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      Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis


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          What constitutes respectful maternity care ( RMC) operationally in research and programme implementation is often variable.


          To develop a conceptualisation of RMC.

          Search strategy

          Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies.

          Selection criteria

          Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date.

          Data collection and analysis

          A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings.

          Main results

          Sixty‐seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent.


          This review presents an evidence‐based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes.

          Tweetable abstract

          Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies.

          Tweetable abstract

          Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies.

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          Most cited references77

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          Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.

          On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
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            Women's expectations and experiences of childbirth.

            to explore, describe and understand the expectations during pregnancy and subsequent experiences of childbirth in primiparae. a qualitative study using a phenomenological approach. Data were collected using unstructured, tape-recorded interviews in late pregnancy and at two weeks post birth. the north of England. eight pregnant women, expecting their first baby. the women all wanted to take an active part in their labour and the feeling of being 'in control' was the main finding and the 'essence' of this study. This was achieved through support from partners, the positive attitudes of the midwives caring for them during pregnancy and labour, information giving during pregnancy and labour and being able to make and be included in decision making during labour. if women are to be empowered by making choices for childbirth and feeling 'in control', then it is important for midwives to explore and discover the wishes and feelings of women in their care so that realistic expectations can be promoted and then hopefully fulfilled. Copyright 2001 Harcourt Publishers Ltd.
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              The meaning of a very positive birth experience: focus groups discussions with women

              Background The experience of giving birth has long-term implications for a woman’s health and wellbeing. The birth experience and satisfaction with birth have been associated with several factors and emotional dimensions of care and been shown to influence women’s overall assessment. Individualized emotional support has been shown to empower women and increase the possibility of a positive birth experience. How women assess their experience and the factors that contribute to a positive birth experience are of importance for midwives and other caregivers. The aim of this study was to describe women’s experience of a very positive birth experience. Method The study followed a qualitative descriptive design. Twenty-six women participated in focus group discussions 6–7 years after a birth they had assessed as very positive. At the time of the birth, they had all taken part in a large prospective longitudinal cohort study performed in northern Sweden. In the present study, thematic analysis was used to review the transcribed data. Results All women looked back very positively on their birth experience. Two themes and six sub-themes were identified that described the meaning of a very positive birth experience. Women related their experience to internal (e.g., their own ability and strength) and external (e.g., a trustful and respectful relationship with the midwife) factors. A woman’s sense of trust and support from the father of the child was also important. The feeling of safety promoted by a supportive environment was essential for gaining control during birth and for focusing on techniques that enabled the women to manage labour. Conclusion It is an essential part of midwifery care to build relationships with women where mutual trust in one another’s competence is paramount. The midwife is the active guide through pregnancy and birth and should express a strong belief in a woman’s ability to give birth. Midwives are required to inform, encourage and to provide the tools to enable birth, making it important for midwives to invite the partner to be part of a team, in which everyone works together for the benefit of the woman and child.

                Author and article information

                John Wiley and Sons Inc. (Hoboken )
                08 December 2017
                July 2018
                : 125
                : 8 ( doiID: 10.1111/bjo.2018.125.issue-8 )
                : 932-942
                [ 1 ] Department of Health Education and Promotion School of Public Health Tehran University of Medical Sciences Tehran Iran
                [ 2 ] Social Determinants of Health Research Centre Zanjan University of Medical Sciences Zanjan Iran
                [ 3 ] Department of Reproductive Health and Research, including UNDP/UNFPA/UNICEF/WHO/World Bank Special Program of Research, Development and Research Training in Human Reproduction World Health Organization Geneva Switzerland
                [ 4 ] Department of Information, Evidence and Research Eastern Mediterranean Region World Health Organization Cairo Egypt
                [ 5 ] Department of Health Management and Economics School of Public Health Tehran University of Medical Sciences Tehran Iran
                [ 6 ] GLIDE Technical Cooperation and Research Ribeirão Preto São Paulo Brazil
                [ 7 ] Department of Paediatrics Ribeirão Preto Medical School University of São Paulo Ribeirão Preto São Paulo Brazil
                [ 8 ] Social Department of Ribeirão Preto Medical School University of São Paulo São Paulo Brazil
                [ 9 ] King Edward Memorial Hospital for Women Subiaco WA Australia
                Author notes
                [*] [* ] Correspondence: Dr E Shakibazadeh, Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Poursina Avenue, PO Box 1417613151, Tehran, Iran. Email shakibazadeh@ 123456tums.ac.ir
                © 2017 World Health Organization; licensed by John Wiley & Sons Ltd on behalf of Royal College of Obstetricians and Gynaecologists

                This is an open access article distributed under the terms of the https://creativecommons.org/licenses/by/3.0/igo/legalcode/ which permits unrestricted use, distribution and reproduction in any medium, provided that the original work is properly cited.

                : 01 November 2017
                Page count
                Figures: 2, Tables: 0, Pages: 11, Words: 7919
                Funded by: Department of Reproductive Health and Research including UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research
                Funded by: Development and Research Training in Human Reproduction
                Funded by: World Health Organization
                Award ID: 2015/549782‐0
                Funded by: United States Agency for International Development (USAID)
                Systematic Review
                Systematic Reviews
                Custom metadata
                July 2018
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.4.3 mode:remove_FC converted:05.07.2018

                Obstetrics & Gynecology
                childbirth,dignity,disrespect and abuse,health facility,hesis,qualitative evidence synt,respectful maternity care


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