Abstract
BackgroundBirthing care matters to women and some women experience mistreatment during childbirth.AimTo determine the effect the ‘CLEVER Maternity Care’ package, a multi-faceted intervention to improve respectful, quality obstetric care.SettingTen midwife-led obstetric units in Tshwane health district, South Africa; five intervention and five control units.MethodsWe conducted an anonymous baseline and end-line survey to measure the change in women’s perceptions and experiences of childbirth care after the implementation of the CLEVER package. A convenience sample of women returning for a postnatal follow-up visit was obtained at baseline (n = 653) and after implementation of CLEVER (n = 679).ResultsSix survey items were selected as proxies for respectful clinical care. There was no significant change in proportions of responses regarding one question, and with regard to patients receiving attention within 15 min of arrival, both the intervention and control group units showed a significant increase in positive responses (odds ratios of 8.4 and 6.1, respectively, and p values of 0.0001 and 0.0007). For the remaining four items (asking permission before doing an examination, positive communication, respectful treatment and overall satisfaction), only the intervention group showed a significant positive change (odds ratios ranging from 2.4 to 4.3; p ≤ 0.0018), with no significant change for the control group (odds ratios between 1.0 and 1.8; p ≥ 0.0736).ConclusionAfter the implementation of CLEVER Maternity Care, women reported a more positive experience of childbirth. The CLEVER intervention is a potential strategy for addressing respectful, quality obstetric care that warrants further investigation.
Highlights
Birthing care matters to women and some women experience mistreatment during childbirth
Health services need to achieve the optimal balance between what health systems can provide in low- and middle-income countries (LMICs) and what women expect during birthing.[1,2]
There is a shift towards respectful, high-quality obstetric care[3] as well as a renewed focus by the World Health Organization (WHO) on improving maternal and neonatal mortality and morbidity in LMICs.[4]
Summary
Birthing care matters to women and some women experience mistreatment during childbirth. Health services need to achieve the optimal balance between what health systems can provide in low- and middle-income countries (LMICs) and what women expect during birthing.[1,2] There is a shift towards respectful, high-quality obstetric care[3] as well as a renewed focus by the World Health Organization (WHO) on improving maternal and neonatal mortality and morbidity in LMICs.[4] Birthing care during labour should be a supportive interaction between a woman and the healthcare providers, with attention to respectful care and meeting the sociocultural, emotional and psychological expectations and needs of the woman.[5] Women’s experience of mistreatment during childbirth could contribute to poor health and issues with relationships.[6]. Strategies for improving respectful maternity care need to follow a collaborative improvement approach[8,9] that incorporates health-systems barriers and systems thinking into pathways of better-sustained care.[10,11,12,13]
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