A Study to Analyze knowledge regarding respectful maternity care among OBG nurses at Sri Ramakrishna Hospital Coimbatore

 

P. A. Rejini

Deputy Nursing Officer, Sri Ramakrishna Hospital, Coimbatore.

 

ABSTRACT:

Objectives: 1. To identify if any form of disrespect or abuse prevailing during childbirth in Sri Ramakrishna Hospital by nursing staff. 2. To improve our quality of care to promote dignified maternal health services. 3. To achieve Safe motherhood. Methodology: The design was observational design. Target Population was parturient women admitted for delivery. The sample size was 75. Convenient Sampling Technique was used. Observation was evaluated by using analyzing questioners (WHO) National Standards. Quantitative analyses were used in order to interpret the data. The data in turn is interpreted in a bar diagram using scoring system. Result: The study results are Dignity and respect 95%, Communication and autonomy 92%, Supportive care 93%, Privacy and Confidentiality 96% and Facility and environment 95%. Conclusion: Based on the results of this study, direct relationship was observed between respectful maternity care and positive childbirth experience.

 

 

 

INTRODUCTION:

“Know your Rights and Demand your Rights”:

Respectful maternity care is Universal care of child bearing women (6). It is achievable. And it's everybody's responsibility. It is a human right. Respectful maternity care (RMC) is not only a crucial component of quality care and it is a universal human right that encompasses the principles of ethics and respect for women’s feelings, dignity, choices, and preferences (1). The promotion of a positive birth experience has been a main goal of the World Health Organization’s (WHO) recent work on improving maternity care. Respectful maternity care is centered on increasing the interpersonal interactions between a woman and health care providers during various stages of childbirth such as labor, delivery, and postpartum.

 

The range of disrespect and abuse encountered by women during childbirth in health institutions consists of physical abuse (beating, slapping, and pinching), undignified care (yelling, chiding, and humiliating comments), abandonment (leaving alone during different phases of delivery), and discrimination based on the cultural group, social status and age. (11)

 

NEED OF THE STUDY:

1.     Healthcare should have the highest attainable standard of care.

2.     The way a child is brought into the world has an important impact on rest of life.

3.     Parturient women should feel

 

·       Free from harm

·       Privacy

·       Dignity and Respect

·       Free from discrimination and ill-treatment.

 

STATEMENT OF THE PROBLEM:

A Study to analyze knowledge regarding respectful maternity care among OBG nurses at Sri Ramakrishna Hospital Coimbatore.

 

OBJECTIVES:

1.     To identify if any form of disrespect or abuse prevailing during childbirth in Sri Ramakrishna Hospital by nursing staff.

2.     To improve our quality of care to promote dignified maternal health services.

To achieve Safe motherhood

 

MATERIAL AND METHODS:

Research approach: Quantitative Research approach

Research design: Observational design

Target population - Parturient women

 

Target population:

·       In patients admitted for deliveries at Sri Ramakrishna Hospital.

·       Focused only on OBG ward staff nurses.

·       The quality of care rendered to the patients is analyzed by questionnaire.

 

Limitations:

·       The period of study is for 1 month

·       Sample size is 75.

 

Inclusion Criteria:

The women who had vaginal birth and lower segmental caesarean section participated in the study with informed verbal consent.

 

Exclusion Criteria:

Antenatal mothers who had still birth/intrauterine death/abortion and fetal anomalies are not included as they experience a stressful situation.

 

Operational Definition:

Study:

A detailed informative session was conducted among staff nurses to reinforce the knowledge regarding Respectful maternity care among OBG Nurses.

 

Knowledge:

The fact, information, and skills acquired on Respectful Maternity Care by the staff nurses through experience or education; the theoretical or practical understanding of a Respectful Maternity Care.

 

Respectful Maternity Care:

Respectful Maternity Care encompasses respect for women’s basic human rights that includes respect for women’s autonomy, dignity, feelings, choices and preferences, including companionship during maternity care. (8)

 

Data Collection Procedure:

Formal Permission obtained from Dean/Medical Director and HOD of Obstetric Department to conduct the audit regarding respectful Maternity Care. The audit team comprises of four members. The tool has 30 questions under five headings. The headings are Dignity and respect (5), Communication and autonomy, Supportive care, Privacy and Confidentiality (9) (10) and Facility and environment (7). The staff nurses were given orientation about Respectful Maternity Care and audit procedure. The audit done by using convenient sampling technique by using a questionnaire (4). Parturient women those who are admitted in SRH hospital for deliveries are encouraged to express their experience and views freely. The total sample size is 75.

 

Data Analysis Method:

Quantitative analyses were used in order to interpret the data. The data in turn is interpreted in a bar diagram using scoring system.

 

Interpretation of Audit Report:

S. No	Tool	Total Scoring	%
1	Dignity and respect	100%	95%
2	Communication and autonomy	100%	92%
3	Supportive care	100%	93%
4	Privacy and confidentiality	100%	96%
5	Facility and environment	100%	95%

 

Audit on Respectful Maternity Care N =75

S. No	Questions	Scoring	Percentage
	Dignity and Respect
1	Where you made to wait to meet your doctors?	100%	95 %
2	Did the nurses and others introduce themselves for the first time?	100%	95 %
3	Did all the health care providers treat you with respect?	100%	96%
4	Did they shout at you, scolded, insulted, threatened or talked rudely?	100%	95 %
5	Did you have the rights to choose?	100%	97%
6	Did the staff ask for your permission or consent before any action or practice?	100%	96 %
7	Did the healthcare provider explain about the labour process?	100%	96 %
Communication and Autonomy
1	During delivery did you feel that you were allowed to be in the position of your choice?	100 %	99 %
2	Did they explain about the medicines given to you?	100 %	94%
3	Did the doctor address all your doubts or questions?	100%	97 %
4	Did the staff provide you with the necessary explanations about breastfeeding?	100%	96 %
5	Was there quick response from staff for any sort of help and information you asked for?	100%	96 %
6	Were your questions answered politely?	100%	96 %
7	Have your questions answered honestly	100%	95%

