A Case Study

Mum arrives at the facility with strong contractions

- 24 yr old G1P0 presents in labour at 39 weeks

- OB hx: this is her first pregnancy
- Medical history: none
- Exam: baby longitudinal, vertex, SVE: 6cm

She labours in the hospital but is treated poorly

- Mum has many questions, answers not provided

- Mum undergoes many vaginal exams without consent
- Mum’s legs are slapped open during delivery
- She delivers a LFI wt 3.2kg, apgars 9/9
- Was this successful? What could be done
differently?
Respectful Maternity Care
Updated June 2022
Section 1

Pre-Test
01
Repairing a a. Non-consented care
perineal laceration b. Non-confidential care
without offering a c. Abandonment
mum any form of d. Physical abuse
anesthesia is an
example of which
of the following?
02
01
Telling a mum she a. Discrimination
must undergo a CS b. Non-consented care
c. Detention
without d. Non-confidential care
explaining why is
an example of
which of the
following?
03
01
Forcing a mum to a. Non-consented care
stay in a facility b. Discrimination
c. Detention
because she is d. Physical abuse
unable to pay her
bill is an example
of which of the
following?
04
01
Which of the a. Provider attitude
following is the b. Cost of birthing services
biggest predictor c. Cleanliness of facility
d. Facility reputation
of a women’s
choice to use
facility-based
childbirth
services?
05
01
Which of the a. Not explaining a procedure to a
woman in a language she
following understands is a form of disrespect
and abuse
statements is true b. We should consider respectful
regarding pregnancy and delivery care services
as a key solution to reducing
respectful maternal mortality
c. Respectful maternity care during
maternity care? labour & delivery is a basic human
right
d. All of the above are true
Learning Objectives
● Understand the different
types of disrespect and
abuse during childbirth
● Know the definitions of
respectful maternity care
and abuse during childbirth
● Understand the problems
associated with disrespect
and abuse
● Brainstorm ways to improve
this problem in your own
facility
Section 2

The Facts
Disrespectful maternity care 20%
is a GLOBAL problem: Of women in kenya
report D&A in
Disrespect and abuse childbirth

(D&A) in the delivery

room is associated with
negative delivery
In Kenya:
experience and poor non-dignified,
maternal care quality non-consensual
care, and physical
abuse are the most
Disrespect and abuse common types of
D&A
are some of the main
barrier to achieving
improved maternal
health outcomes
worldwide
 Sustainable development goals and RMC
go hand in hand

SDG 3.1: Ensure health lives and promote well-being for all at all ages: reduce
the global maternal mortality ratio to less than 70 per 100,1000 live birth
Section 3

Definitions
Respectful Maternity Care (RMC):
is an approach to care
which emphasizes the
fundamental rights of
women, newborns, and
families
Disrespect and Abuse (D&A)
is defined as abuse,
violence, and inhuman or
humiliating care that can
occur both individually (by
health care workers) and
structurally (by systematic
environmental defects)
 Physical abuse Non-consensual
Categories care

of disrespect
include: Discrimination Abandonment

Non-dignified
Non-confidential
Detention care/Verbal
care
abuse
 All physical contact
Physical with our patients
Abuse should be as gentle,
comforting, and
reassuring as possible
Examples include: hitting,
slapping, pushing or
roughly touching a Freedom from physical
woman. May also include abuse is the right of
being restrained or
laceration repair without each of our patients
anesthesia
 Language, educational, and
cultural background may vary

Non-consensual among our patients

care All need careful explanation of

proposed procedures in a
language and at a level they
can understand so that they
can consent to or refuse a
Coerced cesarean
procedure
sections, non-consented
vaginal exams, etc are The freedom to consent to or
examples of refuse care is the right of each
non-consented care
of our patients
“We want nurses who are kind,
who would be patient enough to
tell us what is happening to us.
Most of them (nurses) do not….”
 All women are equally
worthy of our respectful
care regardless of ethnic
Discrimination background, culture, social
standing, educational level
or economic status

Discrimination often
Discrimination is never
occurs towards poor okay. Non-discrimination is
or young mothers the right of each of our
patients
 A woman in labor or
immediately after birth
should never be left alone
Abandonment without a way to get ahold of
of care a healthcare provider.

Attentive care is the right of

each of our patients
May occur
before, during or Women should be able to
after labour have a companion of their
choice to provide
continuous support
 A woman or her baby
should never be
Detention in forcibly kept in a
facilities facility

Freedom from
This often occurs detention is the right
because of an of each of our
inability to pay
patients
 Every woman we care
for is a person of value
Non-dignified and is worthy of our
care/Verbal respect
abuse
We must honor the
dignity of each woman
May include:
intentional
humiliation,blaming Dignified care is the
, rough treatment, right of each of our
scolding, shouting
patients
and name calling
“I think the attitudes of our nurses
are bad because they have no
respect or mercy for a patient
and they insult patients without
been provoked.”
 Patients have a right to
privacy and confidentiality
Non
confidential This includes during
counseling, physical
care examinations, and clinical
procedures, as well as in the
staff ’s handling of patients’
May include: being
medical records and other
examined without
partition, being asked personal information
private questions in the
presence of others, or Confidential care is a right of
delivery in public view each of our patients
“There was not enough space in the
labor room…and they don’t have the
facilities. There were only two rooms
and about 4 doctors…you could hear
them (doctors) talking to other
women.”
Section 4

Impact of
disrespect
and abuse
The concept of “safe
motherhood” is usually
restricted to physical
safety, but safe
motherhood is more
than just the
prevention of death Disrespect and abuse during
facility-based childbirth have a
and disability negative impact on skilled birth care
utilization

It is respect for Fear of disrespect and abuse may

women’s basic human sometimes be a more powerful
deterrent to the use of skilled birth
rights care than geographic and financial
obstacles
Section 5

Discussion
❝ You just call
until you get Is this a problem that
tired and then
you finally you have seen or heard
deliver by about in maternity care
yourself and
die. I have facilities in your
even
witnessed it community or country?
myself ❞
❝ One nurse
told me: 'Lady,
can't you see What does Respectful
that you are in
the way? Go Maternity Care look like?
over there, you
aren't anything
What other factors
but an animal
and talking to
impact Respectful
you is like Maternity Care?
talking to an
animal❞
“When I got
the bill, the What do healthcare
doctor said to workers need to
me, 'Since
you have not provide Respectful
paid, we will
Maternity Care?
keep you
here.”
Questions?
Section 9

Post Test
01
Repairing a a. Non-consented care
perineal laceration b. Non-confidential care
without offering a c. Abandonment
mum any form of d. Physical abuse
anesthesia is an
example of which
of the following?
02
01
Telling a mum she a. Discrimination
must undergo a CS b. Non-consented care
c. Detention
without d. Non-confidential care
explaining why is
an example of
which of the
following?
03
01
Forcing a mum to a. Non-consented care
stay in a facility b. Discrimination
c. Detention
because she is d. Physical abuse
unable to pay her
bill is an example
of which of the
following?
04
01
Which of the a. Provider attitude
following is the b. Cost of birthing services
biggest predictor c. Cleanliness of facility
d. Facility reputation
of a women’s
choice to use
facility-based
childbirth
services?
05
01
Which of the a. Not explaining a procedure to a
woman in a language she
following understands is a form of disrespect
and abuse
statements is true b. We should consider respectful
regarding pregnancy and delivery care services
as a key solution to reducing
respectful maternal mortality
c. Respectful maternity care during
maternity care? labour & delivery is a basic human
right
d. All of the above are true
Additional Video Resources: