Experiences Of Maternity Care Research Articles

A qualitative study on community-based doulas’ roles in providing culturally-responsive care to migrant women in Australia

BackgroundThere is limited exploration into how culturally-responsive care may be provided to migrant women through community-based doulas. AimWe aim to explore the roles of community-based doulas in providing culturally-responsive care to migrant women in Australian maternity settings, from the perspectives of maternity care providers and doulas. MethodsWe used an interpretive phenomenological qualitative approach with in-depth interviews with 30 maternity care providers and Birth for Humankind doulas, in Victoria, Australia. All interviews were conducted over video-call and inductive thematic analysis was performed using NVivo software. FindingsDoulas were seen to support and enhance migrant women’s maternity care experiences through numerous ways, strengthening cultural-responsive care provision. There were three domains which described the role of doulas in providing migrant women with culturally-responsive care: 1) enhanced care; 2) respectful care; and 3) supportive relationships with providers. The three domains included seven themes: 1) continuous individualised support; 2) social connectedness; 3) creating safe spaces; 4) cultural facilitator; 5) non-judgemental support; 6) enhancing communication and rapport with providers; and 7) making connections. DiscussionDoulas appeared to counter negative factors that impact migrant women’s maternity care experiences. Doulas with previous professional birth support qualifications and trauma-informed care training were equipped to create safe spaces and increase emotional safety for migrant women. Doulas may also have more responsibilities expected of them by providers when connecting migrant women with additional services in situations that may be missed through hospital care. ConclusionBirth for Humankind doulas in Victoria play an important role in providing culturally-responsive care to migrant women. Employment models may be the next steps in acknowledging their valuable contribution as a complementary service to maternity settings.

Developing parenthood through giving birth to a dead child – bereaved lesbian mothers’ maternity care experiences in Scandinavia

This phenomenological study uses in-depth interviews to explore how six lesbian couples experience the loss of a child in the perinatal period. Our findings revealed the importance of developing queer parenthood through a meaningful birthing space facilitated by a midwife and enabling time and space to recognize love and beauty in the couple’s grief. Suboptimal maternity care or insensitive comments related to their lesbian status complicated the loss, while care providers’ acknowledgement and sensitivity to the specific needs of queer couples enabled them to be present in the moment and recognize and process their loss.

Provision and experience of care among women with hypertension in pregnancy: a multi-center qualitative study in Ghana

BackgroundHypertensive disorders of pregnancy (HDP) remain a leading global health problem with complex clinical presentations and potentially grim birth outcomes for both mother and fetus. Improvement in the quality of maternal care provision and positive women’s experiences are indispensable measures to reduce maternal and perinatal adverse outcomes.ObjectiveTo explore the perspectives and lived experiences of healthcare provision among women with HDP and the associated challenges.MethodsA multi-center qualitative study using in-depth interviews (IDIs) and focus group discussions (FGDs) was conducted in five major referral hospitals in the Greater Accra Region of Ghana between June 2018 and March 2019. Women between 26 and 34 weeks’ gestation with confirmed HDP who received maternity care services were eligible to participate. Thematic content analysis was performed using the inductive analytic framework approach.ResultsFifty IDIs and three FGDs (with 22 participants) were conducted. Most women were between 20 and 30 years, Akans (ethnicity), married/cohabiting, self-employed and secondary school graduates. Women reported mixed (positive and negative) experiences of maternal care. Positive experiences reported include receiving optimal quality of care, satisfaction with care and good counselling and reassurance from the health professionals. Negative experiences of care comprised ineffective provider–client communication, inappropriate attitudes by the health professionals and disrespectful treatment including verbal and physical abuse. Major health system factors influencing women’s experiences of care included lack of logistics, substandard professionalism, inefficient national health insurance system and unexplained delays at health facilities. Patient-related factors that influenced provision of care enumerated were financial limitations, chronic psychosocial stress and inadequate awareness about HDP.ConclusionWomen with HDP reported both positive and negative experiences of care stemming from the healthcare system, health providers and individual factors. Given the importance of positive women’s experiences and respectful maternal care, dedicated multidisciplinary women-centered care is recommended to optimize the care for pregnant women with HDP.

