Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis

Abstract

BackgroundWhat constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable.ObjectivesTo develop a conceptualisation of RMC.Search strategyKey databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies.Selection criteriaPrimary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date.Data collection and analysisA combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings.Main resultsSixty‐seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent.ConclusionsThis review presents an evidence‐based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes.Tweetable abstractUnderstanding respectful maternity care – synthesis of evidence from 67 qualitative studies.

Perceptions and experiences of labour companionship: a qualitative evidence synthesis

“…The findings from this qualitative synthesis have some similarities with other qualitative and mixed‐methods reviews on quality of maternity care and companionship (Beake 2018; Bohren 2015a; Kabakian‐Khasholian 2017; Munabi‐Babigumira 2017; Shakibazadeh 2018); however none of these reviews had the same focus as this synthesis.…”

Authors' reply re: Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis

“…2 We would like to thank the authors for the interest shown in our paper and for raising this important issue. Here we will try to highlight the views of women interviewed in the primary studies included in our qualitative evidence synthesis (QES) on the issue.…”

“…Here we will try to highlight the views of women interviewed in the primary studies included in our qualitative evidence synthesis (QES) on the issue. 2 In recent years, perspectives on maternity care have gradually shifted from a model of medical paternalism towards one of autonomy and shared decision-making. Similar to other studies, our QES showed that pregnant women are active in seeking information and request opportunities to participate in healthcare decisions, 2,3 especially in high-income countries.…”

“…2 In recent years, perspectives on maternity care have gradually shifted from a model of medical paternalism towards one of autonomy and shared decision-making. Similar to other studies, our QES showed that pregnant women are active in seeking information and request opportunities to participate in healthcare decisions, 2,3 especially in high-income countries. 2 However, making informed choices during labour and childbirth is often complex and multilayered, and includes the provision of sufficient, evidencebased information to support selfdetermination, autonomy and control.…”

“…It is important to recognise that for women with complex heart disease, a number of factors are important when decisions are made regarding future pregnancy. 2 In the study approximately half of the women already had a child from a previous pregnancy, which may influenced their choices regarding embarking upon another pregnancy. Furthermore, almost half of the subsequent pregnancies resulted in termination, ª 2018 Royal College of Obstetricians and Gynaecologists…”