Childbirth Services Research Articles

Does financing for private maternity services improve birth experiences in Poland? A mixed-methods study of the Babies Born Better Survey.

Women in Poland, despite having access to publicly-funded medical care during pregnancy, childbirth and the postpartum period, frequently use private care. Women's experience and satisfaction with childbirth have been considered one of the key indicators of the quality of care. In this study we explore whether and how paying for private childbirth services affects women's experiences and satisfaction with care. The qualitative portion seeks to understand how individual women construct meaning around their childbirth experiences, including their relationships with healthcare personnel, medical interventions, birth environment, and professionalism. This mixed-methods study is based on data from 951 online questionnaires completed by women who gave birth between June 2017 and June 2022, in Poland. This study is part of the international Babies Born Better Survey project. The project used simultaneous quantitative and qualitative data collection, it was exploratory with equivalent status of qualitative and quantitative data. Quantitative data were analyzed descriptively and chi-squared tests were conducted to compare women who used private and public care. Qualitative data were analyzed using inductive thematic analysis. The quantitative and qualitative results were integrated, in accordance with the chosen mixed-methods design. There were no major differences in sociodemographic characteristics (except living standards), health status and satisfaction with labor between women who paid for private services during childbirth and those who used only publicly-funded care. For both groups of women, healthcare personnel and their behavior were the most frequently mentioned aspect shaping childbirth experiences. Other important aspects were: medical interventions, birth environment, and staff professionalism. Although accessing private perinatal services care did not provide women with care consistent with their expectations, women put a lot of trust into private services as a means to receive more attentive care. Further research investigating the interplay between private and public services is needed to explore the question how private services may impact the care women receive and why women put so much trust in these services.

Perinatal care in the earthquake disaster of the century: Nurses' and midwives' experiences.

To determine the experiences of nurses and midwives providing perinatal care in an earthquake area. On February 6, 2023, two earthquakes measuring 7.8 and 7.6 magnitudes struck Turkey, affecting a large area. It is crucial for perinatal care to be rapidly organized, provided under the most suitable conditions, and delivered by qualified health professionals. Understanding the post-disaster experiences of nurses and midwives is crucial to addressing this issue. This is a qualitative study using phenomenological methodology with 8 nurses and 12 midwives in the earthquake-affected area. Personal information and semistructured interview forms were used for data collection. Content analysis was used for data analysis. Participants had a mean age of 33.75 years. The experiences of nurses and midwives were grouped into five themes: emotions experienced, challenges encountered, problems in perinatal services, coping mechanisms, and recommendations. The emotions experienced theme encompasses both positive and negative emotions. The challenges encountered theme includes challenging environmental conditions, organizational issues, problems with medical supplies and drugs, and being a victim of the earthquake. The problems in perinatal services theme includes pregnancy, childbirth, and postpartum services. The coping mechanism's theme encompasses problem-focused and emotion-focused coping strategies. The recommendations theme includes education and awareness, preparedness for disasters, and sustainable services. Nurses and midwives working in the earthquake-affected area experienced numerous physical and psychological challenges and encountered difficulties in delivering health services. Adisaster educationcourse including simulated disaster drills and practice can be integrated into the education system. Strengthening healthcare facilities against disasters and raising awareness among the community are crucial.

The Involvement of Religious Leaders in Supporting Institutional Childbirth in Rural Jimma Zone, Oromia, Southwest Ethiopia: An exploratory Qualitative Study.

This exploratory qualitative study examined the involvement of religious leaders in maternal health practices with a focus on promoting institutional childbirth in the rural Jimma Zone, Oromia, Ethiopia. In-depth interviews with 24 male religious leaders revealed five key themes: awareness of childbirth practices, religious beliefs, experiences of childbirth preparedness, experiences at health institutions, and challenges with using institutional childbirth services. The findings indicate that, while religious leaders significantly influence community attitudes toward institutional childbirth, their impact is often limited by a lack of awareness and insufficient engagement with health services. This study underscores the need for culturally sensitive interventions incorporating religious beliefs into maternal health promotion. Enhanced collaboration between health care providers and religious leaders, along with targeted training, is essential for improving maternal health outcomes and increasing the use of institutional childbirth services in rural Ethiopia and other similar contexts.

