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From “Culture of dehumanization of childbirth” to “Childbirth as a transformative experience”: Changes in 5 municipalities in Northeast Brazil

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Abstract

Brazil has become a country known as having one of the most extreme examples of the consequences of thospital-based medicalization of delivery care, while a model of humanization of birth was developed in the State of Ceara in the 1970s. The Government of Japan, through the Japanese International Cooperation Agency JICA.,collaborated with the Federal Ministry of Health of Brazil and the Government of the State of Ceara, inimplementing the Maternal and Child Health Improvement Project in north-east Brazil 1996�2001. This project focused on ‘humanization of childbirth’, with training based intervention activities. Behavioral changes among health professionals who received the project’s participatory type of training were described using rapid anthropologicalassessment procedure RAP. Results. Changes from ‘a culture of dehumanization of childbirth’ to ‘childbirth as a transformative experience’ were observed. � 2001 International Federation of Gynecology and Obstetrics. All rights reserved. Keywords: Childbirth; Humanization; Behavioral change; Rapid anthropological assessment
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... The ideal treatment expected from a maternity care provider to a woman during childbirth is of importance to the woman, her unborn offspring and the entire family [10]. Naturally, a relationship characterized by empathy, support, trust, confidence, and empowerment, as well as gentle, respectful and effective communication enabling informed decision making is expected. ...
... As a growing body of anecdotal and research evidence collected in maternity care systems worldwide paints a disturbing picture [10,11,12]. This is an urgent problem which creates a growing concern that spans the domains of health care research, quality, human rights and civil rights advocacy [8]. ...
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Introduction: Globally, “Respectful maternity care” is gaining much-deserved recognition and attention from experts working in the field of reproductive health. Disrespect and abuse have been common in maternal and child health care delivery, hence deterring women in seeking proper health services. Objectives: This article places emphasis on the understanding of the experience of respectful maternity care or disrespect and abuse during maternity care in the past amongst women currently receiving antenatal care in Bowen University Teaching Hospital, Ogbomoso, Southwest Nigeria. Methods: A cross-sectional study was carried out on 438 women receiving antenatal care in Bowen University Teaching Hospital to determine whether they had experienced disrespect and abuse during maternity care in the past or not. Results: The study showed that 93.2% (408) of the respondents had experienced one form of disrespect and abuse. Sociodemographic variables were a significant contributor to the knowledge and experience of respectful maternity care. Discussion: There is an important need to ensure a reorientation of healthcare workers and health education to the members of the community.
... In opposition to the use of technology and exorbitant medicalization, obstetric violence and invasive methods, the natural birth care process is often dehumanized. 21 Davis-Floyd affirms that, by humanizing a birth, one becomes compassionate, sensitive, individual, rational, the care model, being a humanist, taking into account biology, psychology and the social environment, as well as recognizing the influence of the mind over the body, since being so associated and communicated, it is impossible to treat something physical without considering the psychological approach, which makes the woman visualize as a person and not just another patient or a bed number, establishing a connection human with her. 22 In recent times there were traumatic experiences between intervened or medicalized childbirth and humanized childbirth, knowing three types of maternity in the country: one with high standards of medicalization, 23 another where humanized childbirth was practiced, and a third where both followed systems were combined. ...
Article
Bringing a new being into the world is a relevant and transcendent event in a woman's life, which will be marked for the rest of her life. However, it can be experienced as a painful and traumatic experience. Objective: Analyze the most effective actions to improve the quality of humanized delivery care in low-risk pregnant women in hospitals of 1st and 2nd level of care. Methodology: A narrative review was carried out that includes a critical, reflective analysis of humanized childbirth. The review of: original articles, revision of doctoral and master's theses was carried out. The adopted search strategy included keywords or descriptors, connected by means of the boolean operator and. The keywords used were "humanization", "delivery", "human needs", and breastfeeding, these being identified through Medical Subject Headings 2020 Serach MeSH, in this way the referred articles, descriptors in language were used for the search. Spanish and English. The search was carried out in various databases. Information collection time 6 months, (August 2022 to February 2023). Results: The review allowed us to analyze in a standardized way the historical evolution of humanized childbirth and the transcultural significance that it represents and to a large extent to be carried out, and how it will reinforce the multidisciplinary health team that cares for women in this process, to offer different strategies. to be this stage an unforgettable and humanistic experience that you will never forget. Conclusions: Humanized childbirth is translated into a birth with a humanistic character which includes: the prenatal stage, labor, delivery and the puerperium, where the protagonists are the pregnant woman and the newborn, receiving dignified, free treatment. of violence and based on human and ethical rights
... A similar pattern of disrespect and abuse has been reported in South Africa [4], Ghana [5], and the Dominican Republic [19]. Being denied companionship during labor or having to deliver alone unattended, as reported by some women in the present study, has been described as a great crime against humanity [3] [4] [7]. The mere presence of a close relative during labor can ensure compassionate and respectful care by birth attendants [3]. ...
