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Background: Reporting the voices of women giving birth in KSA in order to inform policy developments within the Saudi maternity healthcare system is important to understand what the women want from the service and how to improve it. Aim: to explore current birthing services in KSA from care consumers' perspectives by reporting women's birthing experiences and voices. Methods: Within the first 24 hours after giving birth in one of the three selected public hospitals, 169 women shared their birth experience through their responses to an open-ended question on a questionnaire or by contributing in one-to one conversation with the researcher. Findings: Thematically analysing 169 written responses and notes for conversation have produced two main categories which include themes and a number of sub-themes. The first and major category is "The relationship between women and care providers during birth" which is considered by most women the leading cause for better and satisfied birth experience if this relationship is characterised by support, respect, trust, and empowerment. The second category is "Hospital rules and policies and childbirth experience" especially if these policies restrict women's choices and are brought into action without full explanation to women about why these policies are active. Conclusion: Maternity care policy makers in Saudi Arabia have to consider women's voices in building and reviewing maternity policies and focus on empowering childbearing women and ensuring safe motherhood. http://www.me-jn.com/March2016/BirthSA.htm
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ORIGINAL CONTRIBUTION/CLINICAL INVESTIGATION
WhAT WOmEN hAVE TO SAy ABOUT GIVING BIRTh IN SAUdI ARABIA
Ibtesam Jahlan (1)
Virginia Plummer (2)
Meredith McIntyre (3)
Salma Moawed (4)
(1) Ibtesam Jahlan, PhD candidate, MCM RN RM,
Monash University/King Saud University
(2) Plummer, V., Associate Professor Nursing Research, RN PhD FACN FACHSM,
Monash University
(3) McIntyre, M., Director of Education, Coordinator Master of Clinical Midwifery,
PhD MEdSt B.AppSc RN RM, Monash University
(4) Moawed, S. Prof. Dr. Salma Moawed, Professor of Maternity & Gynaecological Nursing,
Ph. D., M.Sc.N., B.Sc.N., King Saud University
Correspondence:
Ibtesam Jahlan
Monash University/King Saud University
Telephone: +61 0421 448 127
Email: ibtesam.o.j@gmail.com
Abstract
Background: Reporting the voices of women giving
birth in KSA in order to inform policy developments
within the Saudi maternity healthcare system is
important to understand what the women want
from the service and how to improve it.
Aim: to explore current birthing services in KSA
from care consumers’ perspectives by reporting
women’s birthing experiences and voices.
Methods: Within the rst 24 hours after giving
birth in one of the three selected public hospitals,
169 women shared their birth experience through
their responses to an open-ended question on a
questionnaire or by contributing in one-to one
conversation with the researcher.
Findings: Thematically analysing 169 written
responses and notes for conversation have
produced two main categories which include
themes and a number of sub-themes. The rst
and major category is The relationship between
women and care providers during birth” which
is considered by most women the leading cause
for better and satised birth experience if this
relationship is characterised by support, respect,
trust, and empowerment. The second category
is Hospital rules and policies and childbirth
experience” especially if these policies restrict
women’s choices and are brought into action
without full explanation to women about why these
policies are active.
Conclusion: Maternity care policy makers in
Saudi Arabia have to consider women’s voices
in building and reviewing maternity policies and
focus on empowering childbearing women and
ensuring safe motherhood.
Key words: Childbirth, Maternity services in Saudi
Arabia
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1. Introduction and Literature Review
Maternity services in the Kingdom of Saudi Arabia (KSA)
have been classed by the World Health Organization
(WHO) as comparable with developing countries (1),
concurrently, health services in KSA are experiencing
rapid modernization, economic growth and diversity (2).
Maternity services are also being inuenced by these
changes. In order to inform policy developments within
the Saudi maternity healthcare system as part of the
modernisation process it is important to understand
what the women giving birth in KSA say about maternity
services.
Australia was one of the rst countries to conduct reviews
of maternity services inviting submissions from women
who have been consumers of those services. The review
sought women’s opinions, experience and degree of
satisfaction experienced with the model of maternity care
they received (3-7). Globally, scholars used women’s
birthing experience and their voices to reect on
maternity services. In Scotland, Sweden, Finland and the
USA, reviews for maternity services were undertaken by
exploring women’s and/or health care providers’ and policy
makers’ views about their experiences within the current
maternity care system (8-11). It was suggested that more
effort is required to improve the information provided to
women and the choices available for women regarding the
care they receive during pregnancy and birth (9). Trusting
the system was found to be a major issue for those women
who sought non medicalised care (10). Women reported
feeling dissatised with the care they received despite the
fact that they were deemed to have been provided quality
care, as measured by the low perinatal mortality rates.
