Respectful Maternity Care
Search and read at least one article on Respectful Maternity Care and share readings in the by replying in this discussion forum.
Towards the end of pregnancy and the beginning of another life lies a great hurdle that women, and women alone, must endure. Labor and childbirth are particularly vulnerable times in the continuum. Both the mother and the baby are subjected to physical, emotional, and mental stress. Such level of vulnerability can be aided by providing women the right and opportunity to decide on health-related options, elimination of harm and mistreatment, and securing a dignified and private child delivery. Thus, it is pertinent that during this period of immense pressure, respectable and quality care is provisioned and enabled to be accessed across women of all status (Asefa et. al, 2021).
Respectful maternity care, abbreviated as RMC, is recommended, and defined by the World Health Organization (WHO) as “the care organized for and provided to all women in a manner that maintains their dignity, privacy and confidentiality, ensures freedom from harm and mistreatment, and enables informed choice and continuous support during labor and childbirth” (Bohren et al, 2020). It focuses to ensure that women will have a positive experience that will result to better health outcomes for the mother and the baby, and increased trust in the system and future healthcare utilization. By empowering women, enabling rights and opportunities to make patient-centered decisions, and providing basic courteousness, RMC attends to mistreatment and violations to rights towards healthcare being experienced by women. However, with the onset of the COVID-19 pandemic, challenges pressed upon the healthcare infrastructure by changing protocols and paradigms to attend to the pandemic caused for strain in the provision of RMC and occurrence of violations committed against women and newborns. The COVID-19 pandemic adversely affected the provision of RMC in a multitude of ways in different settings globally (Asefa et. al, 2021; Bohren et. al, 2020; Reingold et. al, 2020).
As reported by the RMC Global Council, numerous violations of the right to RMC have transpired and observed during the COVID-19 pandemic which includes but not limited to: (1) lack of personal protective equipment when attending to mothers, (2) maternity units being converted into COVID-19 facilities thus, limiting access to MNH services, (3) unavailability of emergency transport, antenatal and postnatal contacts, (4) neglect due to fear of infection; (5) restriction of breastfeeding thereby, going against evidence-based and mandated guidelines; (6) classification of non-abortion as non-essential, (7) unavailability of contraceptive services and commodities; (8) increased occurrence of caesarian section and induction of labor without medical basis, (9) unequal access to telemedicine services, and (10) unavailability of out-of-hospital options for skilled care leading to unattended births (Jolivet et. al, 2020).
In the perspective of medical health workers, the same concern is observed. Based on reports of frontline health workers who is in-charge of providing maternal and newborn care, the clinical and interpersonal elements of care encompassed in RMC is compromised and disrupted. Preferred mode of childbirth, companionship during labor, childbirth, and postpartum, and skin to skin contact between mother and baby were all affected, despite WHO’s guidelines to maintain such health-related activities for more positive outcomes. Negativity associated with the surging cases precipitated fear, confusion, and frustration among health workers thereby, hindering their ability and capacity to provide quality RMC in accordance with evidence-driven guidelines. Adding to this growing burden is the limited number of overworked health workers that has to prioritize providing care to COVID-19 patients, especially those with severe signs and symptoms, over attending to mothers and their newborn. Moreover, with the rapid increase in positive cases that require hospitalizations, some maternal and newborn units are converted to host and contain COVID-19-related cases thus, limiting what has already been few available facilities for labor, delivery, and postpartum care. Unequal or limited resource allocation was also observed to pervade healthcare setting during the pandemic and contributed to faulty patient management and negative experience of women to health services. Such impacts are inextricably linked and therefore, necessitating multilevel, multidimensional, and system-oriented approach to correct and address. Health facilities and health systems must be structured in a way that supports and respects providers and ensures adequate infrastructure and organization of the maternity ward. (Asefa et. al, 2021; Bohren et. al, 2020).
Maintaining high-quality, essential MNH service delivery during COVID-19 upholds the rights of women and newborns. Strategies and solutions that uphold fundamental human rights and best clinical practices need to be developed and reinforced to secure stronger health and human rights outcomes for all. Moreover, accountability should be upheld at all levels of the performance and delivery of healthcare services, and improvement to existing quality and delivery of care should be of foremost concern as well. It is pertinent that in conjunction of the shift in the health infrastructure due to the pandemic, RMC and all services related to maternal and newborn care remain accessible and up to par. Implementing policies and interventions that considers continuous provision of RMC despite the surge of COVID-19 does not only cater to the integration of RMC amidst the pandemic but also recognizes limitations imposed by COVID restrictions and above all, dignifies human rights (Reingold et. al, 2020; Jolivet et. al, 2020).
As global health experts across diverse settings have warned, changes on the provision of antenatal, intrapartum, and postnatal care due to the COVID-19 pandemic. Exacerbating system deficiencies and strained health systems, it exposed the gaps and incompetence in the health care setting. It dramatically altered maternal newborn health (MNH) care delivery; some of the efforts to curb the virus violate the rights of women, their newborns, and families. Women’s right to decide on health options regarding birth companionship, emotional support, effective communication, pain relief measures, preferred birth position, and mobility during labor were deemed to be overlooked and neglected in response to prioritizing delivery and infrastructural mandates related to COVID-19. These key practices in the provision of woman-centered care that ultimately leads to a positive childbirth experience were ultimately cast aside despite data-drive, evidence-based guidelines called by WHO. Moreover, resource allocation, lack of accountability, fear of infection, faulty patient management, switch to unequally accessible telemedicine, and unavailability of basic MNH services, which are system-level errors further casted barriers in accessing healthcare services and the provision of RMC (Reingold et. al, 2020; Jolivet et. al, 2020).
It is essential and crucial to address the violations to informed decision-making of women in health, and neglect in healthcare delivery towards the mother and the baby. The right to health, quality healthcare, and preservation of life are universal and indivisible; they cannot be withdrawn, put aside, or overlooked in spite of the trying times brought upon the COVID-19 pandemic (Jolivet et. al, 2020).
References
Asefa A., Semaan, A., Delvaux, T., Hyusmans, E., Galle, A., Sacks, E., Bohren, M.A., Morgan, A., Sadler, M., Vedam, S. & Benova, L. (2021). The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers. Women and Birth. ISSN 1871-5192. https://doi.org/10.1016/j.wombi.2021.09.003.
Bohren, M.A., Tuncalp, O. & Miller, S. (2020). Transforming intrapartum care: Respectful maternity care. Best Practice & Research Clinical Obstetrics & Gynaecology, 67, 113-12. ISSN 1521-6934. https://doi.org/10.1016/j.bpobgyn.2020.02.005.
Jolivet, R. R., Warren, C. E., Sripad, P., Ateva, E., Gausman, J., Mitchell, K., Hacker, H. P., Sacks, E., & Langer, A. (2020). Upholding Rights Under COVID-19: The Respectful Maternity Care Charter. Health and human rights, 22(1), 391–394.
Reingold, R. B., Barbosa, I., & Mishori, R. (2020). Respectful maternity care in the context of COVID-19: A human rights perspective. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 151(3), 319–321. https://doi.org/10.1002/ijgo.13376