Maternity care experience of Pakistani ethnic minority women in Hong Kong.

Persistent inequalities in maternity care experience and outcomes exist globally for ethnic minority (EM) and migrant women. Despite the fact that this is an important research area, no prior study has been done in Hong Kong (HK) to examine maternity care experience of EM women. To investigate maternity care experience of Pakistani EM women (both local born and immigrants) during pregnancy, birth and after birth in hospital in HK. An evaluation of their satisfaction and factors predicting satisfaction with care during the three phases of maternity care was included in the study. A cross sectional survey was conducted among Pakistani EM women who had given birth in HK in last 3 years, using a structured questionnaire by a bilingual interviewer, from April to May 2020. Counts and percentages were used to describe all categorical variables. Association between predictor variables and overall satisfaction was assessed by bivariate analysis and multiple logistic regression. One hundred and twenty questionnaires were completed. Almost 60 percent of the women were very satisfied with the overall care. More than half of the women described the care they received as kind, respectful and well communicated. After adjusting for age and parity, HK born Pakistani women expressed relatively less satisfaction with care, especially during pregnancy and labor and birth, as compared with Pakistan born women. Women with conversational or fluent English-speaking ability also felt comparatively less satisfied particularly from intrapartum and postnatal care in hospital. Education level had a negative association with satisfaction with care during pregnancy. Maternity care providers should take into account the diversity of EM women population in HK. Our findings suggest that effective communication and care that can meet individual needs, expectations, and values is imperative to improve experience and quality of maternity care for EM women in HK.

Can a quality improvement intervention improve person-centred maternity care in Kenya?

Few evidence-based interventions exist to improve person-centred maternity care in low-resource settings. This study aimed to understand whether a quality improvement (QI) intervention could improve person-centred maternity care (PCMC) experiences for women delivering in public health facilities in Kenya. A pre–post design was used to examine changes in PCMC scores across three intervention and matched control facilities at baseline (n = 491) and endline (n = 677). A QI intervention, using the Model for Improvement, was implemented in three public health facilities in Nairobi and Kiambu Counties in Kenya. Difference-in-difference analyses using models that included main effects of both treatment group and survey round was conducted to understand the impact of the intervention on PCMC scores. Findings suggest that intervention facilities’ average total PCMC score decreased by 5.3 points post-intervention compared to baseline (95% CI: −8.8, −1.9) and relative to control facilities, holding socio-demographic and facility variables constant. Additionally, the intervention was significantly associated with a 1.8-point decrease in clinical quality index pre–post-intervention (95% CI: −2.9, −0.7), decreased odds of provider visits, and less likelihood to plan to use postpartum family planning. While improving the quality of women’s experiences during childbirth is a critical component to ensure comprehensive, high-quality maternity care experiences and outcomes, further research is required to understand which intervention methods may be most appropriate to improve PCMC in resource-constrained settings.

"We Should Be Working Together, and It Felt like They Disrupted That": Pregnant Women and Partners' Experiences of Maternity Care in the First UK COVID-19 Pandemic Lockdown.

Pregnant women were identified as being at elevated risk from COVID-19 early in the pandemic. Certain restrictions were placed upon birth partners accompanying their pregnant partner to in-person maternity consultations and for in-patient maternity care. In the absence of a central directive in England, the nature of restrictions varied across maternity services. Eleven participants (seven pregnant women and four partners), who were expectant parents during the first UK COVID-19 pandemic lockdown, took part in serial interviews in pregnancy and the postnatal period. Data were subject to a reflexive thematic analysis. Four main themes were identified, with sub-themes: uncertainty and anxiety (uncertainty and anxiety about COVID-19, uncertainty and anxiety about maternity services); disruption of partnering and parenting role; complexity around entering hospital spaces (hospitals offering protection while posing threat, individual health professionals in inflexible systems); and attempting to feel in control. Separating couples may result in disruption to their anticipated roles and significant distress to both partners, with potential impacts for mental health and future family relationships. Trauma-informed perspectives are relevant for understanding parents' experiences of maternity care in the pandemic and identifying ways to improve care to promote and protect the mental health of all parents.

