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• W2183014252 abstract "Disrespectful maternity care and mistreatment, often categorised as human rights violations, occur in many labour wards around the globe. This led the World Health Organization to issue a statement on its prevention during facility-based childbirth. In this BJOG commentary, the absence of an agreed definition of respectful maternity care is brought forward as one barrier to progress. The deplorable state of many health systems definitely adds to the problem, with dirty labour wards without any privacy being a reality in many places. Efforts to improve the quality of maternity care such as the Safe Motherhood Initiative have more or less neglected the issue of respectful care and prioritised technical issues of comprehensive emergency obstetric care in facility-based childbirth. Programmes address preparedness for birth among women and communities, while at the same time ignoring preparedness for birth by health facilities. Facilities are seldom welcoming, with many women being told that they came late, were uncooperative or created their own problems by taking local drugs. Health workers are often reluctant to audit their own roles in care provision, although audit and feedback are known to have a positive impact on pregnancy outcome (Ivers et al. Cochrane Database Syst Rev 2012;CD000259; Van den Akker T et al. PLoSOne 2011;6:e20776). The term ‘mistreatment of women during facility-based childbirth’ is important because it leaves out a level of intentionality, making it easier to address mistreatment at the facility level. It is high time to discuss ‘acts of omission’ in maternity care, usually found as results of audit, making use of the Three Phases of Delay (Thaddeus & Maine Soc Sci Med 1994;38:1091–110). A reduced delay in the third phase (prompt diagnosis and treatment) is likely to result in a reduced delay in the first phase (decision to seek care) and improve pregnancy outcome. The poor state of many health systems combined with dire staff shortages contributes to low staff morale. However, this can never be a good reason for being disrespectful to women. Continuous and caring support during labour is an evidence-based intervention that should be introduced even in labour wards with less privacy: it does not cost a single penny (Hodnett et al. Cochrane Database Syst Rev 2013;CD003766). It will reduce the number of unnecessary obstetric interventions without compromising maternal and neonatal outcome. In many hospitals, 10% of babies die after caesarean sections, for which dubious indications are mainstream, resulting in high maternal morbidity and mortality (Rijken et al. Lancet 2015; in press). In our view, not following evidence-based guidelines for monitoring labour is also part of ‘mistreatment’. Although some health professionals are found to perform rounds accompanied by flocks of students, most women are not allowed to bring a companion with them into labour wards. It is true that the World Health Organization has long recommended this low-cost intervention to be pursued. We suggest going a bit further and ask why then this recommendation is not implemented? Would this have anything to do with companions (not in pain) being able to observe (substandard) care in those units? None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
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• W2183014252 date "2015-12-02" @default.
• W2183014252 modified "2023-09-23" @default.
• W2183014252 title "Continuous and caring support right now" @default.
• W2183014252 doi "https://doi.org/10.1111/1471-0528.13775" @default.
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