resort to unskilled birth attendants who may be ‘friendlier’ but with consequence of morbidities and mortality. Therefore, there is need to scale up maternity care in the contemporary health facilities to reflect fundamental human rights. Summing up, both respectful and disrespectful behaviors exist during maternity care, as reported by both the clients and the midwives. Appropriate maternity care must be respectful and rights-based in order to enhance access to skilled care at birth. Midwives need to transform care given to women while providing maternity services through respectful care. This would make a difference by promoting women’s rights and ensuring their dignity.
Reference:
John, M. E., et al. (2020). Respectful Maternity Care and Midwives’ Caring Behaviours During Childbirth in Two Hospitals In Calabar, Nigeria. African Journal of Biomedical Research, 23(2), 165–168. https://ojshostng.com/index.php/ajbr/article/view_/890_0htlmn0.