Trajectories of Digital Prenatal Service Utilization and Pregnancy Outcomes: A Multitrajectory Analysis

ObjectiveTo identify trajectories of prenatal digital service utilization across pregnancy and examine their associations with pregnancy outcomes. Patients and MethodsData were extracted from 5409 pregnant people enrolled in Maven, a comprehensive digital platform for women’s and family health, between January 1, 2020, and May 27, 2022. Multitrajectory modeling used digital service utilization data (eg, articles read, classes attended, and appointments with providers) at each trimester to identify trajectories of digital use across pregnancy. Multinomial logistic regression models tested for associations between the utilization trajectories and user-reported pregnancy education, experiences, and outcomes. ResultsFour distinct trajectories of digital service utilization were identified and labeled as follows: (1) baseline users (52% of users), (2) just-in-timers (16%), (3) learners (26%), and (4) super users (6%). Users varied across trajectories by race, perinatal support interests, mental health, and parity. Compared with baseline users, trajectories reflective of more digital health service utilization were all positively associated with self-reported influence of Maven on pregnancy education, maternity care experience, and clinical outcomes. ConclusionDistinct trajectories of digital health utilization emerged among pregnant individuals with differences in user characteristics and medical risks by trajectory group. Users in higher-use trajectories reported greater benefits from digital health. These findings may be used to inform gaps in existing prenatal care and help provide tailored services to reflect the unique needs of each individual pregnancy.

Verletzte Geburtsintegrität während der COVID-19-Pandemie in Deutschland: Erfahrungen von Gebärenden mit der geburtshilflichen Versorgung

ZusammenfassungEinleitungDie COVID-19-Pandemie könnte die Vulnerabilität von Frauen gegenüber einer Verletzung ihrer Integrität während der Geburt verstärken. In einer Querschnittsstudie (März 2020 bis März 2022) wurde untersucht, wie Gebärende die Geburtshilfe während der Pandemie in Deutschland erlebten und welche Faktoren mit Geburtsintegrität assoziiert sind.MethodikIn der Befragung (validierter Fragebogen und zwei offene Fragen) beschrieben Frauen ≥ 18 Jahre ihre Erfahrungen mit geburtshilflicher Versorgung. Die quantitative Auswertung erfolgte durch deskriptive Statistik und logistische Regressionsanalysen zum Zusammenhang von Erfahrungen mit geburtshilflicher Versorgung und dem Gefühl, würdevoll behandelt und emotional unterstützt zu sein, gedeutet als gewahrte Geburtsintegrität. Die offenen Fragen wurden mittels qualitativer induktiver Inhaltsanalyse analysiert.ErgebnisseDaten von 1271 Gebärenden und 214 Kommentare wurden ausgewertet. Die Mehrheit fühlte sich emotional unterstützt (71 %) und mit Würde behandelt (76 %). Ein Drittel gab an, manchmal oder nie in die Entscheidungsfindung involviert worden zu sein, 14 % sahen sich körperlichen, verbalen oder emotionalen Übergriffen ausgesetzt. Für 57 % der Frauen war die Begleitperson nur begrenzt oder nicht anwesend. Diese Faktoren sind alle mit der Chance assoziiert, sich würdevoll behandelt und emotional unterstützt zu fühlen. Die qualitativen Kommentare geben Aufschluss darüber, was Frauen als integritätsverletzend wahrnehmen.DiskussionWährend der COVID-19-Pandemie zeigt sich die Vulnerabilität von Gebärenden gegenüber Integritätsverletzungen. Maßnahmen zur Förderung einer respektvollen Geburtshilfe umfassen strukturelle und politische Lösungen sowie Forschung zu weiteren Determinanten von Geburtsintegrität.

Providing Accessible Healthcare for Autistic Women

Narratives by autistic women regard their maternity-care experiences with feelings such as being isolated, neglected, stigmatised and judged. They feel hospital environments overload their senses which causes barriers to accessing maternity care. I have spent some time researching and creating a series of support plans to invite conversations between autistic women and maternity staff to create accessible, meaningful healthcare encounters. The aim of this article is to provide some ideas for care adjustments so that future narratives overflow with positive encounters.