Lack of choice and loss of personal autonomy in decision
making regarding the care they received was reported as
a major source of dissatisfaction (12, 13).
Maternity research in the Middle East region has been
focused on reporting a number of clinical outcomes such
as maternal and perinatal mortality and morbidity and
common birthing practices in line with the medicalization
of birth to reect on the quality of the maternity services
in these countries. A number of studies were conducted
in Jordan and were considered to be among the rst of
their kind in the Middle East reporting women’s childbirth
experience. These studies show women’s negative
childbirth experience using different quantitative and
qualitative methodologies (14, 15) (16). The lack of
inclusion of women’s personal experiences of maternity
services evidences a gap in the literature resulting in
limitation of maternity services review ndings for the
Middle East area.
The voices of Middle Eastern women until now have been
silent and unreported, excluded from policy decisions
related to quality of maternity care improvement. This
situation is at odds with maternity services reviews and
research ndings globally, that sought the views of women,
the key stakeholders of the service when it comes to the
quality and safety of maternity services (11, 12, 16, 17).
This study reports Saudi women’s experiences of the
maternity care they received, viewed through the lens of
safe motherhood to provide these women’s voices with
the opportunity to be heard and in doing so potentially
inuence maternity ser vice policy developments in KSA.
2. Methods
2.1 Research design
This study is part of a large mixed method study that
explored birthing services in KSA from two perspectives,
women and health care professionals. Data was collected
using the survey and interviews techniques to describe
birthing services in Saudi Arabia and how these are
viewed by women and maternity health care providers.
This paper addresses the ndings of the qualitative
section of the study related to the women, as consumers
of maternity care.
2.2 Study sites and participants
This study took place in three specialised maternity
hospitals located in three main cities in Saudi Arabia;
Jeddah, Riyadh, Ad Dammam. The number of births in
each hospital is approximately 6000 births/ year (18).
One of the three hospitals has achieved JCA international
accreditation, and offers additional services to those
offered by the other two hospitals and consequently
experiences a strong demand by mothers seeking to give
birth in this hospital. For example, the hospital that had
JCA accreditation provides breast feeding classes and
consultation through a breast feeding specialised clinic
which is run by breastfeeding specialist. The other two
hospitals provide routine maternity care. Ethical approval
to conduct the research was obtained from Monash
University Human Research Ethics Committee after the
approval was gained from the three individual participating
maternity hospitals in KSA.
2.3 Data collection
One hundred and thirty seven women shared their
experiences related to the maternity care they received, in
response to an open-ended question on a questionnaire.
The questionnaire results are reported elsewhere.
Apart from meeting your new baby, and knowing that your
baby had no serious health concerns, and apart from
the pain you had during labour and birth, what was the
best and the worse thing about your recent experience of
giving birth?’. The questionnaires were distributed to all
eligible women giving birth in one of the selected hospitals.
Participating women were aged over 18 years, able to
read and write Arabic language, had given birth within the
previous 24 hours and cleared for discharge from hospital
after giving birth to a single / multiple babies (Table 1). The
questionnaires were collected in a designated sealed box
at the reception desk in each ward. In addition, 32 of the
participating women joined the study through one-to-one
conversation about their last childbirth experience with
the researcher, which was initiated during the distribution
and collection of the questionnaires in the hospital wards.
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Table 1: Participants’ Demographics
Those women either were unable or did not wish to write
down their experiences, but wanted to participate in the
study. Those women enjoyed having the opportunity to
join the conversations to share their birth experiences
especially when these conversations took place in a post-
natal shared room. Within Saudi culture, women enjoy
speaking to other women of their birthing experiences as
part of an informal debrieng process providing opportunity
to express feelings and fears. This unplanned outcome of
this study (female conversations) enriched the qualitative
data ndings with the researcher notes that were written
immediately after each conversation.
2.4 Data Analysis
All women’s answers for open-ended question and
researcher notes for women’s quotes were recorded in
Arabic requiring the data to be translated into English.
Following translation thematic analysis was used to
discover patterns hidden within the texts (19). Thematic
analysis began with preparing the data by transcribing,
translating and organizing the documents. Then the data
was explored through reading and re-reading to a point
where the researcher felt totally integrated and familiar
with the participants` words. After that, the researcher
generated initial codes and searched for themes by
grouping the similar descriptions and expressions coded
until themes emerged. Next, the data analysis ndings
were validated by reviewing the themes with other research
and repeatedly reecting to ensure there was no missed
classication and that the identied themes were valid
representations of the participants` perceptions. The nal
steps were presenting the data analysis and producing
the ndings report, wherein the resulting themes were
identied and described using the participants` words and
comments (19, 20).
