Journal – Research Square
Article type – Pre-print – Clinical research
Publication date – Oct – 2022
Authors – Marjan Mirzania, Elham Shakibazadeh, Meghan A. Bohren, Sedigheh Hantoushzadeh, Farah Babaey, Abdoljavad Khajavi, Abbas Rahimi Foroushani
Keywords – Disrespectful maternity care, Iran, Labour and Childbirth, Maternity Ward, Mistreatment, Qualitative multi-stakeholder research, Quality of care.
Open access – Yes
Speciality – Obstetrics and Gynaecology
World region Middle East
Country: Iran
Language – English
Submitted to the One Surgery Index on October 13, 2022 at 9:25 pm
Abstract:

Background
Mistreatment during labour and childbirth is a common experience for many women around the world. A picture of the nature and types of mistreatment; and especially its influencing factors has not yet been identified in Iran. This study aimed to explore the manifestations of mistreatment and its influencing factors in maternity hospitals in Tehran.

Methods
A formative qualitative study was conducted using in-depth face-to-face interviews between October 2021 and May 2022 in five public hospitals. Participants included women, maternity healthcare providers, and managers at hospital and Ministry of Health levels. Participants were selected using purposive sampling. Recorded interviews were transcribed verbatim and thematically analyzed with a combined deductive and inductive approach using MAXQDA 18.

Results
A total of 60 interviews were conducted. Women experienced various forms of mistreatment during labour and childbirth, including verbal abuse, frequent and painful vaginal examinations, neglect and abandonment, lack of supportive care, denial of mobility and pain relief, and physical abuse. Four main themes were identified as the drivers of mistreatment: (1) individual-level factors (healthcare providers perception about women’s limited knowledge on childbirth process, untrained companions, mismatched expectations of women for care, and discrimination based on ethnicity or low socioeconomic status); (2) healthcare provider-level factors (healthcare provider stress/stressful working conditions, healthcare providers with limited personal experience of pregnancy and childbirth, neglect of midwives’ identities by doctors, poor educational contents and curriculum, and low salary and lack of incentive); (3) hospital-level factors (lack of staff, lack of supervision and control, type of hospital, inadequate physical structures); and (4) national health system-level factors (lack of access to pain management during labour and childbirth and perceptions about forced vaginal birth in public hospitals).

Conclusions
There are multiple level drivers for mistreatment which requires multifaceted interventions. These interventions should emphasize training of pregnant women and their companions, training healthcare providers, encouraging and managing work shifts, strengthening the position of midwives in public hospitals. Moreover, continuous monitoring of the performance of providers, increase staff numbers and improvement of physical space of the maternity wards, as well as implementation of the related guidelines, including painless childbirth, should also be considered.

OSI Number – 21778

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