The Availability of Midwifery Care in Rural United States Communities.

Access to pregnancy-related and childbirth-related health care for rural residents is limited by health workforce shortages in the United States. Although midwives are key pregnancy and childbirth care providers, the current landscape of the rural midwifery workforce is not well understood. The goal of this analysis was to describe the availability of local midwifery care in rural US communities. We developed and conducted a national survey of rural US hospitals with current or recently closed childbirth services. Maternity unit managers or administrators at 292 rural hospitals were surveyed from March to August 2021, with 133 hospitals responding (response rate 46%; 93 currently offering childbirth services, 40 recently closed childbirth services). This cross-sectional analysis describes whether rural hospitals with current or prior childbirth services had midwifery care with certified nurse-midwives available locally and whether rural communities with and without midwifery care differed by hospital-level and county-level characteristics. Among hospitals surveyed, 55% of those with current and 75% of those with prior childbirth services reported no locally available midwifery care. Of the 93 rural communities with current hospital-based childbirth services, those without midwifery care were more likely to have lower populations (37% vs 33%); majority populations that were Black, Indigenous, and people of color (24% vs 10%); and hospitals where at least 50% of births were Medicaid funded (77% vs 64%), compared with communities with midwifery care. Conversely, communities with midwifery care more often had greater than 30% of patients traveling more than 30 miles for hospital-based childbirth services (38% vs 28%). More than half of rural hospitals surveyed reported no locally available midwifery care, and availability differed by hospital-level and county-level characteristics. Efforts to ensure pregnancy and childbirth care access for rural birthing people should include attention to the availability of local midwifery care.

Autonomy and Respect among Postnatal Mothers during Maternity Care in a Tertiary Level Hospital

Background: Lack of respectful maternity care act as more powerful deterrents to skilled birth care utilization than other more commonly recognized deterrents such as geographic and financial obstacles. Ensuring high level of respectful maternity care encourage the women to utilize facility-based care, which is essential for improving maternal and neonatal health. Thus, the objective of the study is to find out autonomy and respect during maternity care among the postnatal mothers in a tertiary level hospital. Methods: A descriptive cross-sectional study was conducted among 214 postnatal mothers receiving child birth services from the facility were selected by using non-probability purposive sampling technique. Analysis of data was done by using descriptive statistics (number, percentage, mean, standard deviation) and chi- square test was used for association between autonomy and respect and selected socio-demographic variables. Results: The study result indicated that (74.8%) of the respondents had high level of autonomy. Similarly, (71%) of the respondents reported that they experience high level of respect. A significant association was present between autonomy of postnatal mothers with caste (p=.027) and parity (p=.005) and a significant association was present between respect of postnatal mothers with type of delivery is with p value (.001). Conclusions: Hence, level of autonomy and respect tends to be high among postnatal mothers during maternity care and is associated with caste, parity and type of delivery. Continuous professional development programme for all cadres of health personnel should be conducted in respectful maternity care of maternity ward.

COVID-19 related barriers to institutional childbirth during the early phase of the pandemic in rural Arsi zone, Ethiopia, 2022: A qualitative study

IntroductionGlobal, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020–June 20/2020) in the rural Arsi zone of Ethiopia. MethodsA community-based Phenomenological study was conducted from January 10–25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020–June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version. ResultsFour major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth. ConclusionsCOVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Maternal health in cities: analysis of institutional maternal mortality and health system bottlenecks in Kampala City Uganda, 2016-2021