"They were quick, insipid, and stuck to the typical medical checkups": A Narrative Study on Women's Expectations and Experiences of Maternity Care in Bangladesh.

The quality of healthcare service delivery is generally determined by how patients' expectations were met successfully. This narrative study explores how women perceive and experience healthcare during childbirth in the context of Bangladesh. This study is inspired by Clandinin and Connelly's three-dimensional paradigm of narrativity that combines temporality, social interaction, and place. To unearth patient-driven narratives, the researcher purposely picked 12 women who gave birth in different private and public health facilities in Bangladesh. Four themes standout from the women's narratives. Excerpts of women's stories have been included in discussing the themes as well as author's conviction on this phenomenon. Most of the participants experienced a shared level of difficulty in choosing the health facilities (private vs public), motivated primarily by delivery costs and social background. Women with a higher level of education and financial means often opted to give birth in private facilities due to their negative perception and experience of the public facility. There was evident discontent when doctors decided for cesarean deliveries. Women were dissatisfied by providers' general lack of empathy and vicarious emotion. However, those women who gave birth in public hospitals expressed some degree of satisfaction which might be attributed to their low expectations and moderate social standing. Women's stories also delved into how societal norms, taboos, and elderly relatives put them in uncomfortable situations. To improve patient-provider interactions, healthcare practitioners should prioritize patient-centered care and collaborative decision-making. Reducing healthcare disparity and resolving superannuated pregnancy norms are also critical challenges.

Women’s Voices, Women’s Realities; Experiences of Respectful Maternity Care During Childbirth in Jos, Nigeria

Introduction: Maternal health has gradually shifted over the years from emphasizing maternal mortality reduction to encouraging respectful maternity care (RMC). Although respectful maternity care is advocated, widespread instances of disrespectful childbirth treatment in maternity facilities have been reported. Nigeria continues to have one of the highest levels of disrespectful care in the world, which calls for a contextual understanding of the experiences of women during childbirth. the study therefore aimed to understand the experiences of respectful care among women who delivered in two hospitals in Jos, Nigeria. Methods: This research was performed using a qualitative, phenomenological approach involving in-depth interviews conducted on purposefully selected 13 mothers who delivered in the labor ward of two selected hospitals. The thematic analysis procedure was used to create the findings of the study are summarized in three major thematic areas: women associated respectful care with labor pain management; women linked respect to having their needs met; and women want to be respected. Descriptive accounts of the study information were analyzed using Nvivo software. Results: The findings of the study are summarized in three major thematic areas: women associated respectful care with labor pain management, women linked respect to having their needs met, and women want to be respected. Discussion: Given that their expectations were not satisfied, the women in this study expressed a tone of discontent with the realities of childbirth. The results point to the necessity of reorganizing labor ward settings to permit companionship and midwives' training on respectful maternity care, stressing the need to meet the expectations and needs of women during childbirth.

Changes in postpartum contraception utilization rates during the early stage of the COVID-19 pandemic.

The first wave of the COVID-19 pandemic was associated with restricted access to reproductive care including delayed abortion and female sterilization procedures, in addition to altered maternity care experiences. Given high rates of unintended and short-interval pregnancies in the United States in general and negative obstetric outcomes specifically associated with COVID-19, access to all effective pregnancy prevention methods during the pandemic was crucial. To investigate changes in contraception utilization rates prior to delivery discharge, at outpatient postpartum visits, and at 10 weeks' postpartum, at the largest healthcare system in Central Massachusetts, during the first wave of the COVID-19 pandemic (15 March to 15 May 2020), compared to the same period in 2019. Retrospective cohort review. Compared perinatal individuals (n = 495) who received prenatal care and delivered at UMass Memorial Medical Center from mid-March to mid-May in both 2019 (non-pandemic) and 2020 (COVID-19 pandemic). Receipt of contraception prior to delivery discharge and at outpatient postpartum visit was estimated and compared between the two time periods using the Chi-square test for categorical variables (or Fisher's exact test when cell counts were < 5) and Student's t-test for continuous variables. Multivariable logistic regression was performed to adjust for confounders. The proportion of individuals who used long-acting reversible contraception before delivery discharge was 4% in 2019 and 13% in 2020 (p = 0.01). Modes of outpatient postpartum visit contraception did not vary from 2019 to 2020, (p = 0.06). Overall, there were no differences in contraception utilization rates at 10 weeks' postpartum from 2019 to 2020, (p = 0.50). Compared to a year prior, immediate postpartum long-acting reversible contraception use increased during the first wave of the COVID-19 pandemic, while overall contraception use at 10 weeks' postpartum remained unchanged. The evaluation of contraceptive use during the most restrictive time of COVID-19 pandemic can help identify opportunities to increase access to effective contraception, such as the immediate postpartum period prior to hospital discharge.

