It does matter where you come from: mothers’ experiences of childbirth in midwife obstetric units, Tshwane, South Africa

Abstract

BackgroundHealth professionals are striving to improve respectful care for women, but they fall short in the domains of effective communication, respectful and dignified care and emotional support during labour. This study aimed to determine women’s experiences of childbirth with a view to improving respectful clinical care practices in low-risk, midwife-led obstetric units in the Tshwane District Health District, South Africa.MethodsA survey covering all midwife-led units in the district was conducted among 653 new mothers. An anonymous questionnaire was administered to mothers returning for a three-days-to-six-weeks postnatal follow-up visit. Mothers were asked about their experiences regarding communication, labour, clinical care and respectful care during confinement. An ANCOVA was performed to identify the socio-demographic variables that significantly predicted disrespectful care. Six items representing the different areas of experience were used in the analysis.ResultsAge, language, educational level and length of residence in the district were significantly associated with disrespectful care (p ≤ 0.01). Overall, the following groups of mothers reported more negative care experiences during labour: women between the ages of 17 and 24 years; women with limited formal education; and women from another province or a neighbouring country. Items which attracted fewer positive responses from participants were the following: 46% of mothers had been welcomed by name on arrival; 47% had been asked to give consent to a physical examination; and 39% had been offered food or water during labour. With regard to items related to respectful care, 54% of mothers indicated that all staff members had spoken courteously to them, 48% said they had been treated with a lot of respect, and 55% were completely satisfied with their treatment.ConclusionThere is a need to improve respectful care through interventions that are integrated into routine care practices in labour wards. To stop the spiral of abusive obstetric care, the care provided should be culturally sensitive and should address equity for the most vulnerable and underserved groups. All levels of the health care system should employ respectful obstetric care practices, matched with support for midwives and improved clinical governance in maternity facilities.Electronic supplementary materialThe online version of this article (dio: 10.1186/s12978-017-0411-5) contains supplementary material, which is available to authorized users.

Mother’s Satisfaction towards Childbirth Care at Public Health Centers in Bench-Maji Zone, Ethiopia: A Facility-Based Cross-Sectional Study

“…Mothers from rural residence were AOR = 2:63 (95% CI (1.43, 5.80)) times more likely to be satisfied by the overall delivery service provided as compared to mothers from urban residence. This finding is substantiated by other studies conducted in Addis Abeba, Ethiopia, Tshwane, South Africa, and Brazil, where mothers coming from rural resi-dence were more satisfied than those from urban residence [25][26][27]. This might be due to the difference in media exposure; mothers from rural residence might have poor media exposure regarding delivery service and have less service expectations compared to their urban counterpart.…”

Confronting the culture of care: a call to end disrespect, discrimination, and detainment of women and newborns in health facilities everywhere

“…Because poor quality of care prevents care utilization, research has been primarily focused in regions of low facility-based coverage, especially for maternal and neonatal health. However, more research is needed on discrimination globally: including differential care based on class and social status [20,21], age and perceived maturity [22], marital status [23], immigrant status [24], HIV or other infection status [25], sexual orientation [26], physical, emotional and cognitive ability [27,28], and membership in ethnic or linguistic minority groups [29], among others.…”

Every woman in the world must have respectful care during childbirth: a reflection

“…For example, in Latin America, advocates pushed for legal frameworks addressing the issue [9]. The articles published in the Respectful Care series of this Journal reflect this, documenting the lack of dignified treatment in many countries: Tunisia, Nigeria, Guinea, Brazil, Tanzania, Ethiopia, India, South Africa, the United States, and among Romani women in Europe [10][11][12][13][14][15][16][17][18][19]. Yet today we find ourselves at an inflection point: it is time for us to move from merely documenting the problem towards engaging women, their families, and communities in jointly designing and testing effective, meaningful interventions.…”