Midwives’ experiences of implementing respectful maternity care knowledge in daily maternity care practices after participating in a four-day RMC training

Abstract

Background: In Ghana, studies documenting the effectiveness of evidence-based specialized training programs to promote respectful maternity care (RMC) practices in healthcare facilities are few. Thus, we designed a four-day RMC training workshop and piloted it with selected midwives of a tertiary healthcare facility in Kumasi, Ghana. The present paper evaluated the impact of the training by exploring midwives’ experiences of implementing RMC knowledge in their daily maternity care practices four months after the training workshop.Methods: Through a descriptive qualitative research design, we followed-up and conducted 14 in-depth interviews with participants of the RMC training, exploring their experiences of applying the acquired RMC knowledge in their daily maternity care practices. Data were managed and analysed using NVivo 12. Codes were collapsed into subthemes and assigned to three major predetermined themes.Results: The findings have been broadly categorized into three themes: experiences of practising RMC in daily maternity care, health facility barriers to practising RMC, and recommendations for improving RMC practices. The midwives mentioned that applying the newly acquired RMC knowledge has positively improved their relationship with childbearing women, assisted them to effectively communicate with the women, and position them to recognize the autonomy of childbearing women. Despite the positive influence of the training on clinical practice, the midwives said the policy and the built environment in the hospital does not support the exploration of alternative birthing positions. Also, the hospital lacked the required logistics to ensure privacy for multiple childbearing women in the open labour ward. The midwives recommended that logistics for alternative birthing positions and for privacy in the ward should be provided. Also, all midwives and staff of the hospital should be taken through the RMC training program to encourage good practice.Conclusion: Despite the report of some RMC implementation challenges, the midwives noted that the 4-day RMC training has had a positive impact on their maternity caregiving practice in the hospital. Policies and programs aimed at addressing the issue of disrespect and abusive practices during maternity care should advocate and include the building of facilities that support alternative birthing positions and privacy of childbearing women during childbirth.

Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana

“…It has thirteen (13) clinical directorates (departments) one of which is the Obstetrics and Gynaecology (O &G) directorate, which has four labour wards. In 2018, the hospital recorded an estimated 4792 Spontaneous vaginal deliveries, an estimated 123 maternal deaths, and 61 neonatal deaths [ 14 ]. The midwife staff strength at KATH is 381.…”

“…The literature is replete with studies that show the existence of significant disparities with respect to who receives RMC [ 12 , 13 ]. For instance, younger women, unemployed women, and those who give birth in higher level facilities tend to have poorer experiences with respect to RMC [ 12 – 14 ]. Furthermore, most studies that have explored the phenomenon of RMC in Ghana have done so from the perspective of the client.…”

“…Respectful maternity care is supposed to be the normal maternity care practice for all healthcare workers. Nevertheless, earlier studies conducted in Ghana have found that disrespectful maternity care often manifested through acts of shouting, pinching, slapping, and physical restraint to a delivery bed, were commonly cited in the labour ward and often exhibited by midwives [ 6 , 7 , 13 , 14 ]. Evidence suggests that midwives who show acts of disrespect to women during childbirth do so on the premise of trying to save the mother or baby [ 6 , 15 ].…”

“…Moreover, with respect to RMC, to the best of our knowledge, there is no empirical evidence that describes the variation in RMC across different cadre of healthcare providers. Evidence available is shows the existence of disrespectful maternity care among midwives [ 6 , 7 , 13 , 14 ].…”