Minoritised ethnic women’s experiences of inequities and discrimination in maternity services in North-West England: a mixed-methods study

BackgroundMinoritised ethnic perinatal women can experience judgemental and stigmatising care due to systemic racism. Discriminatory care contributes to increased risks of poor maternal and infant outcomes, including higher rates of mental ill-health. This study aimed to explore minoritised ethnic women’s experiences of maternity services, including maternity care and mental health support, within a North-West England locality. Here we use an equity lens to report the findings that describe if and how women’s personal, cultural, and spiritual needs were met, their experiences of discriminatory and prejudicial care, and to identify recommendations for service provision.MethodsA mixed-methods study was undertaken comprising an online survey, interviews, and community consultations. Questions explored access to and experiences of antenatal care and education; information, communication, and choice; experiences of (dis)respect and judgement; mental health needs and support; cultural/religious needs and support; and overall experiences of maternity care. Eligibility criteria were: women, 18+ years, from self-reported minoritised ethnic backgrounds, who had given birth in the previous 2 years and received maternity care in the locality. Surveys were available in seven languages and distributed via social media, mother-baby groups, and community locations. English-speaking survey participants were invited to take part in a follow-up interview. Community staff were approached to collect data on behalf of the study team. Quantitative data were analysed descriptively (n, %) and merged with qualitative data into descriptive themes.ResultsOverall, 104 women provided data; most self-identified as Asian (65.0%) or Black (10.7%) and were aged between 30–34 (32.0%) or 25–29 years (23.3%). Four descriptive themes are reported: ‘accessing care’ details variations and barriers in accessing maternity care; ‘communication needs, and resources’ describes views on adaptions and resources for specific communication needs; ‘meeting religious and cultural needs’ outlines how various religious and cultural needs were met by maternity providers; ‘discriminatory or stigmatising care’ reports on experiences of pejorative and inequitable care.ConclusionsAn equity lens helped identify areas of discriminatory and inequitable care. Key recommendations include cultural safety training for staff; service-user engagement and co-production of research and resources, and appropriate facilities and recording systems to facilitate individualised, needs-based maternity care.

Woman-centred ethics: A feminist participatory action research

IntroductionContemporary ethical issues in the maternity system are nuanced, complex and layered. Medicalisation and the reported rise in incidence of mistreatment and birth trauma, has been described as unethical. Some authors suggest bioethical principles are limited in terms of guiding everyday care of pregnancy and birth. There is currently no known published research which explores what birthing people say is ethical. AimsThis study sought to explore women's experience of maternity care from an ethical perspective. MethodA Feminist Participatory Action Research (FPAR) was conducted over three years, in two phases. A Community Action Research Group (CARG) was formed of nine participants, and data were captured from five focus groups. A further ten participants were recruited for individual in-depth interviews, the data corpus was combined, and thematic analysis was applied. All 19 participants had experienced a midwifery model of care in Western Australia. ResultsA unique ethical perspective was described by the participants. The central theme: ‘Radical desires: Individuals values and context’ placed the woman at the centre of the care, in determining what is ethical. Two categories captured the care experienced: Woman-centred ethics or Authoritarian ethics. A conceptual model Woman-centred ethics is offered to enhance everyday ethical midwifery care. DiscussionThe participants in this study perceived care as either ethical or unethical based on the quality of the relationship, the knowledge that was shared and the manner of the care given. The Woman-centred ethics model may be a starting point for moving the field forward in ethical discussion.

