The facilitating factors and barriers encountered in the adoption of a humanized birth care approach in a highly specialized university affiliated hospital

Abstract

BackgroundConsidering the fact that a significant proportion of high-risk pregnancies are currently referred to tertiary level hospitals; and that a large proportion of low obstetric risk women still seek care in these hospitals, it is important to explore the factors that influence the childbirth experience in these hospitals, particularly, the concept of humanized birth care.The aim of this study was to explore the organizational and cultural factors, which act as barriers or facilitators in the provision of humanized obstetrical care in a highly specialized, university-affiliated hospital in Quebec province, in Canada.MethodsA single case study design was chosen. The study sample included 17 professionals and administrators from different disciplines, and 157 women who gave birth in the hospital during the study. The data was collected through semi-structured interviews, field notes, participant observations, a self-administered questionnaire, documents, and archives. Both descriptive and qualitative deductive content analyses were performed and ethical considerations were respected.ResultsBoth external and internal dimensions of a highly specialized hospital can facilitate or be a barrier to the humanization of birth care practices in such institutions, whether independently, or altogether. The greatest facilitating factors found were: caring and family- centered model of care, professionals' and administrators' ambient for the provision of humanized birth care besides the medical interventional care which is tailored to improve safety, assurance, and comfort for women and their children, facilities to provide a pain-free birth, companionship and visiting rules, dealing with the patients' spiritual and religious beliefs. The most cited barriers were: the shortage of health care professionals, the lack of sufficient communication among the professionals, the stakeholders' desire for specialization rather than humanization, over estimation of medical performance, finally the training environment of the hospital leading to the presence of too many health care professionals, and consequently, a lack of privacy and continuity of care.ConclusionThe argument of medical intervention and technology at birth being an opposing factor to the humanization of birth was not seen to be an issue in the studied highly specialized university affiliated hospital.

Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia

“…Attendance of unknown and unwanted persons during childbirth has been reported to be associated with dissatisfaction in women using childbirth services in Jordan [ 16 ]. The problem of maintaining privacy in the studied health facilities may be due to presence of a large number of health care professionals and student interns who might have interfered with women’s privacy, especially in the hospital; this may instill a lack of intimacy and affect the continuity of care women receive from health institutions [ 17 , 18 ].…”

“…Denying women this support is not only against evidence-based practice [ 20 ], but is also associated with dissatisfaction of women with childbirth services [ 21 ]. In addition, institutional rules and strategies that restrict the presence of a birth companion are reported to be a significant barrier to humanized birth care [ 7 , 18 ], exacerbating facility-based disrespect and abuse during childbirth.…”

Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals

“…[ 7 ] Another topic of debate concerns the model of care provided. Some authors argue in favour of more person-centred care with a focus on the needs expressed by the pregnant woman [ 8 , 9 ] However, such concepts are not always applied or interpreted in the same way [ 10 - 12 ], and what is actually implemented may therefore differ across healthcare providers. Nevertheless, in recent decades women, as end users of these services, have become key protagonists when it comes to deciding the kind of maternity care they want, and they have called for greater respect to be shown towards their wishes; in this context, user groups have sometimes put considerable pressure on health policymakers to ensure that the care offered is more respectful of the physiology of labour [ 13 ].…”

Disrespect and Abuse During Facility‐Based Childbirth in North Showa Zone, Ethiopia

“…However, more than half of the women in this study reported that this was disallowed. The mere presence of a birth companion can ensure respectful care (43) whereas restricting the presence of a birth companion is reported to be a signi cant barrier to humanized birth care (25,44,45). This suggests that health care providers know the way they behave in the absence of a companion is inappropriate and treat a client differently when a companion of the client is present (46).…”