Alarming rates of avoidable maternal (and newborn) mortality and morbidity are often linked to poor quality of care; and according to Bohren, Tunçalp, and Miller (2020), there is increasing evidence suggesting that disrespectful and undignified care is common in many settings. These include practices that may make a woman feel dehumanized, disempowered, or not in control of her birth, such as physical or verbal abuse, discrimination, non-consented vaginal exams and/or procedures (e.g., cesarean section, episiotomy, induction of labor), lack of privacy, lack of supportive care, and neglect.
In a study conducted by Bohren et al. (2020), the evidence of respectful maternity care were reviewed and considerations for professional practice for healthcare providers were discussed. According to them, after undergoing revisions, respectful maternity is now used to refer to “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.”
The World Health Organization (WHO) highly recommends healthcare institutions to adopt and implement respectful maternity care, as it is in accordance with human rights-based approaches to maternity care and is proven to be effective in improving women’s experiences in labor and childbirth and in addressing health inequalities. With the potential of serving as a reference or guide for healthcare institutions, Shakibazadeh and his colleagues, as cited by Bohren et al. (2020), developed twelve domains of respectful maternity care from the perspectives of women and healthcare providers, and these include:
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Being free from harm and mistreatment.
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Maintaining privacy and confidentiality
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Preserving women's dignity
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Prospective provision of information and seeking informed consent
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Ensuring continuous access to family and community support
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Enhancing quality of physical environment and resources
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Providing equitable maternity care
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Engaging with effective communication
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Respecting women's choices that strengthens their capabilities to give birth
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Availability of competent and motivated human resources
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Provision of efficient and effective care
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Continuity of care
In providing quality care, respectful maternity care and clinical care provision must be given equal importance. When women feel supported, respected, safe, and able to participate in shared decision-making with their providers, they may be more likely to have positive childbirth experiences; however, when women experience disrespectful care, they may be less likely to use facility-based maternity care services in the future and may be more likely to have negative birth experiences. All women have the right to freedom from harm and ill treatment, the right to provide informed consent and refusal to consent, and regard for choices and preferences, including companionship during maternity care; and it is the responsibility of healthcare providers, whether they are in the field of nursing, midwifery, or medicine, to ensure that these are not violated and are respected at all times.
Reference:
Bohren, M. A., Tunçalp, Ö., & Miller, S. (2020). Transforming intrapartum care: Respectful maternity care. Best Practice & Research Clinical Obstetrics & Gynaecology. doi:10.1016/j.bpobgyn.2020.02.005