Assessment of the implementation of respectful maternity care charter in North Central Nigeria (Federal Capital Territory and Kwara State): study protocol

Respectful Maternity Care (RMC) charter is one of the tools for ensuring quality of care in maternity services. Nigeria is a signatory to RMC charter; therefore, the charter is expected to be the standard of care. However, in Nigeria and other countries, reports of disrespectful maternity care abound; this discourages women from accessing facility-birth. Therefore, to improve the quality of care towards increase in uptake, it is expedient to assess the level of implementation of the RMC charter by key stakeholders for sustainability, impact and scale-up of charter-compliant maternity care in Nigeria. The study aims to assess the implementation of RMC charter in North-central Nigeria. The study is a mixed-method, cross-sectional study; the expected participants are key stakeholders in healthcare (Healthcare workers, Healthcare Administrators, Project Managers, Policy makers) in North-Central Nigeria (Federal Capital Territory and Kwara state). A multistage sampling technique would be used to enroll participants from 18 healthcare facilities (Primary, Private, Secondary and Tertiary) in rural and urban areas and Ministries of Health officials at local and state government levels. Expected outcomes: The study is expected to provide information on the current status of knowledge and implementation of the RMC charter in Nigeria. It would also identify the enablers and barriers to the implementation process and provide evidence for effective scale-up of the process in Nigeria. The outcomes will be widely disseminated to healthcare workers, health administrators and decision-makers in healthcare services through post-study meetings, conference presentations, journal publications and policy briefs for effective RMC charter implementation in Nigeria.

Respectful maternity care for positive birthing experience at Pravara Rural Hospital

Background: Many women in developing countries experience disrespect and abuse during labour and delivery. Respectful maternity care (RMC) is considered as one of the basic reproductive health rights of the women. It is one of the essential components of LaQshya programme of Government of India. The aim of the study was to highlight the important components of the RMC, its implementation and its impact on patient turnover in the maternity unit of Pravara Rural Hospital Loni and review the literature on the subject.Methods: A prospective observational study was conducted for a period of one year from January 2019 to December 2019 at tertiary care hospital. The implementation of RMC was observed and important findings were documented. The patient turnover and cliental satisfaction was noted.Results: It was observed that all components of RMC were strictly followed in maternity unit of Pravara Rural Hospital Loni. The staff and doctors were trained and oriented towards importance of RMC. The patient turnover has increased exponentially year by year. The patient feedback system about the quality of care in labour and delivery ward shows overall satisfaction score of 4.3 on the 5-point Likert scale. There was a surveillance system that supervises and closely monitor the quality of care in labour room in general and RMC in particular.Conclusions: RMC is one of the important components of LaQshya certification process. Respectful maternity care is implemented at Pravara Rural hospital in its true spirit. It has resulted in gaining the faith and trust of the community, which is reflected through exponential rise in the number of deliveries taking place in the hospital.

Models of maternity care: a continuity of midwifery care

Pregnancy and birth are significant life events for women and their families and midwife supports a woman throughout pregnancy, birth and the postnatal period. So, the demand for services that are family friendly, women focused, safe and accessible is increasing. Evidence has shown that midwifery care is associated with lower cost, higher satisfaction rates among women, and less intervention. Because pregnancy and childbirth involve every part of feelings, physical and practical needs, hopes, religious and spiritual beliefs can all affect pregnancy and birth. So, model of maternity care addresses all these aspects to help give birth safely, naturally and confidently. The aim of this review is how midwives working in different model care constructed their midwifery role in order to maintain a positive work-life balance. Evidence from high income countries found such models to be a cost-efficient way to improve health outcomes, reducing medical interventions and increasing satisfaction with care.

Interventions to reduce caesarean section rates at government medical college and hospital Aurangabad, India