Article
Objective: To determine the prevalence and pattern of disrespectful and abusive care during facility-based child- 17 birth in Enugu, southeastern Nigeria. Methods: A questionnaire-based, cross-sectional study was undertaken at 18 Enugu State University Teaching Hospital betweenMay 1 and August 31, 2012.Women accessing immunization 19 services for their newborns were eligible when they had delivered in the previous 6 weeks and had received 20 prenatal care and delivery services at the hospital. The main outcome was the proportion of women who had ex- 21 perienced disrespectful and abusive care during their last childbirth. Results: In total, 437 (98.0%) of 446 respon- 22 dents reported at least one form of disrespectful and abusive care during their last childbirth. Non-consented 23 services and physical abuse were the most common types of disrespectful and abusive care during facility-based 24 childbirth, affecting 243 (54.5%) and 159 (35.7%) respondents, respectively. Non-dignified care was reported by 25 132 (29.6%) women, abandonment/neglect during childbirth by 130 (29.1%), non-confidential care by 116 26 (26.0%), detention in the health facility by 98 (22.0%), and discrimination by 89 (20.0%). Conclusion: Disrespect 27 and abuse during childbirth are highly prevalent in Enugu. The findings indicate the size of the issue of disre- 28 spectful and abusive care during childbirth in low-income countries.
... Satisfaction is an important indicator of the quality of care during childbirth1234. For example, in Brazil, after healthcare managers improved delivery rooms, pregnant women were more satisfied and the number of deliveries at that health facility increased [5]. To provide better birth environments, healthcare managers and policy makers have tried to understand mothers' experiences678. ...
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Satisfaction is an important indicator of the quality of care during childbirth. Previous research found that a good environment at a health facility can increase the number of deliveries at that facility. In contrast, an unsatisfying childbirth experience could cause postpartum mental disorder. Therefore it is important to measure mothers' satisfaction with their childbirth experiences. We tested whether the eight-item Client Satisfaction Questionnaire (CSQ-8) provided useful information about satisfaction with childbirth-related care. The government of the Philippines promotes childbirth at health facilities, so we tested the CSQ-8 in the Philippine cities of Ormoc and Palo. This was a cross-sectional study. We targeted multigravid mothers whose last baby had been delivered at a hospital (without complications) and whose 2nd-to-last baby had been delivered at a hospital or at home (without complications). We developed versions of the CSQ-8 in Cebuano and Waray, which are two of the six major Filipino languages. Reliability tests and validation tests were done with data from 100 Cebuano-speaking mothers and 106 Waray-speaking mothers. Both the Cebuano and Waray versions of the CSQ-8 had high coefficients of internal-consistency reliability (greater than 0.80). Both versions were also unidimensional, which is generally consistent with the English CSQ-8 in a mental-health setting. As hypothesized, the scores for data regarding the second-to-last delivery were higher for mothers who had both their second-to-last and their last delivery in a hospital, than for mothers who had their second-to-last delivery at home and their last delivery in a hospital (Cebuano: p < 0.001, rho = 0.51, Waray: p < 0.001, rho = 0.55). Scores on the CSQ-8 can be used as indices of general satisfaction with childbirth-related services in clinical settings. This study also exemplifies a convenient method for developing versions of the CSQ-8 in more than one language. These versions of the CSQ-8 can now be used to assess mothers' satisfaction, so that mothers' opinions can be taken into account in efforts to improve childbirth-related services, which could increase the proportion of deliveries in medical facilities and thus reduce maternal mortality.
... Humanized birth means the woman is placed in the centre of decision making and providing her information regarding the process and what is happening during childbirth. Dehumanization of childbirth has been experienced and reported in several other countries as a key deterrent to utilization of skilled birth attendance with different manifestation of disrespect and abuse [18]. D&A is a global problem in many low and high income countries although not well documented. ...
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Background Increases in the proportion of facility-based deliveries have been marginal in many low-income countries in the African region. Preliminary clinical and anthropological evidence suggests that one major factor inhibiting pregnant women from delivering at facility is disrespectful and abusive treatment by health care providers in maternity units. Despite acknowledgement of this behavior by policy makers, program staff, civil society groups and community members, the problem appears to be widespread but prevalence is not well documented. Formative research will be undertaken to test the reliability and validity of a disrespect and abuse (D&A) construct and to then measure the prevalence of disrespect and abuse suffered by clinic clients and the general population. Methods/design A quasi-experimental design will be followed with surveys at twelve health facilities in four districts and one large maternity hospital in Nairobi and areas before and after the introduction of disrespect and abuse (D&A) interventions. The design is aimed to control for potential time dependent confounding on observed factors. Discussion This study seeks to conduct implementation research aimed at designing, testing, and evaluating an approach to significantly reduce disrespectful and abusive (D&A) care of women during labor and delivery in facilities. Specifically the proposed study aims to: (i) determine the manifestations, types and prevalence of D&A in childbirth (ii) develop and validate tools for assessing D&A (iii) identify and explore the potential drivers of D&A (iv) design, implement, monitor and evaluate the impact of one or more interventions to reduce D&A and (v) document and assess the dynamics of implementing interventions to reduce D&A and generate lessons for replication at scale.
