Labouring women perspectives on mistreatment during childbirth: a qualitative study.

BACKGROUND: Respectful care during labour and childbirth, which has recently received a great deal of attention around the world, is vital for providing high-quality maternity care. However, this area has been underexplored in developing countries including Iran. RESEARCH AIM: This study aimed to assess postpartum women's views regarding disrespect and abuse during labour and childbirth in Iran. METHODS: A qualitative study that involved a purposive sample of 21 postpartum women was conducted in Tehran, Iran, between 2019 and 2020. Following the semi-structured individual interviews, a conventional content analysis was performed. ETHICAL CONSIDERATIONS: This research approved by Shahid Beheshti University of Medical Sciences in Tehran, Iran, with the ethical approval number 1396.810. Following explanation of the study's objectives, eligible women consented to participate in the study. The confidentiality of the participants' information and the anonymity of the analysis were maintained at all stage of the study. All data was stored on the password protected file in the researcher computer The findings were only disseminated in summary form, with no identifying of individual participants. RESULTS: Analysis of the data resulted in two main themes: 'inappropriate interaction' and 'inadequate quality care'. The 'inappropriate interaction' theme includes 'lack of empathy' and 'verbal abuse'. The second theme includes five sub-themes 'lack of participation in decision-making', 'lack of privacy', 'ignorance of women's pain and medical needs', 'rushed labour and painful procedures', and "unsatisfying facilities'. CONCLUSION: Providing supportive care, respectful communication, adequate participation in decision-making, maintaining privacy, attending to women's labour pain and medical needs, and improving the quality of the physical birth environment are all examples of what labouring women consider to be respectful maternity care. To minimise disrespect and maltreatment of women during childbirth, an all-inclusive strategy engaging women, communities, healthcare professionals, managers, and educators is required.

Midwives' knowledge and practice of Respectful Maternity Care: a survey from Iran.

BACKGROUND: In the past decade, countries worldwide aimed to evaluate the quality of childbirth care and reduce the high rates of disrespect and abuse during childbirth. Few studies have attempted to identify providers' characteristics associated with respectful maternity care quantitatively. This study aims to evaluate midwives' knowledge and practice of respectful maternity care (RMC). METHODS: A cross-sectional study was carried out in 15 teaching and non-teaching hospitals in Tehran, Iran. The hospitals were selected by using a cluster sampling design. Midwives' Knowledge and Practice of Respectful Maternity Care scale (MKP-RMC) was administered to 250 midwives working in maternity units at study hospitals. The data were analysed by statistics package for social science (SPSS, version 21.0, Chicago, IL). RESULTS: Findings demonstrated that the mean score for knowledge and practice of midwives were 20.96 ± 3.54 and 101.64 ± 11.49, respectively. Also, in both knowledge and practice scales, midwives had the highest score in "providing safe care' domain and the lowest score in "preventing mistreatment" domain. CONCLUSION: Our findings showed that for Iranian midwives, providing care to preserve mothers' and their babies' wellbeing is more critical than preventing maternal mistreatment, resulting from the importance of the care provision in the Iranian healthcare system. Promoting midwives' knowledge and practice through developing a tailored educational program to prevent mistreatment and providing emotional support alongside physical care is recommended.

Psychometric evaluation of the women's perception of respectful maternity care scale Turkish version.

This study aimed to assess the validity and reliability of the Turkish version of the Women's Perception of Respectful Maternity Care Scale. This methodological, cross-sectional study was conducted between December 2020 and July 2021. The sample of the study consisted of 259 women who had vaginal birth and gave birth to a healthy baby with normal birth weight. Data analysis and evaluation were performed using factor analysis, Cronbach's alpha, split-half, item-total score correlation, Hotelling T2, Tukey's test and ceiling and floor effect of the scale. The scale consists of 19 items and three sub-dimensions. The scales explained 76.04 percent of the total variance. In both exploratory and confirmatory factor tests, the overall factor loading was greater than 0.30. In the confirmatory factor analysis, all the goodness-of-fit indexes were greater than 0.90, and the root mean square error of approximation was less than 0.08. The Cronbach's alpha coefficient of the scale was 0.96, with Cronbach's alpha values ranging between 0.88 and 0.95 for the subscales. In conclusion, this scale can be used by nurses, midwives and other health professionals as a valid and reliable measurement tool to evaluate women's perception of respectful maternity care.

Psychometric Evaluation of the Persian Version of the Childbirth Experience Questionnaire (CEQ).

Women's childbirth experience is an outcome indicator for evaluating maternity care. This study evaluated the psychometric properties of the Persian version of the Childbirth Experience Questionnaire (P-CEQ). The study recruited two hundred and fifty primiparous postpartum women in the 1-3 months following birth from one private and three public hospitals in Mazandaran province, Iran. First, face validity and content validity were evaluated. Moreover, confirmatory factor analysis (CFA) was conducted, and discriminant validity was assessed by applying the known-groups method. Intraclass correlation coefficient (ICC) was measured to confirm the stability and Cronbach's alpha to confirm the internal consistency. CFA also confirmed the values of fit indices (RMSEA = 0.05, SRMSR = 0.06, CFI >0.93, χ 2/df = 1.80). ICC was 0.88 and Cronbach's alpha for all items was 0.85. Furthermore, discriminant validity of the P-CEQ was approved given that it effectively differentiated women whose stay in the labor unit exceeded twelve hours from those with a shorter stay. The P-CEQ questionnaire is a valid and reliable tool for assessing childbirth experiences. It is an easy-to-use questionnaire that can be used for evaluating quality of care in terms of women's childbirth experience. It can be used in maternity services that aim to improve quality of care during labor and childbirth.

