Are underprivileged and less empowered women deprived of respectful maternity care: Inequities in childbirth experiences in public health facilities in Pakistan.

BACKGROUND: Attainment of healthcare in respectful and dignified manner is a fundamental right for every woman regardless of the individual status. However, social exclusion, poor psychosocial support, and demeaning care during childbirth at health facilities are common worldwide, particularly in low- and middle-income countries. We concurrently examined how women with varying socio-demographic characteristics are treated during childbirth, the effect of women's empowerment on mistreatment, and health services factors that contribute to mistreatment in secondary-level public health facilities in Pakistan. METHODS: A cross-sectional survey was conducted during August-November 2016 among 783 women who gave birth in six secondary-care public health facilities across four contiguous districts of southern Sindh. Women were recruited in health facilities and later interviewed at home within 42 days of postpartum using a WHO's framework-guided 43-item structured questionnaire. Means, standard deviation, and average were used to describe characteristics of the participants. Multivariable linear regression was applied using Stata 15.1. RESULTS: Women experiencing at least one violation of their right to care by hospital staff during intrapartum care included: ineffective communication (100%); lack of supportive care (99.7%); loss of autonomy (97.5%); failure of meeting professional clinical standards (84.4%); lack of resources (76.3%); verbal abuse (15.2%); physical abuse (14.8%); and discrimination (3.2%). Risk factors of all three dimensions showed significant association with mistreatment: socio-demographic: primigravida and poorer were more mistreated; health services: lesser-education on birth preparedness and postnatal care leads to higher mistreatment; and in terms of women's empowerment: women who were emotionally and physically abused by family, and those with lack of social support and lesser involvement in joint household decision making with husbands are more likely to be mistreated as compared to their counterparts. The magnitude of relationship between all significant risk factors and mistreatment, in the form of ß coefficients, ranged from 0.2 to 5.5 with p-values less than 0.05. CONCLUSION: There are glaring inequalities in terms of the way women are treated during childbirth in public health facilities. Measures of socio-demographic, health services, and women's empowerment showed a significant independent association with mistreatment during childbirth. At the health system level, there is a need for urgent solutions for more inclusive care to ensure that all women are treated with compassion and dignity, complemented by psychosocial support for those who are emotionally disturbed and lack social support.

Vuelta a casa con el bebé. Cómo se prepara en los programas de educación maternal en Madrid / How to prepare the back home with baby in the maternal education programs in Madrid

Justificación: para mejorar la salud maternoinfantil es importante abordar la reorganización familiar después del parto en los programas de Educación Maternal. Objetivos: conocer la evidencia científica de los cuidados postnatales. Buscar un marco teórico que fundamente el trabajo enfermero. Explorar las estrategias educativas que emplean las matronas en los programas de Educación Maternal. Metodología: revisión de la evidencia de cuidados antenatales y postnatales. Revisión de los modelos de Enfermería. Estudio cualitativo. Muestra probabilística de 42 matronas de Atención Primaria de la Comunidad de Madrid que imparten programas de Educación Maternal en el año 2011. Entrevistas en profundidad. Las transcripciones de las entrevistas fueron codificadas y clasificadas de acuerdo con el método de la teoría fundamentada mediante el análisis comparativo constante. Consideraciones éticas y legales. Resultados: catorce guías clínicas, diez revisiones y miles de artículos de cuidados postparto. Una teoría de rango medio que permite fundamentar el trabajo enfermero en la reorganización familiar. El 100% de las matronas aborda el tema y lo considera muy importante. El 36% trabaja con un caso; el 27% invita a padres; el 14% expone el tema; el 11% utiliza dinámica de grupo; el 7% realiza coloquio y el 5% emplea películas. No emplean marcos conceptuales, ni evaluaciones específicas, ni tareas para casa. Conclusión: los datos permiten conocer la evidencia científica y cómo se trabaja la reorganización familiar, con lo que se realizan propuestas de investigación para ofrecer cuidados de mayor calidad(AU)

Justification: To improve maternal and child health is important to work the postpartum familiar reorganization in the maternal education programs. Objective: To know the scientific evidence of the postnatal care. To look for a framework for nursing. To explore the educative strategies that midwives use in maternal education in Madrid (SPin). Methods: Review of the evidence of prenatal and postnatal cares. Review of nursing models. Qualitative study. Probabilistic sample about 42 midwives of Primary Attention in Madrid that delivered programs of Maternal Education in 2011. Deep interviews. Interviews were coded and classified according to the method of "based theory" through constant comparative analysis. Ethic and legal considerations. Results: 14 clinic guides, 10 revisions and thousand of articles about postpartum care found. A theory of middle range found that allows to base nursing work in the familiar reorganization. 100% of midwives approached the topic and considered it very important. 36% of midwives worked with a case; 27% invited parents to a class; 14% showed the topic to pregnant woman; 11% used group dynamics; 7% through colloquium and 5% used cinema material. They did not use conceptual frameworks, allow us to know the scientific evidence, the approach that is performed in maternal education and new investigation proposals to offer care of high quality(AU)

Ethical considerations for genetic testing, infertility, and balancing maternal-fetal needs.

