Knowledge, attitude and practice of healthcare providers on mistreatment during labour and childbirth: a cross-sectional study in Tehran, Iran, 2021

Mirzania, Marjan; Shakibazadeh, Elham; Bohren, Meghan A; Babaey, Farah; Hantoushzadeh, Sedigheh; Khajavi, Abdoljavad; Foroushani, Abbas Rahimi

doi:10.21203/rs.3.rs-1806039/v1

Cited by 3 publications

(2 citation statements)

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“…They believed that their educational content focused on issues of ethics rather than issues of respect, independence, and patient choice. The results of our previous study also showed that healthcare providers had poor knowledge and attitudes about disrespectful maternity care [43]. Therefore, it is necessary to review the curriculum of obstetrician and midwifery education as well as in-service continuing training based on the concept of dis/ respectful maternity care.…”

Section: Discussionmentioning

confidence: 95%

Mistreatment of women during childbirth and its influencing factors in maternity hospitals in Tehran, Iran: a formative qualitative multi-stakeholder study

Mirzania

Shakibazadeh

Bohren

et al. 2022

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Background Mistreatment during labour and childbirth is a common experience for many women around the world. A picture of the nature and types of mistreatment; and especially its influencing factors has not yet been identified in Iran. This study aimed to explore the manifestations of mistreatment and its influencing factors in maternity hospitals in Tehran. Methods A formative qualitative study was conducted using in-depth face-to-face interviews between October 2021 and May 2022 in five public hospitals. Participants included women, maternity healthcare providers, and managers at hospital and Ministry of Health levels. Participants were selected using purposive sampling. Recorded interviews were transcribed verbatim and thematically analyzed with a combined deductive and inductive approach using MAXQDA 18. Results A total of 60 interviews were conducted. Women experienced various forms of mistreatment during labour and childbirth, including verbal abuse, frequent and painful vaginal examinations, neglect and abandonment, lack of supportive care, denial of mobility and pain relief, and physical abuse. Four main themes were identified as the drivers of mistreatment: (1) individual-level factors (healthcare providers perception about women’s limited knowledge on childbirth process, untrained companions, mismatched expectations of women for care, and discrimination based on ethnicity or low socioeconomic status); (2) healthcare provider-level factors (healthcare provider stress/stressful working conditions, healthcare providers with limited personal experience of pregnancy and childbirth, neglect of midwives' identities by doctors, poor educational contents and curriculum, and low salary and lack of incentive); (3) hospital-level factors (lack of staff, lack of supervision and control, type of hospital, inadequate physical structures); and (4) national health system-level factors (lack of access to pain management during labour and childbirth and perceptions about forced vaginal birth in public hospitals). Conclusions There are multiple level drivers for mistreatment which requires multifaceted interventions. These interventions should emphasize training of pregnant women and their companions, training healthcare providers, encouraging and managing work shifts, strengthening the position of midwives in public hospitals. Moreover, continuous monitoring of the performance of providers, increase staff numbers and improvement of physical space of the maternity wards, as well as implementation of the related guidelines, including painless childbirth, should also be considered.

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Section: Discussionmentioning

confidence: 95%

Mistreatment of women during childbirth and its influencing factors in maternity hospitals in Tehran, Iran: a formative qualitative multi-stakeholder study

Mirzania

Shakibazadeh

Bohren

et al. 2022

Preprint

Self Cite

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“…The project, which was initiated in October 2021 in ve public teaching hospitals in Tehran, Iran, consists of ve phases: (1) needs assessment (to assess knowledge, attitudes and practices of maternity healthcare providers about mistreatment during labour and childbirth, and the manifestations of mistreatment and its in uencing factors); (2) designing interventions to reduce mistreatment during childbirth; (3) identifying the challenges of implementing the interventions; (4) designing implementation strategies for intervention; and (5) testing implementation strategies in a real-life setting. The ndings of the rst phase of the project are described elsewhere [11,27].…”

Section: Methodsmentioning

confidence: 99%

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the consolidated framework for implementation research

Mirzania

Shakibazadeh

Babaey³

et al. 2023

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Background: Mistreatment during childbirth is a growing concern worldwide, especially in developing countries such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experience in the birth facilities. In this study, we identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the consolidated framework for implementation research (CFIR). Methods: An exploratory qualitative study involving thirty in-depth and semi-structured interviews was conducted between July 2022 and February 2023. Participants include a purposive sample of key informants at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results: The identified challenges were: (1) Individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companion: e.g., patient needs and resources, structural characteristics, culture); (2) Healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) Hospital level (evaluating the performance of maternity healthcare providers: e.g., external policies and incentives, executing); and (4) National health system level (implementation of painless childbirth guidelines: e.g., networks and communications, knowledge and beliefs about the intervention, executing, reflecting and evaluating). Conclusions: This study shows a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth; and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise in the implementation of their current programs and policies regarding the quality of maternity care by focusing on identified challenges.

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Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research

Mirzania,

Shakibazadeh,

Bohren

et al. 2024

Reprod Health

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Background Mistreatment during childbirth is a growing concern worldwide, especially in developing countries, such as Iran. In response, we launched a comprehensive implementation research (IR) project to reduce mistreatment during childbirth and enhance positive birth experiences in birth facilities. This study identified the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth using the Consolidated Framework for Implementation Research (CFIR). Methods An exploratory qualitative study, involving 30 in-depth interviews, was conducted between July 2022 and February 2023. Participants included a purposive sample of key stakeholders at different levels of the health system (macro: Ministry of Health and Medical Education; meso: universities of medical sciences and health services; and micro: hospitals) with sufficient knowledge, direct experience, and/or collaboration in the implementation of the studied interventions. Interviews were transcribed verbatim and coded using directed qualitative content analysis (CFIR constructs) in MAXQDA 18. Results The identified challenges were: (1) individual level (childbirth preparation classes: e.g., adaptability, design quality and packaging, cosmopolitanism; presence of birth companions: e.g., patient needs and resources, structural characteristics, culture); (2) healthcare provider level (integrating respectful maternity care into in-service training: e.g., relative priority, access to knowledge and information, reflecting and evaluating); (3) hospital level (evaluating the performance of maternity healthcare providers: e.g., executing, external policies and incentives); and (4) national health system level (implementation of pain relief during childbirth guidelines: e.g., networks and communications, patient needs and resources, executing, reflecting and evaluating). Conclusions This study provides a clear understanding of the challenges of implementing a multi-level intervention to reduce mistreatment of women during childbirth and highlights potential implications for policy makers and practitioners of maternal health programs. We encourage them to take the lessons learned from this study and revise their current programs and policies regarding the quality of maternity care by focusing on the identified challenges.

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Knowledge, attitude and practice of healthcare providers on mistreatment during labour and childbirth: a cross-sectional study in Tehran, Iran, 2021

Cited by 3 publications

References 35 publications

Mistreatment of women during childbirth and its influencing factors in maternity hospitals in Tehran, Iran: a formative qualitative multi-stakeholder study

Mistreatment of women during childbirth and its influencing factors in maternity hospitals in Tehran, Iran: a formative qualitative multi-stakeholder study

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the consolidated framework for implementation research

Challenges to the implementation of a multi-level intervention to reduce mistreatment of women during childbirth in Iran: a qualitative study using the Consolidated Framework for Implementation Research

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