Development and psychometric properties of Midwives' Knowledge and Practice Scale on Respectful Maternity Care (MKP-RMC).

OBJECTIVE: To develop a scale for evaluating knowledge and practice of midwives on Respectful Maternity Care (RMC). METHODS: An exploratory sequential mixed method study was conducted from January 2018 to July 2019 in two non-teaching public hospitals in Tehran, Iran. In the first part of the study, a literature review and qualitative study were carried out in order to develop the preliminary item pool. Then face, content and construct validity and reliability (internal consistency and test-retest) were assessed. RESULTS: The MKP-RMC scale has 23-item in knowledge and 23-item in practice section that loaded in three factors: Giving emotional support, providing safe care and preventing mistreatment. Exploratory factor analysis accounted for 43.47% and 58.62% of observed variance in knowledge and practice sections, respectively. The internal consistency and internal correlation coefficient of both section of MKP-RMC indicated acceptable reliability. CONCLUSION: The MKP-RMC is a valid and reliable tool for measuring midwives' knowledge and practice of respectful care during labor and childbirth. The MKP-RMC could be used in maternity services to evaluate and improve quality of childbirth care through development of educational interventions for effective behavioral change. Confirmation of validity and reliability of translated version of the scale in other maternity care providers and different contexts is recommended.

Midwives' perspectives of respectful maternity care during childbirth: A qualitative study.

The adoption of respectful maternity care during labor and birth is a complex process which needs both scientific and interpersonal skills of providers. In this regard, identifying the potential barriers and applying effective strategies for implementing respectful maternity care are essential. This study aimed to explore the perceptions of Iranian midwives regarding respectful maternity care during labor and childbirth. This was a qualitative study which was conducted from September-December 2018 in two non-teaching public hospitals in Tehran, Iran. Twenty-four semi-structured interviews were conducted with midwives, who had more than one year work experience in labor and childbirth units, through a purposive sampling method. A content analysis approach was used to analyze the data and identify themes. Three themes were extracted including "showing empathy", "women-centered care" and "protecting rights". Showing empathy reflects that "establishing a friendly relationship" and "being with women". Women-centered care encompassed "keeping women safe" and "participating in decision making". Protecting rights reflected a need for "safeguarding dignity" as well as "giving equal care" and "preparing appropriate environment". Iranian midwives considered respectful maternity care a broader concept than just preventing mistreatment. Providing supportive care through friendly interaction with women was the first step for providing respectful maternity care. Respectful care is also promoted by providing safe care, implementing evidence-based care and involving women in their care as well as by providing an appropriate environment for women, families and caregivers.

Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions.

AIM: To determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth. METHODS: This single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or "show". The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann-Whitney and Chi-square tests. The level of statistical significance was set as p<0.05. FINDING: There were significant differences between the intervention and control groups in the number of caesarian section (CS) (p<0.001). Two groups had a statistically significant difference in amniotomy (p=0.003), augmentation by oxytocin (p<0.001), number of vaginal examinations (p<0.001) and fundal pressure (p<0.001). CONCLUSIONS: Using a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.

A questionnaire to assess women's perception of respectful maternity care (WP-RMC): Development and psychometric properties.

OBJECTIVE: To develop and assess the psychometric properties of Women's Perspection-Respectful Maternity Care (WP-RMC) Questionnaire. DESIGN: An exploratory sequential mixed method study was carried out from March to August 2018 in Tehran, Iran. The questionaire items were generated from the literature review and qualitatatve study. The revised items of questionnaire were assessed for validity via testing for face, content and construct validity and relibility. SETTING: Public and semi-public hospitals, and public primary health care centers. PARTICIPANTS: Postpartum women who had a low risk pregnancy, normal vaginal childbirth and gave birth to a healthy baby with normal birth weight. FINDINGS: The WP-RMC has 19 items that loaded in three factors: Providing comfort, Participatory care and Mistreatment. Exploratory factor analysis jointly accounted for 53.05% of observed variance. The CVI was 0.97 and the CVR in all items was more than 0.79. Cronbach's alpha for all items was 0.91 and ICC was 0.9. KEY CONCLUSIONS: 'The WP-RMCquestionnaire is a valid and reliable tool to measure women's experiences of Respectful Maternity Care. This questionnaire could assess subjective features of quality of childbirth care. It can be used in maternity services trying to evaluate and improve women's care experiences during labour and childbirth. The use of the translation of WP-RMC questionnaire in other countries is recommended.

Association of serum vitamin D levels and urinary tract infection in pregnant women: A case control study.