 

Supportive Care
S. No	Questions		Scoring		Percentage
1	Did the doctors and staff pay attention to care you?		100%		94 %
2	Did they limit your eating or drinking?		100%		95 %
3	Were you allowed to move or forced to stay in bed?		100%		95 %
4	Whether a companion was allowed during the labour?		100%		89 %
5	Did the doctor and nurse try to understand your pain or anxiety?		100%		92 %
6	Do you feel that labour team took best care of you?		100%		92%
7	Were you discriminated because of race/caste/creed/language?		100%		97 %
8	Was skin to skin immediate baby contact offered?		100%		95 %
9	Did you breastfeed the baby within one hour of delivery?		100%		96 %
Privacy and Confidentiality
1		During examinations were you kept covered with a cloth or curtains for you to not feel exposed?		100%		95 %
2		Do you feel that your health information is kept confidential at this centre?		100 %		97%
Facility and Environment
1		Were the labour room and postnatal wards crowded?		100%		96%
2		Do you feel the wards, washrooms were clean?		100%		93%
3		In general did you feel safe in this centre?		100 %		96%
4		Was the electricity/water facility good?		100 %		95%

 

DISCUSSION:

Women are vulnerable during pregnancy, especially during labor and childbirth therefore, failure to receive respectful maternity care can result in negative experiences including fear of childbirth and reduced vaginal childbirths and a opt to have cesarean section.(2)

The study results are as follows Dignity and respect 95%, Communication and autonomy 92%, Supportive care 93%, Privacy and Confidentiality 96% and Facility and environment 95%. Individual staff was called and necessary instruction and education given to improve quality nursing care. Being a pilot study a period of 1 month was taken to make it convenient to practice so that staff is groomed well. This will be continued to sustain quality which in turn increases patient satisfaction.

 

CONCLUSION:

Based on the results of this study, direct relationship was observed between respectful maternity care and positive childbirth experience.

 

RECOMMENDATION:

·       Health care facilities must offer women privacy through use of curtains or partitions and allow her to choose her own support person/birth attendant.(9)

·       Maternity staff nurses need to be valued and respected, and provide them with adequate support, mentorship and training, which will enable them to provide respectful and maternity care successfully.

·       Ensuring patient care areas have functional washrooms and are kept clean.

·       Will implement and continue.

 

REFERENCES:

1.      The White Ribbon Alliance for Safe Motherhood. Respectful Maternity Care: The Universal Rights of Childbearing Women. White Ribbon. Alliance Safe Mother. 2011

2.      Schroll A, Kjrgaard H, Midtgaard J. Encountering abuse in health care; lifetimeexperiences in postnatal women - a qualitative study. BMC Pregnancy Childbirth. 2013;3:74

3.      Freedman LP, Kruk ME. Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas. Lancet. 2014;384(9948):e42-4.

4.      Dencker A, Taft C, Bergqvist L, Lilja H, Berg M. Childbirth experience questionnaire (CEQ): development and evaluation of a multidimensional instrument. BMC Pregnancy Childbirth. 2010;10(81):1–8.

5.      Abuya T, Warren CE, Miller N, et al. Exploring the prevalence of disrespect and abuse during childbirth in Kenya. PloS ONE. 2015;10(4):e0123606

6.      Windau-Melmer T. A Guide for Advocating for Respectful Maternity Care. [Internet]. Washington DC: Futures Group, Health Policy Project; 2013:11–96. Available from: https://www.whiteribbonalliance.org/wp-content/uploads/2017/11/RMC-Guide_FINAL.pdf

7.      Government of India. National Family Health Survey III (2005-06). Mumbai: IIPS, Ministry of Health and Family Welfare; 2007.

8.      Diana B, Hill K. Exploring evidence for disrespect and abuse in facility-based childbirth: Report of a landscape analysis; 2010. Available at www.urc chs.com/ uploads/resourceFiles/Live/RespectfulCareatBirth920101Final.pdf (accessed on 10 Jul 2019

9.      Bhattacharya S, Sundari Ravindra T. Silent voices: Institutional disrespect and abuse during delivery among women of Varanasi district, northern India. BMC Pregnancy Childbirth. 2018;18:1–8. [PMC free article] [PubMed] [Google Scholar]

10.   Singh A, Chhugani PM, James MM. Direct observation on Respectful maternity care in India: A cross sectional study on health professionals of three different health facilities in New Delhi. Indian J Sci Res. 2018;7:821–5. [Google Scholar]

11.   Sudhinaraset M, Treleaven E, Melo J, Singh K, Diamond-Smith N. Women's status and experiences of mistreatment during childbirth in Uttar Pradesh: A mixed methods study using cultural health capital theory. BMC Pregnancy Childbirth. 2016;16:1–12. [PMC free article] [PubMed] [Google Scholar]

12.   World Health Organization (WHO), UNICEF, UNFPA. Women-friendly health services: experiences in maternal care. Mexico City: WHO/UNICEF/UNFPA; 1999

 

 

 

Received on 18.05.2022         Modified on 21.08.2022

Accepted on 15.10.2022       ©A&V Publications All right reserved