Abstract
BackgroundRespectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines. In the absence of any documented evidence, this study aimed to ascertain maternity care-givers’ perceptions of respectful care provided for childbearing women in Czech Republic.MethodsFollowing ethical approval, an online quantitative survey with qualitative comments was completed by 52 respondents recruited from workshops on promoting normal birth, followed by snowball sampling. The majority were midwives (50%) or doulas (46%) working in one of 51 hospitals, or with homebirths. Chi-square analysis was used for comparisons.ResultsNon-evidenced-based interventions, described as ‘always’ or ‘frequently’ used in hospitals, included application of electronic fetal monitoring in normal labour (n = 40, 91%), shaving the perineum (n = 10, 29%), and closed-glottal pushing (n = 32, 94%). Positions stated as most often used for spontaneous vaginal births were semi-recumbent (n = 31, 65%) or lying flat (n = 15, 31%) in hospital, and upright at home (n = 27, 100%). Average episiotomy and induction of labour rates were estimated at 40 and 26%, respectively, higher than accepted norms.Eighteen respondents (46%) said reasons for performing vaginal examinations were not explained to women in hospitals, and 21 (51%) said consent was ‘never’ sought. At home, 25 (89%) said reasons were explained, and permission ‘always’ sought (n = 22, 81%). Thirteen (32%) said hospital clinicians explained why artificial rupture of membranes was necessary, but only ten (25%) said they ‘always’ sought permission. The majority said that hospital clinicians ‘never’/‘almost never’ explained reasons for performing an episiotomy (13 = 34%), gained permission (n = 20, 54%) or gave local anaesthetic (n = 19, 51%). Contrastingly, 17 (100%) said midwives at home explained the reasons for episiotomy and asked permission. When clinicians disagreed with women’s decisions, 13 (35%) respondents said women might be told to ‘face the consequences’, six (16%) stated that the ‘psychological pressure’ experienced caused women to ‘give up and give their permission’, and four (11%) said the intervention would be performed ‘against her will.’ConclusionsFindings reveal considerable levels of disrespectful, non-evidenced-based, non-consensual and abusive practices that may leave women with life-long trauma.
Highlights
Respectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines
Plain English summary An online survey which aimed to find out levels of respectful maternity care in the Czech Republic was completed by 52 respondents, mostly midwives and doulas, working in one or more of 51 hospitals or with homebirths
Practices not supported by research and described by between a third and a half of respondents as ‘always’ or ‘frequently’ used included: attaching an electronic monitor to women’s abdomen to monitor baby’s heart in labour, shaving the area around the vagina, giving women enemas in early labour to empty the bowels and telling women to hold their breath to push when birthing
Summary
Respectful maternity care includes treating women with dignity, consulting them about preferences, gaining consent for treatment, respecting their wishes, and giving care based on evidence, not routines. Disrespectful intrapartum interventions, and/or interventions shown to be harmful when overused, include advising interventions to women whose labour is progressing normally and the baby is well, routine admission cardiotocography (CTG), continuous electronic fetal monitoring (EFM), decision-making in labour based on CTG findings alone, amniotomy, not encouraging women to birth in positions other than lying supine/ semi-supine, episiotomies, giving enemas in labour and performing fundal pressure (Kristeller manoeuvre). In 2014, the International Federation of Gynaecologists and Obstetricians (FIGO) issued a working paper on Mother and Baby Friendly Birthing Facilities [21] and, with the International Confederation of Midwives (ICM), WHO and several other organisations, signed the White Ribbon Alliance’s (WRA’s) Charter on the Universal Rights of Childbearing Women [19] outlining the 10 criteria describing their essential attributes
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