Understanding variation in person-centered maternity care: Results from a household survey of postpartum women in 6 regions of Ethiopia

Effective communication, respect and dignity, and emotional support are critical for a positive childbirth experience that is responsive to the needs and preferences of women. This study evaluated the performance of a person-centered maternity care scale in a large, representative household sample of postpartum women, and it describes differences in person-centered maternity care across individuals and communities in Ethiopia. The study used data from 2019 and 2020 from a representative sample of postpartum women in 6 regions of Ethiopia. It measured person-centered maternity care using a scale previously validated in other settings. To assess the scale validity in Ethiopia, we conducted cognitive interviews, measured internal consistency, and evaluated construct validity. Then, we fit univariable and multivariable linear regression models to test for differences in mean person-centered maternity care scores by individual and community characteristics. Lastly, multilevel modeling separated variance in person-centered maternity care scores within and between communities. Effective communication and support of women's autonomy scored lowest among person-centered maternity care domains. Of 1575 respondents, 704 (44.7%) were never asked their permission before examinations and most said that providers rarely (n=369; 23.4%) or never (n=633; 40.2%) explained why procedures were done. Person-centered maternity care was significantly higher for women with greater wealth, more formal education, and those aged >20 years. Variation in person-centered maternity care scores between individuals within the same community (τ2=58.3) was nearly 3 times greater than variation between communities (σ2=21.2). Ethiopian women reported widely varying maternity care experiences, with individuals residing within the same community reporting large differences in how they were treated by providers. Poor patient-provider communication and inadequate support of women's autonomy contributed most to poor person-centered maternity care.

Women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini.

People living with disabilities are often women and the elderly and those from low-income families. There is paucity in research on women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini. To explore and describe women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini. The study was conducted in the Hhohho and Manzini regions in Eswatini, between March 2019 and July 2019. A qualitative, exploratory, descriptive and contextual research design was followed. Purposive sampling and snowballing techniques were used to sample women with mobility disabilities to participate in the research. Individual interviews were conducted, and Giorgi's method of data analysis was used. Women with mobility disabilities experienced midwives as being brutal, unsupportive and judgemental. In addition, participants reported several maternity care challenges related to a lack of protocol and infrastructure, and they needed to be cared for by experienced midwives during pregnancy, labour and puerperium. Women with mobility disabilities experienced various challenges during pregnancy, labour and puerperium in Eswatini. There is a need to develop guidelines to facilitate support and holistic maternity care for these women. The study contributed to the scientific knowledge of women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium.

What women identify as positive aspects and areas for improvement of maternity care and services in Ireland: An online survey

BackgroundAn important aspect of achieving the provision of woman-centred maternity services is to seek women’s experiences of maternity care. AimTo explore women’s experiences of the care received within the Irish maternity system and to identify aspects of positive care and areas requiring improvement. MethodsThe Babies Born Better pan-European online survey asked open-ended questions on positive aspects of care and aspects of care that could be improved. Data from women who birthed in Ireland within the previous five years were included. Socio-demographic data were analysed descriptively, and descriptive content analysis was conducted for the qualitative comments. FindingsData from 736 participants were included. Four categories were generated from the analysis: Women’s interactions with healthcare professionals included five sub-categories of competence and expertise, continuity and consistency, respectful care, communication, and shared decision-making; Interventions and procedures included the five sub-categories of medical interventions, breastfeeding support, pain relief, birth partner’s presence and involvement, and facilitating mother and baby attachment; Organisational and infrastructural issues contained three sub-categories of facilities and services, environment and atmosphere, and staffing levels; and the fourth category, Overall evaluations and specific statements, showed the diversity of women’s experiences within the services. ConclusionsSeveral positive aspects of care within the Irish maternity services were identified, many of which related to interpersonal factors and interactions with healthcare professionals. The findings also revealed what could be changed, some of which would require minimal resources or effort, so that women would experience positive care.