Background: Caesarean sections are effective in saving maternal and infant lives, but only when they are performed for medically indicated reasons, The Objective of this study was to reduce caesarean Section rate at GMCH, Aurangabad and to improve overall birthing experience with respectful maternity care.Methods: The caesarean sections done at GMCH Aurangabad were audited using Robson`s Ten Group classification system to identify the major contributors to the overall CS rate. The following clinical and non-clinical interventions were applied dynamically to control the caesarean section rates. Clinical Interventions were changes in protocols regarding induction of labour, Intermittent auscultation as opposed to continuous electronic foetal monitoring in low risk cases, use of a partogram, encouragement of different birthing positions, promoting TOLAC to reduce the secondary CS rate. Nonclinical interventions include encouragement of DOULA (birth companion), ante-natal counselling of the expectant mothers, training of healthcare staff for respectful maternity care and use of evidence based clinical practice guidelines with mandatory second opinion for every non recurrent indication of CS. Auditing of caesarean section using Robson classification.Results: In this study there has been steady decline in LSCS rates from 33% to 26.9%. On analysis with Robson classification, group 5 (previous LSCS) made largest contribution of 36.9% followed by Group 1, 2, 10 each contributed 18.01%,13.2% and 11.2% respectively. Group 6 to 10 account for 23%. Various birthing positions lowered use of oxytocics from 33 % to 19% as well lowered episiotomy rates with greater success in vaginal delivery.Conclusions: Modification of induction protocols have reduced the primary LSCS rates and successful VBAC using FLAMM score was helpful in reducing the repeat caesarean Sections. Various birthing positions, DOULA gave greater success in vaginal delivery. LSCS rates in mothers with breech, multiple or oblique/transverse lies were largely unmodifiable. Limiting the CS rate in low-risk pregnancies by individualizing every labour and not to set a time limit as long as mother and baby are closely monitored.

The Current State of Maternity Care and Suggestions for Improvement in the Management of High-risk Pregnancies in South Korea

Since the year 2000, low birth rates have resulted in significant decreases to maternity care services throughout many Korean hospitals. However, there has been a concomitant increase in the number of high-risk pregnancies, due to growing trends in delayed marriages and subsequent pregnancies. Increased maternal age is a risk factor associated with complicated pregnancies and high-risk deliveries, both of which are strongly related to maternal death. With this in mind, the Ministry of Health and Welfare has supported the establishment of a regional perinatal center for high-risk pregnancies, estimated to be be fully completed by the year 2020. Despite this, maternity care services for high-risk pregnancies remain insufficient. According to previous reports, the total number of maternity care hospitals and beds available for high-risk pregnant women were 60 and 399, respectively. This is in stark contrast to previous bed estimates of 1,640. The establishment of a maternity care system for high-risk pregnant women is integral to ensuring optimal conditions for both pregnancy and childbirth. This review briefly evaluates the existing maternity care system for high-risk pregnancies, and proposes several new suggestions for improvements.

Midwives’ Attitude and Barriers of Evidence Based Practice in Maternity Care

Objectives: Midwives have a crucial role in providing optimal care for pregnant women.One of the most important policies for quality improvement in maternity care is implementation ofevidence-based practice. However, the application of evidence-based practice within the maternityhealth care setting faces many challenges. The purpose of this study was to describe Iranianmidwives’ attitude and perceived barriers of evidence based practice in maternity care.Methods: In this descriptive, cross-sectional study, a census sample of 76 midwives fromtwo public hospitals and urban health centers in Torbat Heydariyeh, a city east of Iran weresurveyed. Data collection tools were two reliable and valid questionnaires that measure midwives'attitudes and barriers of implementation of evidence-based practice. Data were analysed usingSPSS version 16.Results: The mean age and years of experience were 29.30 ± 4.86 and 5.22 ± 4.21 years,respectively. The mean score of attitude was 40.85 ± 4.84 (range = 30–60). This study also foundtime constraints (2.70 ± 0.92), inadequate facilities (2.64 ± 0.72), non-compilation of literaturein one place (2.59 ± 0.92), lack of cooperation of physicians (2.48 ± 1.06) and the feeling ofinadequate authority (2.45 ± 0.88) as the top five barriers to implementing EBP.Conclusion: Survey participants demonstrated a positive attitude toward EBP.Organisational comprehensive strategies such as time efficiency, adequate material and humanresources, familiarity with organisations such as the Cochrane Collaboration and managerialsupport for increasing professional legitimate authority are recommended to promote the use ofEvidence-Based Practice in Iran.

