What makes or mars the facility-based childbirth experience: thematic analysis of women’s childbirth experiences in western Kenya

Abstract

BackgroundSub-Saharan Africa accounts for approximately 66% of global maternal deaths. Poor person-centered maternity care, which emphasizes the quality of patient experience, contributes both directly and indirectly to these poor outcomes. Yet, few studies in low resource settings have examined what is important to women during childbirth from their perspective. The aim of this study is to examine women’s facility–based childbirth experiences in a rural county in Kenya, to identify aspects of care that contribute to a positive or negative birth experience.MethodsData are from eight focus group discussions conducted in a rural county in western Kenya in October and November 2016, with 58 mothers aged 15 to 49 years who gave birth in the preceding nine weeks. We recorded and transcribed the discussions and used a thematic approach for data analysis.ResultsThe findings suggest four factors influence women’s perceptions of quality of care: responsiveness, supportive care, dignified care, and effective communication. Women had a positive experience when they were received well at the health facility, treated with kindness and respect, and given sufficient information about their care. The reverse led to a negative experience. These experiences were influenced by the behavior of both clinical and support staff and the facility environment.ConclusionsThis study extends the literature on person-centered maternity care in low resource settings. To improve person-centered maternity care, interventions need to address the responsiveness of health facilities, ensure women receive supportive and dignified care, and promote effective patient-provider communication.

A Rapid Review of Available Evidence to Inform Indicators for Routine Monitoring and Evaluation of Respectful Maternity Care

“…16,49 Respectful care is a complex and multidimensional construct that is not well-captured by a single satisfaction measure in which responses are often inflated and lack sufficient specificity to be actionable. 7,50,51 Also, just because a woman was not verbally or physically abused does not mean she was treated with dignity and respect. Additionally, experiences of respect may be intermixed with disrespect.…”

“…For example, a growing body of research has highlighted that women also have poor experiences during prenatal care. [6][7][8][9] Thus, there is a need for indicators to track women's experiences along the reproductive, maternal, newborn, and child health continuum. Some of the indicators recommended have been used to measure women's experiences during prenatal care, 9 but more work is needed in this area.…”

“…Much of this work has focused on intrapartum care, although there is emerging evidence that D&A also occurs along the reproductive, maternal, newborn, and child health continuum. [6][7][8][9] Most quantitative studies have investigated D&A based on the categories proposed by Bowser and Hill: physical abuse, nonconsented care, nonconfidential care, nondignified care, discrimination, abandonment of care, and detention in facilities. 10 Some have also applied the typologies of mistreatment proposed by Bohren et al (2015) that include these third-order themes: physical, sexual, and verbal abuse; stigma and discrimination; failure to meet professional standards of care; poor rapport between women and providers; and health system conditions and constraints.…”

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana

“…The training content was based on evidence-based practices on the management of the complications and recommended practices known to have positive effects on birth outcomes and women's experiences such as support and mobility during labor and nonsupine position at delivery. 3,[20][21][22][23][24][25] In addition, simulation scripts had prompts for certain behaviors from the patient actress: For example, if providers did not introduce themselves, the patient actress asked "who are you? ", and if providers did not explain what they were doing or found from examinations, she asked "what are you doing to me?"…”

Developing of a new guideline for improving birth experiences among Iranian women: a mixed method study protocol

“…A qualitative study with a content analysis approach explained the childbirth experience of women in the west of Kenya. The experience of this group of women was affected by external factors, such as the behaviour of clinical staff, their support, and childbirth facilities and environment [25].…”