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High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care. Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded. Of 967 titles and 412 abstracts screened, 125 full-text papers were reviewed and 81 included. Around two-thirds used qualitative methods and over half studied public-sector facilities. Most studies were in Africa (n = 55), followed by Asia and the Pacific (n = 17). Fifty-eight studies covered only negative attitudes or behaviours, with a minority describing positive provider behaviours, such as being caring, respectful, sympathetic and helpful. Negative attitudes and behaviours commonly entailed verbal abuse (n = 45), rudeness such as ignoring or ridiculing patients (n = 35), or neglect (n = 32). Studies also documented physical abuse towards women, absenteeism or unavailability of providers, corruption, lack of regard for privacy, poor communication, unwillingness to accommodate traditional practices, and authoritarian or frightening attitudes. These behaviours were influenced by provider workload, patients' attitudes and behaviours, provider beliefs and prejudices, and feelings of superiority among MHCPs. Overall, negative attitudes and behaviours undermined health care seeking and affected patient well-being. The review documented a broad range of negative MHCP attitudes and behaviours affecting patient well-being, satisfaction with care and care seeking. Reported negative patient interactions far outweigh positive ones. The nature of the factors which influence health worker attitudes and behaviours suggests that strengthening health systems, and workforce development, including in communication and counselling skills, are important. Greater attention is required to the attitudes and behaviours of MHCPs within efforts to improve maternal health, for the sake of both women and health care providers.
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This cross-sectional, household survey was conducted in four municipalities in the state of Ceará, Brazil to assess the utilization and satisfaction with maternal health care services among pregnant women. We identified a total of 207 women who had given birth within the first six months of 2000 (January-June). Study findings suggest that government efforts to further improve women’s health within the context of the Family Health Program (i.e. PSF) in Ceará should focus on three areas: 1) improvements in the quality of care provided to women during pregnancy, delivery and postpartum based on the WHO recommendations; 2) increase the percentage of women receiving postpartum care including health education interventions that address women’s beliefs and attitudes towards postpartum care; and 3) increase availability and accessibility of family planning services to all women, with especial attention to the needs of adolescents and teen pregnancy prevention. In addition, intervention programs to be successful need also to address gender inequality, target both young women and men and focus on raising women’s level of awareness in childbearing age so that they know their rights and responsibilities as young women to themselves and society.
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OBJECTIVE: To assess factors associated to cesarean section. METHODS: A cross-sectional study was conducted in a university hospital in Florianópolis, Southern Brazil, from 2001 to 2005. Socioeconomic, reproductive, obstetric and institutional information were collected. Data from 7,249 deliveries was obtained from medical records and admission, delivery and post-delivery records. Cox regression was used in the analysis to estimate cesarean prevalence ratios in the categories of variables studied. RESULTS: Cesarean rates increased from 27.5% to 36.5% during the period studied and they were higher than those associated with medical indications. After adjustment for confounders cesarean rates were positively associated with previous cesarean section (PR=2.65, 95% CI: 2.31;3.05), non-cephalic presentation (PR=2.23, 95%CI: 1.69;2.95), oxytocin use (PR=1.77, 95%CI: 1.43;2.19), dilatation at admission (PR=2.74, 95%CI: 2.18;3.44), and obstetrician profile (>35% of cesarean sections) (PR=1.82, 95%CI: 1.36;2.42). CONCLUSIONS: The factors associated with cesarean section indicate the need of interventions focusing on women and their reproductive experience and changes in obstetrician practice as well.
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OBJECTIVE: To evaluate the quality of birth care based on the World Health Organization guidelines. METHODS: A case-control study was carried out in a public and a private maternity hospitals contracted by the Brazilian Health System in the city of Rio de Janeiro, Brazil, from October 1998 to March 1999. The sample comprised 461 women in the public maternity hospital (230 vaginal deliveries and 231 Cesarean sections) and 448 women in the private one (224 vaginal deliveries and 224 Cesarean sections). Data was collected through interviews with puerperal women and review of medical records. A summarization score of quality of delivery care was constructed. RESULTS: There was low frequency of practices that should be encouraged, such as having an accompanying person (1% in the private hospital for both vaginal delivery and C-sections), freedom of movements throughout labor (9.6% of C-sections in the public hospital and 9.9% of vaginal deliveries in the private hospital) and breastfeeding in the delivery room (6.9% of C-sections in the public hospital and 8.0% of C-sections in the private hospital). There was a high frequency of known harmful practices such as enema administration (38.4%); routine pubic shaving; routine intravenous infusion (88.8%); routine use of oxytocin (64.4%), strict bed rest throughout labor (90.1%) and routine supine position in labor (98.7%) in vaginal deliveries. The best summarizing scores were seen in the public maternity hospital. CONCLUSIONS: The two maternity hospitals have a high frequency of interventions during birth care. In spite of providing care to higher risk pregnant women, the public maternity hospital has a less interventionist profile than the private one. Procedures carried out on a routine basis should be pondered based on evidence of their benefits.
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