Providing respectful maternity care in northern Ghana: A mixed-methods study with maternity care providers

Moyer, Cheryl A.; McNally, Brienne; Aborigo, Raymond; Williams, John E.; Afulani, Patience A.

doi:10.1016/j.midw.2020.102904

Cited by 10 publications

(26 citation statements)

References 23 publications

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“…Midwives' weakest components of autonomy and communication were low involvement of women in decision about their care and choice of birthing position. These are consistent with evidence that midwives dominated decision making process in care and birth position [5,8,22,25,29,30,33,35,37,38,47], but contrasts with studies wherein midwives encouraged women involvement in caring decisions and choice of childbirth position [32,36,37]. As similarly found in previous studies, there were power imbalances between midwives and women, such that women always relied on midwives for caring decisions [30,49].…”

Section: Discussionsupporting

confidence: 85%

“…A growing body of studies related to PCMC in African countries highlight context-specific enablers of and gaps in respectful and dignified care, communication and autonomy, and supportive maternity care. Midwives commonly reported verbal abuse, physical abuse, lack of visual privacy, poor record confidentiality, neglect, and non-dignified care [5,8,[22][23][24][25][26][27][28][29][30][31][32][33]. Disrespectful care of childbearing women results from lack of co-operation from women [8,22,23,26,31], lack of resources [5,22,23,28,29,34], midwives' normalisation of abuse [31], negative view of women [27,31], exertion of power and control over women [8,24,25,30,31], fear of being blamed for poor childbirth outcomes and medical necessity [5,8,22,23,26,31], high workload and tiredness [5,29,34], and use of moral judgement [24,35].…”

Section: Introductionmentioning

confidence: 99%

“…Although some midwives encourage close relationship between midwives and women [28,36], women involvement in care decisions [32], and women's choice of childbirth position [36,37], poor communication and autonomy practices are common in prior African studies. Midwives acknowledged rarely introducing themselves to women [22]; limiting women involvement in decision-making [5,8,22,25,29,30,33,37]; and discouraging women's choice of birthing position [5,22,35,38].…”

Section: Introductionmentioning

confidence: 99%

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Midwives’ perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study

Ogbuabor

Okoronkwo

2021

PLoS ONE

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Background Person-centred maternity care (PCMC) is acknowledged as essential for achieving improved quality of care during labour and childbirth. Yet, evidence of healthcare providers’ perspectives of person-centred maternity care is scarce in Nigeria. This study, therefore, examined the perceptions of midwives on person-centred maternity care (PCMC) in Enugu State, South-east Nigeria. Materials and methods This study was conducted in seven public hospitals in Enugu metropolis, Enugu State, South-east Nigeria. A mixed-methods design, involving a cross-sectional survey and focus group discussions (FGDs) was used. All midwives (n = 201) working in the maternity sections of the selected hospitals were sampled. Data were collected from February to May 2019 using a self-administered, validated PCMC questionnaire. A sub-set of midwives (n = 56), purposively selected using maximum variation sampling, participated in the FGDs (n = 7). Quantitative data were entered, cleaned, and analysed with SPSS version 20 using descriptive and bivariate statistics and multivariate regression. Statistical significance was set at alpha 0.05 level. Qualitative data were analysed thematically. Results The mean age of midwives was 41.8 years ±9.6 years. About 53% of midwives have worked for ≥10 years, while 60% are junior midwives. Overall, the prevalence of low, medium, and high PCMC among midwives were 26%, 49% and 25%. The mean PCMC score was 54.06 (10.99). High perception of PCMC subscales ranged from 6.5% (dignity and respect) to 19% (supportive care). Midwives’ perceived PCMC was not significantly related to any socio-demographic characteristics. Respectful care, empathetic caregiving, prompt initiation of care, paying attention to women, psychosocial support, trust, and altruism enhanced PCMC. In contrast, verbal and physical abuses were common but normalised. Midwives’ weakest components of autonomy and communication were low involvement of women in decision about their care and choice of birthing position. Supportive care was constrained by restrictive policy on birth companion, poor working conditions, and cost of childbirth care. Conclusion PCMC is inadequate in public hospitals as seen from midwives’ perspectives. Demographic characteristics of midwives do not seem to play a significant role in midwives’ delivery of PCMC. The study identified areas where midwives must build competencies to deliver PCMC.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Midwives’ perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study

Ogbuabor

Okoronkwo

2021

PLoS ONE

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“…This is owing to the fact that when women are denied the respect that they deserve, they are less inclined to return to health facilities for future births [ 6 , 7 , 11 ]. 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 ].…”

Section: Introductionmentioning

confidence: 99%

“…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 ].…”

Section: Introductionmentioning

confidence: 99%

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

Dzomeku

Mensah

Nakua

et al. 2022

BMC Pregnancy Childbirth

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Background Evidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives’ perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility. Methods We employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study. Results The findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO’s quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building. Conclusion We conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities.

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Turkish validity and reliability study of the “respectful maternity care” knowledge and practice scale of midwives

DAĞLI

Reyhan

TOPKARA

et al. 2023

European Journal of Obstetrics & Gynecology and Reproductiv

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Providing respectful maternity care in northern Ghana: A mixed-methods study with maternity care providers

Cited by 10 publications

References 23 publications

Midwives’ perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study

Midwives’ perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study

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

Turkish validity and reliability study of the “respectful maternity care” knowledge and practice scale of midwives

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