Background Recent estimates have shown a stagnation in maternal mortality reduction globally. Levels and trends in maternal mortality in urban settings in Africa are of interest due to health system challenges posed by rapid urbanisation. Given the high percentage of births occurring in city health facilities, tracking the institutional maternal mortality ratio (IMMR) can reveal key performance issues. We described the trends in IMMR between 2016 and 2021, and the causes and characteristics of maternal deaths in Kampala, Uganda. Methods This retrospective study utilised routine data from all facilities in Kampala that provided childbirth services from 2016 to 2021. Three key variables were used: number of deliveries, live births, and maternal deaths. Additionally, from medical records in three purposively selected hospitals, we extracted information on characteristics of women recorded as maternal deaths and their causes for the period 2016-2021 from death notification and review forms. We conducted descriptive analysis and assessed time trends in IMMR. Results For the six-year period, the Kampala-level IMMR was 189/100,000 deliveries (194/100,000 livebirths). The IMMR declined from 213 (2016) to 109/100,000 deliveries in 2019 (p=0.04) and then increased to 258 in 2021 (p=0.12). A review of 358 maternal death records showed that 65% of deaths were women referred from other health facilities, and 47% lived in the surrounding district (Wakiso). Obstetric haemorrhage (44%) and hypertensive disorders in pregnancy (28%) were the most commonly recorded causes of death. Health system factors such as lack of blood and other supplies contributed to 65% of the deaths reviewed. Conclusions IMMR in Kampala increased from 2019-2021. Health infrastructure changes and maternal health initiatives potentially accounted for the observed trend by affecting data quality. Referral and facility readiness were underlying reasons for maternal deaths. Addressing bottlenecks in emergency referral processes may contribute to mortality reduction. Further research should determine the relative contribution of key influences on mortality levels and examine the dynamics between women’s care-seeking pathways and service delivery arrangements for emergency obstetric care in urban settings.

Status of the midwifery workforce and childbirth services and the impact of midwife staffing on birth outcomes in China: a multicentre cross-sectional study

ObjectiveTo investigate the status of the midwifery workforce and childbirth services in China and to identify the association between midwife staffing and childbirth outcomes.DesignA descriptive, multicentre cross-sectional survey.SettingMaternity hospitals from...

Increased utilisation and quality: a focus on inequality and a learning health system approach—explaining Nepal’s success in reducing maternal and newborn mortality 2000–2020

IntroductionMaternal mortality in Nepal dropped from 553 to 186 per 100 000 live births during 2000–2017 (66% decline). Neonatal mortality dropped from 40 to 21 per 1000 live births during...

Barriers to use of institutional childbirth services: a qualitative study in the rural Jimma Zone, Ethiopia

Background/Aims Institutional birth and skilled birth attendants are two important elements of preventing maternal and newborn deaths. In Ethiopia, despite improved health access, many women give birth without skilled assistance. This study was conducted to identify barriers to institutional childbirth in the Jimma Zone, Ethiopia. Methods An exploratory qualitative case study was conducted, incorporating 16 focus group discussions and 18 in-depth interviews carried out in the Jimma Zone, Ethiopia in 2019. The participants were purposefully recruited and included members of the Women's Development Army, religious leaders, health extension workers, midwifery nurses, primary healthcare unit directors and women of reproductive age. Data were transcribed and translated into English and thematically analysed. Results Five themes emerged from the data: knowledge gaps, beliefs about pregnancy and childbirth, poor access to healthcare services, lack of resources and poor community involvement in institutional childbirth. Conclusions Healthcare services should be aware of local beliefs and cultural norms when encouraging the use of institutional childbirth services. The Ministry of Health must ensure that all services are equipped with adequate resources, both in terms of medical supplies and staff.

Prevalence of and factors associated with home births in western Nepal: Findings from the baseline of a community-based prospective cohort study

Problem consideredHome birth in a resource-poor setting such as Nepal is a maternal and newborn survival risk factor. Although the proportion of home births in Nepal has decreased substantially over the last two decades, the progress has yet to be equal in all regions. This study aimed to explore the prevalence of and investigate the factors associated with home birth in the western region of Nepal. MethodsA community-based prospective cohort study was conducted in the Rupandehi district of western Nepal. A total of 735 mother-infant pairs were included (rural = 378, urban = 357). Factors affecting home births were first assessed using chi-square tests, followed by multiple logistic regression. ResultsOnly 11.8% of mothers had their childbirth at home. Women who had ≤3 antenatal care (ANC) visits (Adjusted Odds Ratio (AOR): 3.15; 95% Confidence Interval (CI): 1.88, 5.29), reported receiving sub-optimal ANC services (AOR: 1.98; 95% CI: 1.18, 3.33), and were multiparous (AOR: 2.18; 95% CI: 1.13, 4.23), were more likely to have home births. Conversely, women from rich families (AOR: 0.19; 95% CI: 0.06, 0.57) were less likely to have home births. ConclusionFuture public health interventions need to focus on ensuring the equitable distribution of maternal health services. There is a need to adapt the maternal incentive schemes to remove the demand side barriers to increase access to childbirth services for women from poor wealth backgrounds. Furthermore, within the supply side, improving the access to and quality of ANC is likely to reduce home births.

