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.

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.

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.