It does matter where you come from: mothers’ experiences of childbirth in midwife obstetric units, Tshwane, South Africa

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Abstract

Background

Health professionals are striving to improve respectful care for women, but they fall short in the domains of effective communication, respectful and dignified care and emotional support during labour. This study aimed to determine women’s experiences of childbirth with a view to improving respectful clinical care practices in low-risk, midwife-led obstetric units in the Tshwane District Health District, South Africa.

Methods

A survey covering all midwife-led units in the district was conducted among 653 new mothers. An anonymous questionnaire was administered to mothers returning for a three-days-to-six-weeks postnatal follow-up visit. Mothers were asked about their experiences regarding communication, labour, clinical care and respectful care during confinement. An ANCOVA was performed to identify the socio-demographic variables that significantly predicted disrespectful care. Six items representing the different areas of experience were used in the analysis.

Results

Age, language, educational level and length of residence in the district were significantly associated with disrespectful care ( p ≤ 0.01). Overall, the following groups of mothers reported more negative care experiences during labour: women between the ages of 17 and 24 years; women with limited formal education; and women from another province or a neighbouring country. Items which attracted fewer positive responses from participants were the following: 46% of mothers had been welcomed by name on arrival; 47% had been asked to give consent to a physical examination; and 39% had been offered food or water during labour. With regard to items related to respectful care, 54% of mothers indicated that all staff members had spoken courteously to them, 48% said they had been treated with a lot of respect, and 55% were completely satisfied with their treatment.

Conclusion

There is a need to improve respectful care through interventions that are integrated into routine care practices in labour wards. To stop the spiral of abusive obstetric care, the care provided should be culturally sensitive and should address equity for the most vulnerable and underserved groups. All levels of the health care system should employ respectful obstetric care practices, matched with support for midwives and improved clinical governance in maternity facilities.

Electronic supplementary material

The online version of this article (dio: 10.1186/s12978-017-0411-5) contains supplementary material, which is available to authorized users.

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Most cited references 39

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

Suellen Miller, Edgardo Abalos, Monica Chamillard … (2016)

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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Quality maternity care for every woman, everywhere: a call to action.

Marjorie Koblinsky, Cheryl A Moyer, Clara Calvert … (2016)

To improve maternal health requires action to ensure quality maternal health care for all women and girls, and to guarantee access to care for those outside the system. In this paper, we highlight some of the most pressing issues in maternal health and ask: what steps can be taken in the next 5 years to catalyse action toward achieving the Sustainable Development Goal target of less than 70 maternal deaths per 100 000 livebirths by 2030, with no single country exceeding 140? What steps can be taken to ensure that high-quality maternal health care is prioritised for every woman and girl everywhere? We call on all stakeholders to work together in securing a healthy, prosperous future for all women. National and local governments must be supported by development partners, civil society, and the private sector in leading efforts to improve maternal-perinatal health. This effort means dedicating needed policies and resources, and sustaining implementation to address the many factors influencing maternal health-care provision and use. Five priority actions emerge for all partners: prioritise quality maternal health services that respond to the local specificities of need, and meet emerging challenges; promote equity through universal coverage of quality maternal health services, including for the most vulnerable women; increase the resilience and strength of health systems by optimising the health workforce, and improve facility capability; guarantee sustainable finances for maternal-perinatal health; and accelerate progress through evidence, advocacy, and accountability.

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Improvement of maternal and newborn health through midwifery.

Petra ten Hoope-Bender, Luc de Bernis, James Campbell … (2014)

In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and beyond 2015.

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Author and article information

Contributors

Sarie J. Oosthuizen:

ORCID: http://orcid.org/0000-0002-6093-9883

Sarie.silberbauer@gmail.com

Anne-Marie Bergh: anne-marie.bergh@up.ac.za

Robert C. Pattinson: robert.pattinson@up.ac.za

Jackie Grimbeek: jackie.grimbeek@gmail.com

Journal

Journal ID (nlm-ta): Reprod Health

Journal ID (iso-abbrev): Reprod Health

Title: Reproductive Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1742-4755

Publication date (Electronic): 16 November 2017

Publication date PMC-release: 16 November 2017

Publication date Collection: 2017

Volume: 14

Electronic Location Identifier: 151

Affiliations

[1 ]ISNI 0000 0001 2107 2298, GRID grid.49697.35, Tshwane District Health and Department of Family Medicine, , University of Pretoria, ; Pretoria, South Africa

[2 ]ISNI 0000 0001 2107 2298, GRID grid.49697.35, South African Medical Research Council Unit for Maternal and Infant Health Care Strategies, , University of Pretoria, ; Pretoria, South Africa

[3 ]ISNI 0000 0001 2107 2298, GRID grid.49697.35, Department of Obstetrics and Gynaecology, , University of Pretoria, ; Pretoria, South Africa

Author information

Sarie J. Oosthuizen http://orcid.org/0000-0002-6093-9883

Article

Publisher ID: 411

DOI: 10.1186/s12978-017-0411-5

PMC ID: 5689145

PubMed ID: 29145897

SO-VID: b008cce6-51c0-4767-83a6-1ee038610de7

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 4 August 2017

Date accepted : 2 November 2017

Custom metadata

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: respectful maternity care,midwife obstetric units,predictors of respectful care,childbirth,south africa

Data availability:

ScienceOpen disciplines: Obstetrics & Gynecology

Keywords: respectful maternity care, midwife obstetric units, predictors of respectful care, childbirth, south africa

It does matter where you come from: mothers’ experiences of childbirth in midwife obstetric units, Tshwane, South Africa

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Most cited references 39

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

Quality maternity care for every woman, everywhere: a call to action.

Improvement of maternal and newborn health through midwifery.

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