Exploring midwives’ understanding of respectful and non-abusive maternal care in Kumasi, Ghana: Qualitative Inquiry

Background Various aspects of disrespect and abusive maternity care have received scholarly attention because of frequent reports of the phenomenon in most healthcare facilities globally, especially in low- and middle-income countries. However, the perspectives of skilled providers on respectful maternal care have not been extensively studied. Midwives’ knowledge of respectful maternity care is critical in designing any interventive measures to address the menace of disrespect and abuse in maternity care. Therefore, the present study sought to explore the views of midwives on respectful maternity care at a Teaching Hospital in Kumasi, Ghana. Methods Phenomenological qualitative research design was employed in the study. Data were generated through individual in-depth interviews, which were audio-recorded and transcribed verbatim. Data saturation was reached with fifteen midwives. Open Code 4.03 was used to manage and analyse the data. Findings The midwives’ understanding of respectful maternity care was comprised of the following components: non-abusive care, consented care, confidential care, non-violation of childbearing women’s basic human rights, and non-discriminatory care. Probing questions to solicit midwives’ opinions on an evidenced-based component of respectful maternity care generated little information, suggesting that the midwives have a gap in knowledge regarding this component of respectful maternity care. Conclusion Midwives reported an understanding of most components of respectful maternity care, but their gap in knowledge on evidenced-based care requires policy attention and in-service training. To understand the extent to which this gap in knowledge can be generalized for midwives across Ghana to warrant a redesign of the national midwifery curriculum, the authors recommend a nationwide cross-sectional quantitative study.


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Methods: Phenomenological qualitative research design was employed in the study. Data were 22 generated through individual in-depth interviews, which were audio-recorded and transcribed 23 verbatim. Data saturation was reached with fifteen midwives. Open Code 4.03 was used to manage 24 and analyse the data.   The rise in facility-based deliveries with skilled providers in low-and-middle-income countries 38 (LMICs) has resulted in decreased maternal and neonatal morbidities and mortalities [1][2][3][4][5]. In . 55 One intervention integrated specific components of RMC, like dignity, respect, communication, 56 autonomy, and supportive care, into a simulation training [13]. The simulation training was 57 designed to improve the identification and management of obstetric and neonatal emergencies [13]. 58 It was piloted in the East Mamprusi District in the northern region of Ghana [13]. The findings 59 showed that RMC training workshops have the potential to improve childbearing women's 60 childbirth experiences in LMICs [13].

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To prevent and eliminate facility-based D&AC during childbirth, WHO recommended five key 62 actions, one of which is to generate data related to respectful and disrespectful care practices [11].

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In line with this, several studies have generated knowledge on the perspectives of childbearing 64 women and skilled providers on D&AC [6,[16][17][18][19][20]. The few studies that explored the views of 65 skilled providers on RMC were from countries other than Ghana [21,22]. Thus, the present study 4 66 seeks to explore the experiences and understanding of midwives on RMC in a tertiary health facility 67 in Kumasi, Ghana The study setting was a tertiary health facility in Kumasi, located in the Ashanti region, the central The study population was composed of midwives in this tertiary health facility in Kumasi, Ghana. 91 Inclusion criteria were midwives working on the labour wards for at least one year. Purposive 92 sampling ensured that participants with expertise were enrolled. The first author and two research 93 assistants (RAs) recruited the study participants. All participants who officially agreed to be 94 included completed the study, and saturation of data was achieved with fifteen (15) midwives, at       The midwives interviewed had experiences that compromised or enhanced the wellbeing of 288 childbearing women. Thus, they understood childbearing women's reactions to both abusive and 289 non-abusive care. From the midwives' views, it's revealed that childbearing women's wellbeing is 290 one notable motivation for providing RMC. According to the midwives, childbearing women 291 remain appreciative to them due to the RMC they received.

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The most important thing is to deliver a healthy baby, but that ultimately depends on the kind of 293 care rendered to the mother. So, if the childbearing woman is wet, she must be wiped and changed.
294 …The baby inside the mother also experiences whatever you do for the mother. The midwives indicated that the benefits they have reaped due to providing RMC encouraged them 309 to continually provide RMC. The benefits were economic, social, and psychological in nature.

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Paramount among the benefits they accrued from providing RMC was emotional appraisal from 311 postnatal women and their relatives. The midwives made reference to intrinsic and extrinsic motivations for providing RMC. These

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Midwives also mentioned that educating childbearing women about labour and pain management 386 will ensure optimal RMC. This recommendation is an example of how quick midwives are to 387 outline measures directed at childbearing women to curtail D&AC. It's laudable to provide quality 388 pain management education to childbearing women during antenatal care visits; however, the 389 training of midwives to learn to provide childbearing women with comfort measures that help them 390 cope with and manage pain during the experiences of childbirth is an essential strategy for 391 promoting respectful maternity care [13].