Among the ethical issues confronting maternal-child nurses are questions surrounding genetic testing, contraception and sterilization, infertility/assisted reproductive technology, and equality in balancing maternal-fetal needs. This article explores these issues, reviews the literature currently available, and discusses nursing clinical implications for each as well as representative case studies. The types of support needed by childbearing families who are facing ethical issues requires emotional and physical support, informational support, and advocacy support. The role of the nurse in educating women about the ethical implications of their choices cannot be overestimated. When women have been educated about the implications of their decisions and are therefore empowered to make informed decisions about their lives and their pregnancies, clinical nurses who practice ethically respect those decisions and support the women in their choices.

An overview of ethics in maternal-child nursing.

Ethical issues across the childbearing year are multiple and complex. This article addresses ethical challenges facing maternal-child nurses and identifies strategies for making ethical decisions utilizing ethical principles and frameworks. Coping strategies for dealing with moral distress, how nurses demonstrate moral courage, and the attributes of an effective ethical decision maker are described. Ethical issues related to healthcare team relationships are discussed, with implications for nurses provided.

Foundations for social justice-based actions in maternal/infant nursing.

The purpose of this article is to discuss health disparities and inequities and their most significant effects on maternal/infant health. A literature background on the social context of justice and distinct ethical theories is provided. Different ethical approaches to guide interventions that can improve the health of mothers and infants are presented. By adopting an ethical framework of social justice, nurses can better understand and thus influence outcomes and ameliorate health disparities and inequalities.

Social justice as a wider lens of support for childbearing women.

The ecological model is used as a framework for applying social justice concepts to the care of childbearing women and families. In this model, the environment of childbearing women has 3 distinct levels: macrosystem, mesosystem, and microsystem. Two scenarios are described and examples of nursing actions to promote social justice at each level are provided. This article demonstrates how maternal/infant nursing practice can be expanded to promote health equities, social justice, and support.

When the fetus is alive but the mother is not: critical care somatic support as an accepted model of care in the twenty-first century?

There has been an increase in cases involving the maintenance of brain dead pregnant women on life support to allow for fetal growth toward viability and birth. This article provides an ethical analysis and discusses the critical care nursing needs of the maternal patient.

The conduct of ethical research collaboration across international and culturally diverse communities.

OBJECTIVE: to present recently developed guidelines by the International Confederation of Midwives (ICM) to guide the ethical conduct of research by midwives across international and culturally diverse communities. To illustrate the complexities of conducting collaborative research across diverse communities, a case study is provided highlighting unequal power balances, legal, ethical and cultural constraints. BACKGROUND: the research guidelines are structured using a human rights framework. The document was developed with input and consideration by the ICM Research Standing Committee and comments of 35 delegates who participated in a workshop to evaluate the guidelines from the perspectives of frontline midwifery clinicians, leaders and researchers. It is intended to serve as a blueprint for midwives aiming to enter into a collaborative research partnership with ethnic and culturally diverse groups. CONCLUSIONS: although the document was developed with the international midwifery community in mind, it will guide any researcher seeking to conduct research in the best interest of women, their newborn babies, their families, and their wider communities.

Ejercicio liberal de la enfermera(o) en el área materno infantil / Liberal exercise of nursing in the infantile maternal area

Este artículo hace referencia a los resultados de la investigación sobre el ejercicio liberal de la enfermera(o) en el área materno-infantil, donde se refleja cuál es el desempeño de la enfermera en el ejercicio liberal de su profesión en el área materno-infantil en Santafé de Bogotá. Para realizar esta investigación se propusieron tres objetivos particulares: caracterizar el desempeño liberal de la enfermera en labores propias del área materno-infantil; identificar el papel que ha desempeñado la enfermera en el ejercicio liberal de la enfermería en el área materno-infantil; identificar las actividades que han realizado las enfermeras en el ejercicio liberal de la disciplina. La metodología utilizada corresponde a un diseño de tipo fenomenológico, descriptivo, analítico, cuya técnica central es el análisis de contenido. El universo del trabajo fueron las enfermeras que ejercen la enfermería en forma liberal en el área materno-infantil en Santafé de Bogotá. Los hallazgos se presentaron acompañados de gráficas alusivas al tema, y se obtuvieron interesantes conclusiones