CLEVER maternity care: A before-and-after study of women’s experience of childbirth in Tshwane, South Africa

Abstract

Background: Birthing care matters to women and some women experience mistreatment during childbirth.Aim: To determine the effect the ‘CLEVER Maternity Care’ package, a multi-faceted intervention to improve respectful, quality obstetric care.Setting: Ten midwife-led obstetric units in Tshwane health district, South Africa; five intervention and five control units.Methods: We conducted an anonymous baseline and end-line survey to measure the change in women’s perceptions and experiences of childbirth care after the implementation of the CLEVER package. A convenience sample of women returning for a postnatal follow-up visit was obtained at baseline (n = 653) and after implementation of CLEVER (n = 679).Results: Six survey items were selected as proxies for respectful clinical care. There was no significant change in proportions of responses regarding one question, and with regard to patients receiving attention within 15 min of arrival, both the intervention and control group units showed a significant increase in positive responses (odds ratios of 8.4 and 6.1, respectively, and p values of 0.0001 and 0.0007). For the remaining four items (asking permission before doing an examination, positive communication, respectful treatment and overall satisfaction), only the intervention group showed a significant positive change (odds ratios ranging from 2.4 to 4.3; p ≤ 0.0018), with no significant change for the control group (odds ratios between 1.0 and 1.8; p ≥ 0.0736).Conclusion: After the implementation of CLEVER Maternity Care, women reported a more positive experience of childbirth. The CLEVER intervention is a potential strategy for addressing respectful, quality obstetric care that warrants further investigation.

The roles of multi-component interventions in reducing mistreatment of women and enhancing respectful maternity care: a systematic review

“…Owing to the wide range of methodological inadequacies of the studies, all selected reports were included in the analysis for pragmatic reasons, which were relevant to the aim of the review and comprised the highest available methodological rigor of all assessed studies. Three of the 12 included studies were RCTs [ 22 , 36 , 38 ], and the remaining nine were pre-and-post/ quasi experimental studies [ 23 , 33 – 35 , 37 , 39 – 42 ]. Out of the 12 studies included, it is worth noting that regardless of no criteria used to exclude studies based on their geographical region, eleven studies were conducted in sub-Saharan Africa (specifically, in Ethiopia, Tanzania, South Africa, Ghana, Kenya, and Sudan) and one study was conducted in India.…”

“…All quasi-experimental studies scored positive ('Yes') for more than half of the appraisal domains, ranging from five to seven of nine quality domains. In four out of nine quasi-experimental studies [ 23 , 33 , 37 , 39 ], the participants in the comparison groups were not similar. In contrast, all studies identified causes (interventions) and effects (mistreatment and/or respectful maternity care).…”

“…In contrast, all studies identified causes (interventions) and effects (mistreatment and/or respectful maternity care). Only Oosthuizen et al [ 39 ] included a parallel control group before and after the intervention. The remaining quasi-experimental studies used the survey findings conducted before the interventions were implemented as comparison groups.…”

Health care providers’ perceptions of barriers to perinatal mental healthcare in South Africa

“…• Continue expansion of psychosocial support via NurseConnect mobile health application supported by National Department of Health [ 49 ]. • Identify lessons learned from the CLEVER Maternity Care intervention, which aims to increase respectful, quality obstetric care [ 50 ]. Sociocultural • Increase awareness and availability of support from doulas: trained professionals who provide culturally competent, continuous physical, emotional and informational support to mothers before, during and shortly after childbirth.…”

“…• Identify lessons learned from the CLEVER Maternity Care intervention, which aims to increase respectful, quality obstetric care [ 50 ].…”