Project20: Maternity care mechanisms that improve (or exacerbate) health inequalities. A realist evaluation

BackgroundWomen with low socioeconomic status and social risk factors are at a disproportionate risk of poor birth outcomes and experiences of maternity care. Specialist models of maternity care that offer continuity are known to improve outcomes but underlying mechanisms are not well understood. AimTo evaluate two UK specialist models of care that provide continuity to women with social risk factors and identify specific mechanisms that reduce, or exacerbate, health inequalities. MethodsRealist informed interviews were undertaken throughout pregnancy and the postnatal period with 20 women with social risk factors who experienced a specialist model of care. FindingsExperiences of stigma, discrimination and paternalistic care were reported when women were not in the presence of a known midwife during care episodes. Practical and emotional support, and evidence-based information offered by a known midwife improved disclosure of social risk factors, eased perceptions of surveillance and enabled active participation. Continuity of care offered reduced women’s anxiety, enabled the development of a supportive network and improved women’s ability to seek timely help. Women described how specialist model midwives knew their medical and social history and how this improved safety. Care set in the community by a team of six known midwives appeared to enhance these benefits. ConclusionThe identification of specific maternity care mechanisms supports current policy initiatives to scale up continuity models and will be useful in future evaluation of services for marginalised groups. However, the specialist models of care cannot overcome all inequalities without improvements in the maternity system as a whole.

A Study to Analyze knowledge regarding respectful maternity care among OBG nurses at Sri Ramakrishna Hospital Coimbatore

Objectives: 1. To identify if any form of disrespect or abuse prevailing during childbirth in Sri Ramakrishna Hospital by nursing staff. 2. To improve our quality of care to promote dignified maternal health services. 3. To achieve Safe motherhood. Methodology: The design was observational design. Target Population was parturient women admitted for delivery. The sample size was 75. Convenient Sampling Technique was used. Observation was evaluated by using analyzing questioners (WHO) National Standards. Quantitative analyses were used in order to interpret the data. The data in turn is interpreted in a bar diagram using scoring system. Result: The study results are Dignity and respect 95%, Communication and autonomy 92%, Supportive care 93%, Privacy and Confidentiality 96% and Facility and environment 95%. Conclusion: Based on the results of this study, direct relationship was observed between respectful maternity care and positive childbirth experience.

Measurement of respectful maternity care in exit interviews following facility childbirth: a criterion validity assessment in Nigeria

Background Valid methods for assessing women’s experiences of maternity care are essential to the global efforts toward providing positive childbirth environments for all women in all health facilities. Methods This criterion validity study used observation of childbirth as the reference standard compared to exit interviews with women upon discharge with a live baby, usually within 24 hours of childbirth. We investigated eight positive and sixteen negative maternity care experience indicators. Data were collected from ten primary healthcare facilities in Gombe State, northeast Nigeria, in August 2018 and August 2019. Data analysis involved tabulation of demographic characteristics of women and childbirth context, computation of individual level validity metrics including the area under the receiver operating curve (AUC) and estimating population level validity using the inflation factor (IF). Results A total of 724 women were observed and interviewed at the time of discharge (exit) following facility childbirth, 15% of whom were adolescents, 99% were married, 43% had no formal education, and a skilled birth attendant had attended only 12%. The prevalence of positive maternity care experience indicators ranged between 25% and 96% in childbirth observations. For these positive indicators, the agreement between childbirth observations and exit interviews ranged from 55% to 97%. Six of the eight positive maternity care experience indicators had high overall validity, meaning AUC≥0.70 and 0.75&lt;IF&lt;1.25, with high sensitivity (89% to 99%) and moderate to high specificity (44% to 84%). The prevalence of the 16 negative maternity care experience indicators ranged between 0.1% and 18% in childbirth observations. For these negative indicators, agreement ranged from 87% to 99%. Just six of the 16 negative maternity care experience indicators met the criteria for validation analysis; and these showed low to moderate sensitivity (32% to 74%), high specificity (97% to 100%) and moderate (0.60&lt;AUC&lt;0.70) to high (AUC≥0.70) individual-level validity. Conclusions In this high mortality setting with relatively low coverage of skilled attendance at birth, exit interviews with women following facility-based childbirth care provided responses consistent with the observation of childbirth for eight positive and six negative maternity care experience indicators.