Secure Plan of Appropriate Obstetricians and Nurses for Safe Childbirth in Korea

Because childbirth is a complex and difficult process, intensive preparation, and the immediate availability of emergency assistance during every step of delivery support to maternal safety. The World Health Organization recommends that pregnant women must be able to access the right care at the right time. Appropriate obstetricians is important factor for easy access during pregnancy. Especially, an increase in the number of specialists in maternal-fetal medicine would greatly improve the pregnancy outcomes of high-risk women. In 2013, a total of 2,274 obstetricians were employed in maternity hospitals and clinics in Korea. Their average age was 44.8 years and they will get older soon. By 2026, 740 junior obstetricians will join the maternity care system, but 916 senior obstetricians will have retired on night duty at hospital because of above 60 years of age. Thus, obstetrician numbers will fall by 176. Korea requires 2,338~3,507 obstetricians based on an annual number of deliveries per obstetrician in 2016. However, Korea has a shortage of obstetricians because of the low birth rate-induced business losses, inadequate payment system by the national health insurance program, and the quality-of-life preferences of young doctors. Ensuring an appropriate supply of obstetricians is essential for infrastructure of safe childbirth. I believe that adequate payment by the national health insurance program, and new medical insurance fees for management of high-risk pregnancies, will encourage young doctors to become obstetricians. The government should also introduce additional night duty fees and overseas training programs for young obstetricians.

Mediating effect of social support on relationship between negative emotion and coping style in HIV-infected pregnant women / 第二军医大学学报

Objective To explore the mediating effect of social support on the relationship between negative emotion and coping style in human immunodeficiency virus (HIV)-infected pregnant women. Methods A total of 202 HIV-infected pregnant women were enrolledby a convenient sampling method in this study. Participants completed questionnaires including social support rating scale (SSRS), knowledge, attitudes and practices scale for preventing mother-to-child transmission of human immunodeficiency virus (KAPS-PMTCT), selPrating anxiety scale (SAS), selrating depression scale (SDS), Berger HIV stigma scale (BHSS), and simplified coping style questionnaire (SCSQ). The relationships of these variables were analyzed by Pearson correlation analysis and structure equation modeling analysis. Results The correlations between negative emotion, social support and coping style were all significant. Social support was negatively correlated with negative emotion (P<0. 05) and negative coping style (P<0. 01), and was positively correlated with positive coping style (P<0. 01). Negative emotion was weakly negatively correlatedwith positive coping style (P < 0. 07), and was strongly positively correlated with negative coping style (P<0. 01). Structure equation modeling analysis showed that negative emotion indirectly affected the coping style of HIV-infected pregnant women mainly through the mediating effect of social support (x2/df=1. 835, foodness of ht index [GFI]=0. 975, adjusted goodness of ft index [AGFI]=0. 961, normed bt index [NFI]=0. 950, incremental bt index [IFI]=0. 938, comparative bt index [CFI] =0. 981, parsimony comparative fit index [PCFI]=0. 452, root mean square error approximation [RMSEA]=0.064), with the total amount of mediating effect of the positive coping style and negative coping style being -0.273 and 0.522, respectively. Conclusion Social support is an important mediator between negative emotion and coping style in HIV-infected pregnant women.

Maternity care system for high risk pregnant women in obstetrically underserved area

The number of maternity care hospitals in underserved areas has been falling since 2004 because of business losses steming from low birth rates, inadequate insurance payments for obstetric services, and the shortage of obstetricians. However, the proportion of pregnant women at high risk in Korea has been increasing for decades because of the delay of marriage and the greater number of older pregnant women. High-risk pregnancies tend to lead to pregnancy complications and are associated with high-risk deliveries. An insufficient maternity care system for highrisk pregnant women in Korea has resulted in an increase in maternal mortality. The Ministry of Health and Welfare has supported the establishment of maternity care centers in underserved areas and regional perinatal centers to reduce maternal mortality. Even though the regional perinatal centers are a good system for reducing maternal mortality, they are limited in scope, in that they are not being established quickly on a nationwide scale to detect high-risk pregnancies earlier. This review briefly describes the current maternity care system for high-risk pregnancies and proposes a direction for the development of a health care delivery system between the regional perinatal centers and the maternity care system in underserved areas.

Direct Cost of Maternity-care Services in South Delhi: A Community Survey.

The study was conducted to estimate the direct maternity-care expense for women who recently delivered in South Delhi and to explore its sociodemographic associations. A survey was conducted using the two-stage cluster-randomized sampling technique. Two colonies each from high-, middle- and low-income areas were selected by simple random sampling, followed by a house-to-house survey in each selected colony. Information was collected by recall of healthcare expenses for mother and child. In total, 249 subjects (of 282 eligible) were recruited. The mean expense for a normal vaginal delivery (n=182) was US$ 370.7, being much higher in a private hospital (US$ 1,035) compared to a government hospital (US$ 61.1) or a delivery in the home (US$ 55.3). Expenses for a caesarean delivery (n=67) were higher (US$ 1,331.1). Expenses for the lowest-income groups were ~10% of their annual family income at government facilities and ~26% at private hospitals. The direct maternity expense is high for large subsections of the population.