Correlation among experience of person-centered maternity care, provision of care and women’s satisfaction: Cross sectional study in Colombo, Sri Lanka

Abstract

Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women’s and families’ preferences, needs, and values. In this cross-sectional study we aimed to evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women’s satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women’s overall satisfaction was assessed on a 1–10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3–43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5–9). PCMC implementation had a moderate correlation with women’s satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.

Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region

“…Overall, this study adds to previous evidence 1 , 10 , 13 , 31 , 32 , 33 , 34 , 37 , 38 , 39 , 40 suggesting that health care around the time of childbirth needs to be driven by evidence-based practices, programmes, and policies, to achieve sustainable maternal and newborn health and wellbeing worldwide. The WHO Standards should be monitored and upheld, including during times of crisis such as the current global pandemic.…”

“…A limitation of this study is that the overall sample of women participating in the survey had a relatively high level of education compared to the expected in the overall general population, but it is difficult to estimate how this selection may have affected study findings. Higher women’ s education 15 , 17 , 24 , 38 has been reported as associated with receiving better QMNC (and in this scenario our data could overestimate the actual QMNC), but it is also possible that mothers with higher education were more empowered to freely express their views, and were more critical toward the health system thereby under-estimating the QMNC. 15 , 17 …”

“…Comparison between countries for subjective measures should be interpreted with caution, acknowledging that individual women's perceptions may be affected by individual and national culture, norms, and expectations. 17 , 38 Evidence has shown that mistreatment of women, including disrespect and abuse, may be normalized and therefore under-reported in some settings, 17 , 38 while in other settings where the population is more empowered and has higher expectations for QMNC, women may be more critical of the health system. For example, data from Spain, one of the three countries with the highest proportion of women reporting having suffered abuses (20·8%), should be interpreted both considering recent large studies reporting high rates (38·3%) of obstetric violence, and co-existing major efforts from many agencies and bodies during the last 15 years in promoting the concept of respectful maternal care.…”

Large gaps in the quality of healthcare experienced by Swedish mothers during the COVID-19 pandemic: A cross-sectional study based on WHO standards

“…One important limitation was a relative over-representation of highly educated women as compared to expected levels in the general population. Higher education in women [ 48 ] has been reported to be associated with a better quality of maternal and newborn care, which would implicate that there is a possible overestimation in our study. On the other hand, it is well known that mothers with higher education are more empowered to express their views freely and have better access to internet resources [ 48 ].…”

“…Higher education in women [ 48 ] has been reported to be associated with a better quality of maternal and newborn care, which would implicate that there is a possible overestimation in our study. On the other hand, it is well known that mothers with higher education are more empowered to express their views freely and have better access to internet resources [ 48 ]. This, in turn, may lead them to be overly critical causing an under-estimation of the actual quality of care.…”