Mojgan Mirghafourvand
1 
, Maryam Vaezi
2 , Sakineh Mohammad-Alizadeh-Charandabi
3 , Shahla Meedya
4 , Khadije Hajizadeh
5* 1 Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Department of Obstetrics and Gynecology, Alzahra Teaching Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
3 Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
4 South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine, and Health, University of Wollongong, Wollongong, Australia
5 Department of Midwifery, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract
Background. Respectful maternity care (RMC) is a crucial approach to enhancing the experiences of mothers. This study aimed to explore women's views on the factors contributing to disrespect and abuse (D&A) during childbirth.
Methods. A qualitative study was conducted with 12 postpartum women selected through purposive sampling to ensure maximum diversity. Data were gathered through in-depth semi-structured interviews and analyzed using a conventional content analysis method.
Results. The analysis revealed seven key categories. These categories included respect for women, meeting needs and preferences, involvement of women, continuity of care, empathy, adequate human and non-human resources, and factors that deter D&A.
Conclusion. It is essential to develop effective interventions to enhance RMC across various dimensions. Providing RMC during and after childbirth necessitates the involvement of policymakers and health managers. This can be accomplished by addressing the welfare and environmental needs, showing empathy towards mothers, safeguarding their privacy, alleviating staff workloads, and transforming the attitudes of healthcare workers.
Extended Abstract
Background
Childbirth is one of the most important, critical, stressful, and at the same time, glorious periods of every woman's life. Usually, in childbirth, the concept of "safe motherhood" is limited to physical safety, while childbirth has deep cultural and personal significance for the woman and her family. Therefore, the concept of safe motherhood should go beyond the prevention of illness or death, and other concepts, including respect for human rights such as independence, dignity and respect, choices and preferences, and companionship with women, should be considered. In recent years, the use of respectful maternity care (RMC) has been promoted by emphasizing the importance of ethics and considering the psychological, social, and cultural aspects of childbirth. RMC) is an important strategy for improving mothers’ experiences. This study aimed to explain women’s perceptions of aspects and determining factors of disrespect and abuse (D&A) during childbirth.
Methods
Upon sampling in the quantitative stage, the RMC questionnaire was analyzed, and according to the results of the average overall scores of RMC in postpartum women, the women who had 10% of the upper and lower RMC scores (extreme cases) were selected as the target population of this study. The sampling method used was purposive, meaning that women who were included in the final cases and were willing and capable of sharing their views on the elements and influencing factors of their respectful maternity care (RMC) during childbirth were chosen. Informed consent was secured from those women who agreed to take part in the study. Ultimately, 12 postpartum women with a wide range of backgrounds participated in this qualitative research. Data were gathered through in-depth semi-structured interviews and were analyzed concurrently using a conventional content analysis method.
Results
The data analysis revealed seven primary categories. These categories encompassed respect for women, satisfaction of needs and preferences, women's involvement, care maintenance, empathy, suitable human and non-human resources, and the factors influencing D&A. The importance of maintaining the human dignity of childbirth centers was highlighted as essential for achieving respectful maternity care (RMC). Some participants noted that caregivers were attentive to their physical or physiological requirements, such as access to water, food, and appropriate clothing, and made efforts to address the mother's needs during labor and postpartum.
Conclusion
Given that women's interactions with caregivers can either foster peace and comfort or undermine their self-confidence and self-esteem, the relationship between women and their pregnancy care providers, as well as the overall pregnancy care system, is crucial during pregnancy, childbirth, and the postpartum period. Therefore, based on the study's findings, several recommendations should be made. These include creating conditions that allow women to understand the various aspects of childbirth, ensuring privacy, preventing discriminatory behavior from caregivers and birth attendants, obtaining informed consent, and protecting women from blame, insults, threats, humiliation, mockery, and any form of inappropriate or violent treatment. Additionally, care should be delivered with attention, empathy, and encouraging words. In essence, staff should work to enhance birthing centers by creating a calming physical environment, providing necessary facilities and equipment, allowing women to communicate with their families via phone, and ensuring adequate anesthesia during episiotomies and their repair.