Are women satisfied with childbirth services provided in public health facilities? Evidence from two districts in Bihar, India

PurposeThis study aims to measure the level of satisfaction among women with childbirth services provided at public health facilities. Further, to analyse the impact of their socio-economic and obstetric characteristics on their level of satisfaction.Design/methodology/approachTo accomplish these objectives a cross-sectional survey was conducted in two districts of an Indian state, Bihar. Structured questionnaire was developed based on the scale proposed by Okumu and Oyugi (2018) both for vaginal and caesarean birth patients. For empirical analysis multiple linear regression model was employed.FindingsResults suggest that majority of mothers are satisfied with the care they received during childbirth, regardless of whether they chose a caesarean (55%) or vaginal delivery (53%). Women report the lowest levels of satisfaction with postpartum care and the privacy that was preserved by healthcare personnel at health facility. Further the study also confirms the association between patient’s socio-economic characteristics and their satisfaction level.Originality/valueThis is the first study of its kind to highlight the situation of public healthcare system in Bihar, which is the third most populated state in India with poor social and health indicators.

Maternal Mortality from 2014 To 2017: Trend and Risk Factors at the Kintambo Maternity Ward, Democratic Republic of Congo

Introduction: Maternal mortality is a tragedy and constitutes a triple scourge. It is dramatic for the family (which falls apart after the death of the woman), unacceptable for the medical profession (since there are obstetric means to save mothers), and unacceptable for society (dying while giving birth). However, it seems to increase every year in the city of Kinshasa, due to several factors including the lack of easy access to quality care and childbirth services. The main objective for this study was to investigate the trend in maternal mortality at the Kintambo maternity ward from 2014-2017 including the relative contribution of risk factors linked to the lack of easy access to care and services quality delivery. Methods: This is an observational case-control study among pregnant women who followed ANC or not at the Kintambo maternity ward, but who all gave birth from January 2014 until December 2017. The use of the survey method, based on the analysis of registers, with a data collection sheet (check list) which was used for the collection of data, proved essential to bring this to fruition research. The sample size was exhaustive for cases (63 cases) and 63 controls. Results: Trend in female mortality between 2014-2017 at the Kitambo maternity ward in the city of Kinshasa has been decreasing, i.e. 22 cases in 2014, 17 cases in 2015, 14 cases in 2016 and 10 cases in 2017. It was observed that the variables show a very significant difference in relation to the factors which are the age of the pregnant woman, attendance at the CPN, delivery in the same center, the number of doctors in the delivery room and the distance between the residence and the center with an added value (P) less than 0.008; In comparison to pregnant women who die or not during childbirth and the factors in relation to their Chi-square, the age of gestation has a higher. Conclusion: Reducing this mortality requires strengthening the capacities of midwives /midwives in the care of pregnant women from conception to delivery and in the postpartum period , providing maternity wards with all the assets for good operationalization in the farthest corners of the city center , raising awareness among pregnant women of the importance of attending the CPN, ensuring good monitoring of the pregnant woman during her pregnancy and during childbirth, and for women to be always accompanied by their husbands during the CPN in order to help them internalize certain notions.

