Promoting respectful maternity care: challenges and prospects from the perspectives of midwives at a tertiary health facility in Ghana

Abstract

Background Evidence shows that women in Ghana experience disrespectful care (slapping, pinching, being shouted at, etc.) from midwives during childbirth. Hence, evidence-based research is needed to advance the adoption of respectful maternity care (RMC) by midwives. We therefore sought to explore and document midwives’ perspectives concerning challenges faced and prospects available for promoting RMC in a tertiary health facility. Methods We employed an exploratory descriptive qualitative study design. In total, we conducted 12 interviews with midwives educated on RMC. All audio data were transcribed verbatim and exported to NVivo-12 for data management and analyses. We relied on the Consolidated Criteria for Reporting Qualitative Research guideline in reporting this study. Results The findings were broadly categorised into three themes: emotional support, dignified care and respectful communication which is consistent with the WHO’s quality of care framework. For each theme, the current actions that were undertaken to promote RMC, the challenges and recommendations to improve RMC promotion were captured. Overall, the current actions that promoted RMC included provision of sacral massages and reassurance, ensuring confidentiality and consented care, and referring clients who cannot pay to the social welfare unit. The challenges to providing RMC were logistical constraints for ensuring privacy, free movement of clients, and alternative birthing positions. Poor attitudes from some midwives, workload and language barrier were other challenges that emerged. The midwives recommended the appointment of more midwives, as well as the provision of logistics to support alternative birthing positions and privacy. Also, they recommended the implementation of continuous training and capacity building. Conclusion We conclude that in order for midwives to deliver RMC services that include emotional support, dignified care, and respectful communication, the government and hospital administration must make the required adjustments to resolve existing challenges while improving the current supporting activities.

Charge midwives’ awareness of and their role in promoting respectful maternity care at a tertiary health facility in Ghana: A qualitative study

“…Health workers are expected to demonstrate the utmost professionalism in areas such as handling clients with respect, dignity, and protecting their privacy. Our finding is consistent with those of other studies [ 17 – 21 ], which stipulated that women seeking maternal healthcare services are to be treated with respectful care regardless of their background characteristics such as ethnic group, socio-economic status, and level of education among other. This also accords with our earlier observations, which showed that maintaining privacy and confidentiality; preserving women’s dignity, and not causing harm or mistreatment as the major component of RMC [ 20 – 23 ].…”

“…Also, this study design allows us to be able to answer questions about why and how ward-in-charges play a role in RMC. Our study forms part of a larger study that seeks to explore RMC practice in Ghana [ 11 , 17 ].…”

“…The study was conducted in the maternity ward at Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana’s Ashanti region. This hospital is Ghana’s second biggest and the only tertiary hospital in the Ashanti region [ 17 ]. With a bed capacity of 1,200 and midwife staff strength of about 381, KATH serves as the principal maternal referral health facility for the middle and savannah zones of Ghana [ 17 ].…”

“…All of the prospective participants consented to have a face-to-face interview. The charge midwives who participated in the study had an in-depth understanding of RMC because they had participated in RMC training modules such as “alternative birthing positions, focused antenatal care, and empathetic and ethical communication with childbearing women” [ 17 ].…”

“…We conducted member checking with three of the charge midwives who confirmed that the findings reflected their perspectives. The dataset analysed in this study forms part of a major study conducted in Ghana [ 11 , 17 ].…”