OBJECTIVE: Urinary tract infection (UTI) is common during pregnancy and can cause serious complications for the mother and fetus. Vitamin D, is known to have an effect on the urothelium, with immunomodulatory capacity against bacterial infection. This study explored the association between serum vitamin D levels and urinary tract infections in pregnant women. STUDY DESIGN: In this case control study, 187 participants including, 97 pregnant women diagnosed as a symptomatic UTI (case group) and 90 matched healthy pregnant women (control group) were consecutively enrolled from prenatal care clinic of Imam Reza Hospital in Urmia, North West of Iran. The two groups were matched for trimester and parity, and sexual intercourse. Blood samples were collected from both groups. Chemiluminescent immunoassay (CLIA) was used to evaluate the serum vitamin D levels. We used a binary multivariate unconditional logistic regression approach to evaluate the association between UTI and vitamin D and risk factor of the UTI. RESULTS: Vitamin D deficiency (less than 20 ng/mL) was diagnosed in 85.7% of case group and 52.2% of control group. The serum vitamin D levels were significantly lower in pregnant women in the case group compared to the control group (12.7 ±â€¯5.9 ng/ml vs 26.05 ±â€¯10.37; p < 0.001). Pregnant women in case group with acute pyelonephritis had significantly lower serum vitamin D levels than those with Cystitis (p < 0.05). The serum vitamin D level of less than 20 ng/ml was the only factor associated with UTI after adjusting for all the confounders in multiple binary logistic regression modeling (AdjOR = 3.67; 95% of CI: 1.19-6.24; p < 0.001). CONCLUSIONS: Women with vitamin D deficiencies are at increased risk of urinary tract infections during pregnancy. However, further studies are essential to confirm these observed results.

Women's experiences of routine care during labour and childbirth and the influence of medicalisation: A qualitative study from Iran.

OBJECTIVE: to understand women's experiences of routine care during labor and childbirth in a medicalised context. DESIGN: twenty-six in-depth interviews were conducted during the late postpartum period and thematic analysis was applied. SETTING: four public hospitals in Tehran with a high rate of births, providing services to low and middle income families. PARTICIPANTS: women who had a low risk pregnancies and gave a birth to a healthy infant by normal vaginal delivery. FINDINGS: two main themes emerged: 'An ethos of medicalisation' which indicates that women's perception of childbirth was influenced by the medicalised context of childbirth. And 'The reality of fostered medicalisation' which illustrates the process by which interventions during labor affected women's pathway through childbirth, and how the medicalisation resulted in a birth experience which often included a preference for Caesarean Section rather than vaginal birth with multiple interventions. IMPLICATIONS FOR PRACTICE: contextual factors such as legal issues, state's regulations and the organisational framework of maternity services foster medicalised childbirth in Tehran public hospitals. These factors influence the quality of care and should be considered in any intervention for change. The aim should be a high quality birth experience with minimal interventions during normal vaginal delivery. A midwifery model of care combining scientific evidence with empathy may address this need for change.

An evaluation of the quality of care for women with low risk pregnanacy: The use of evidence-based practice during labour and childbirth in four public hospitals in Tehran.

OBJECTIVE: there is a consensus that the adoption of evidence-based practice contributes to the improvement of maternity care. Iranian National Guidelines for Normal Childbirth included evidence-based practice and were disseminated to hospitals in 2006 but little is known about the success of implementation. This study investigates the provision of care during labour and childbirth in comparison with national guidelines in four public hospitals in Tehran. DESIGN: this was a descriptive evaluation study and investigated the provision of care during labour and childbirth using current evidence-based practice as the indicator of quality. PARTICIPANTS AND SETTING: the observational and interview data were collected using checklist and interview guide based upon standards for evidence-based care in four public hospitals in Tehran. In 24 women who were admitted in normal labour, practices were observed until the end of the third stage of labour, to determine concordance with Iranian National Guidelines for Normal Childbirth. A further 100 postpartum woman were interviewed about their care during labour and childbirth in the early postpartum period before discharge from the postnatal ward. FINDINGS: beneficial and lifesaving practices such as assessing mothers' well-being; removal of the placenta in the third stage of labour, as well as skin-to-skin contact and early initiating of breast feeding were recorded in most cases. However, the use of practices such as routine augmentation and induction of labour, fundal pressure, conducting routine episiotomy were noted. KEY CONCLUSIONS: this evaluation study shows good practice and areas for improvement as practices fail to meet evidence based standards. Thus, there is potential for quality improvement and economic savings in Tehran maternity hospitals. However closing the gap between guidelines based on best evidence and actual clinical practice in childbirth is a challenge. Practical solutions to enable implementation of evidence-based guidelines for normal childbirth in low risk women require further studies, especially from the providers' perspective. IMPLICATIONS FOR PRACTICE: national programs which focus on organisational framework, interventions to change providers' attitudes towards the development of a culture of birth as a normal and physiological process are more likely to be important in the Iranian context. Involving professional midwives more in the care for normal childbirth may help to improve quality of care during normal labour and childbirth in terms of evidence-based practice.