PELATIHAN HYPNOBIRTHING BASIC UNTUK MANAJEMEN NYERI PERSALINAN PADA IBU HAMIL DI DESA TARAWEANG, KECAMATAN LABBAKKANG, KABUPATEN PANGKEP, PROPINSI SULAWESI SELATAN

Hypnosis, self-hypnosis, and hypnobirthing are techniques to overcome childbirth anxiety. Expectant mothers are taught to trust their bodies, regain confidence in their ability to give birth, and release tension and pain through deep relaxation, breathing, and visualization techniques. Despite the many relevant studies cited, hypnobirthing has not been an institutionally preferred option offered by childbirth service providers such as government health centers and hospitals, possibly due to a lack of written policy support. This option is available through private childbirth service providers or hypnobirthing practitioners who provide complementary therapies. The lack of comprehensive childbirth preparation (physical, mental, and social) among young mothers in Taraweang Village, Labbakkang Sub-district, Pangkep District This prompted us to present a new approach to childbirth by introducing the concept, benefits, and how to do self-hypnosis independently to increase awareness and readiness before birth. This activity was implemented on April 5, 2023, after a socialization process with the partners in March 2023. The activity, which involved 15 pregnant women from Taraweang Village, began with a screening process for labor readiness and the mother's mental health condition using a distress scale form. Then followed socialization and training, as well as a 60-minute hypnosis simulation using reclusiveness techniques to increase awareness and readiness for dealing with pain. The activity ended with a pre-test to assess the mother's reaction to the therapy results. Based on data analysis, we concluded that pregnant women who received 60 minutes of hypnobirthing relaxation therapy experienced a decrease in the distress scale. This activity is expected to be carried out independently at the mothers' homes using the knowledge that has been provided in the process of community partnership activities in 2023. This activity will be further developed and evaluated, especially to ensure the sustainability of the benefits felt by partners in subsequent activities.

A Qualitative Study on the Living Conditions of Filipino Domestic Helpers in Hong Kong

While Filipino domestic assistants in Hong Kong are not entitled to get the Hong Kong Permanent Identity Card, they do have access to complimentary medical care in Hong Kong, which includes the option of receiving childbirth services. In light of the aforementioned context, a pertinent concern that arises pertains to the potential mistreatment of Filipino domestic workers, encompassing issues such as discrimination, access to adequate healthcare, and equitable treatment of local citizens. This study aims to investigate the experiences of Filipino migrant workers regarding discrimination and labor alienation. This study aims to examine the potential experiences of racial discrimination and challenges in cultural communication faced by individuals from diverse ethnic backgrounds. In relation to the economic dimension, it is important to examine the feasibility of individuals leading a satisfactory lifestyle within the confines of their employer-provided remuneration. This study aims to examine the potential for individuals to integrate into Hong Kong society in terms of interpersonal relationships. This study aims to examine the issue of labor protection, specifically focusing on the potential exploitation of workers by their employers and the availability of aid from relevant institutions. Filipino domestic helpers, Hong Kong, Living conditions.

Ethnography of Communication: SPEAKING Analysis on Childbirth Services in Sa'dan, North Toraja

This study aims to identify cultural communication gaps in three common childbirth speech events, namely among the Toraja ethnic community in Sa'dan, North Toraja involving childbirth attendants and different locations, namely (1) childbirth attended by a midwife in a healthcare facility, (2) childbirth attended by a to'mappakianak (traditional birth attendant) at the mother's home, and (3) childbirth with collaborative efforts between a midwife and to'mappakianak in a healthcare facility. To pursue the aim of this study, SPEAKING analysis was used. The SPEAKING analysis (Scene/Setting-Participants-Ends-Act-Key-Instruments-Norms-Genre) is a framework in communication ethnography study developed by Dell Hymes to understand and analyse the society and culture of an ethnic group through communication processes. The results indicated that both midwives and to'mappakianak culturally shared the same goal of safely attending childbirth. However, within the context of different speech community's perspectives, the experiences and cultural nuances of participants, including childbirth attendants, mothers, and families, also conveyed different meanings. These differences could be positive or negative for the involved participants. This study could provide insights for policy of maternal and child health service providers to consider cultural and communication factors in health services for Toraja ethnics in Sa'dan, North Toraja. In short, competent childbirth attendants should be culturally communicative and adhere to safe motherhood principles.

Literature Review: Comparison of the Quality of Delivery Services at Independent Midwife Practices and Public Health Center

Introduction: The role of quality service is important for health facilities to maintain their existence in the community, including Public Health Centers and Independent Midwife Practices that provide delivery services for pregnant women. Delivery services at health care facilities are one of the factors leading to the reduction of the Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR). This review was conducted to determine a comparative picture of the quality of delivery services at Independent Midwife Practices and Public Health Center.Methods: The study was conducted using a literature review approach of national journal articles retrieved from the Google Scholar database. The keywords used were quality of delivery services, quality of delivery services, patient satisfaction, Independent Midwife Practices, and Public Health Center. With a publishing range of no more than the last 5 years or from 2018-2023.Results: Five journals were eligible to be analyzed in relation to the quality of delivery services. The study showed that the quality of health services at the Independent Midwife Practices and Public Health Center is influenced by the factors of reliability, responsiveness, assurance, empathy, and tangibles. Both the Independent Midwife Practice and the Public Health Center have good quality of service in childbirth.Conclusion: It is important to maintain the quality of childbirth services both at Independent Midwife Practices and at Public Health Center.

Engaging Czech-Slovak Roma women in the co-creation of an antenatal care information resource

Abstract Background Czech-Slovak Roma women in the UK suffer barriers to antenatal care such as stigma contributing to reduced engagement with health services. There is a scarcity of research and intervention studies with this population. This study aims to co-create an antenatal care community information resource with a group of these women through participatory research. Women's stories of their pregnancy journeys would be able to provide an understanding of their maternity needs, to inform design considerations for a prototype of an antenatal care information resource. Objectives 1. To understand Roma women's needs in pregnancy, childbirth, and maternity services through storytelling 2. To share with women publicly available antenatal information resources such as pregnancy apps 3. To co-create a low-resolution paper prototype of an antenatal care information resource that meets their needs Research activities 1. Six two-hour workshops with 6-8 women supported by a peer researcher and an interpreter. 2. Two workshops focused on the co-creation of an antenatal information resource. 3. Design-based participatory methods and thematic analysis, culminating in a community event and webinar for public and professional stakeholders. Findings The women's pregnancy journeys covered several topics such as unplanned pregnancies, nausea and vomiting, pregnancy loss and birth trauma. Through all these, the main message they wished to convey was the need for women in the community to overcome the stigma of seeking help for their mental health. Our information resource developed using a co-creative participatory approach, signposts Roma women to reliable information and healthcare provision potentially reducing poor maternal and perinatal health outcomes. This study could be replicated in other marginalized newly arrived groups of migrant women to facilitate timely uptake of antenatal and mental health support services. Key messages • Czech-Slovak Roma women face stigma in seeking help for their mental health during pregnancy. • Roma women can be supported to overcome stigma through design-based participatory research.

Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool

IntroductionIncreasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed. Research aimThe aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth. MethodsA survey tool was created including the following measures: German adaptations of the short and long form of the “Mothers on Respect” (MOR) index (MOR-7 and MOR-G); the “Mothers’ Autonomy in Decision Making” (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale – Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018. FindingsMore than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively). ConclusionsThis study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.

PEMBERDAYAAN KADER POSYANDU DALAM DETEKSI DINI KEHAMILAN RISIKO TINGGI DENGAN SKRINING KARTU SKOR POEDJI ROCHJATI DI WILAYAH KERJA PUSKESMAS SATELIT KOTA BANDAR LAMPUNG

The maternal mortality rate (MMR) during pregnancy is still quite high, estimated at 115 per 100,000 live births by 2020. The cause of the high maternal mortality rate may be due to inadequate quality of health care services for pregnant women and childbirth, poor health status of pregnant women such as anemia. , pregnant women with diabetes, hypertension, tuberculosis, HIV, hepatitis B. and four more. One of the efforts to reduce maternal mortality (MMR) is to increase the use of community health facilities, starting with antenatal care by recognizing the presence of pregnant women at risk. high chance through screening or early detection, one of which can be done by posyandu officer. The purpose of this service is to increase managers' knowledge about early detection of high-risk pregnancies using the Poedji Rochjati Scorecard Screening. This service approach includes counseling for early detection of high-risk pregnancies. The results of this activity show that, the average test score before the submission of documents is 75, while after the submission of documents and training, the average value increases to 86. Based on the results of the table, the value of knowledge has increased to 16%. &#x0D; &#x0D; Keyword : MMR, Early detection, Cadre