Rigor was maintained using the golden criteria of
trustworthiness for qualitative research outlined by
Guba and Lincoln (21), which has been applied widely
for ensuring the rigor in most qualitative studies. The
criteria, including credibility, dependability, conrmability
and transferability were attained through repor ting the
ndings by supporting each theme with women’s own
words and commentary reecting women’s voices clearly
through each theme. Moreover, sufcient description for
the sample, data collection and analysis is provided for
any possible transferability (22).
3. Results
Thematically analysing women’s written responses
provided through returned questionnaires and researcher’s
notes for woman-to-woman conversations resulted in a
variety of women’s comments that reect the approach
of maternity care delivered in each hospital. Two main
categories of comments evolved from the data collected
regarding what women believed was the best and the worse
things that happened to them during their experiences of
maternity care. A variety of themes and subthemes have
been reported within these two categories. The extracted
categories and themes represent women’s childbirth
experience in Saudi Arabia. The rst and major category
is “the relationship between woman and care providers”.
The second category is ‘hospital rules and policies and
the childbirth experience’. (Table 2)
3.1 The relationship between women and care
providers during childbirth
The relationship between women and care provider is
one of medical domination in Saudi Arabian maternity
services where women are expected to leave all important
decisions to the staff (nurses and doctors) as they are
perceived to know best. The rst common experience
reported by women relates to the maternity care providers’
support and attitude towards the women and their respect
and interactions with the women. This category has been
divided into seven themes.
3.1.1 To be respectful “treating me with respect and not
underestimating me as a human”:
A number of mothers reported appreciation of the staff
who treated them respectfully:
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Table 2
P23: “In the labour and delivery room the staff treated me
very well and with respect.
P134: “the best thing was treating me with respect and
humanity and not underestimating me as a human”.
Conversely, women who were treated with disrespect
during their birth experience expressed their unpleasant
feelings in their words.
P6: “The worse thing was ignoring me…and not respecting
my psychological condition during labour”.
P300: I felt the difference between the treatment of the
nurse who treats with more respect than the consultant
did.”
Similarly, a number of women described feeling
embarrassed by some staff actions that they considered
as disrespectful and humiliating:
P189: “the worse thing was that during suturing time after
birth, the situation was bad as the Dr.(F) and complete
medical team were in the room which embarrassed me.”
C31: “during pushing and delivering the baby’s head,
some blood splashed over the doctor. So, she got angry
and said “what brings me here?” what does she means
by that? Why she is working in this area if it cause her
disgust …..”
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3.1.2 Explain everything “I did not have any choice in
anything” “not enough information was given to me”:
A number of women expressed their satisfaction with the
information and explanation they received during their last
birthing experience. This was dominated by women who
gave birth via caesarean section because of its surgical
requirements and by those who had previous childbirth
experiences.
P51: “as it was a caesarean section I knew everything”.
P173: the best thing was knowing the labour and birth
stages”.
A group of women from the three hospitals expressed
their needs for adequate ante-natal education and during
birth explanations to understand what would be done to
them during labour and birth and why.
P267: “I did not know what was the injection given with
I.V? Also what was the injection given in my thigh?”
P12: “I did not have any choice in everything, the midwife
left me without dilatation [episiotomy] till the baby came
out without any assistance.”
Moreover, women sought for more information during
pregnancy to correct any misconceptions about labour
and birth and how to take care of themselves and their
babies after birth.
P273: when the labour pain started I had too much of
(ower water + saffron) which increased the pain with no
cervical dilatation occurring. I do not recommend taking
anything without a doctor’s prescription”
P193: “Not enough information given to me about my
stitches and how to take care of them.”
P80: “I refused to take a deep breath during pushing
because that will draw the baby water…
Some women needed more information about their
childbirth experience than others.
P80: “my daughter had the umbilical cord tied around her
neck and I think this is happened because they did not let
me push when I was ready to, is that true?”
Another group of mothers questioned the presence and
the role of some maternity care providers who attended
their labour and birth.
P11: “I am a human, and having student trainer during
my birth increased my fears. They should ask for my
permission on that.”
P309: “the worse thing was having a male doctor and
nurses in my birthing room while no need for that.”
A large number of women have not understood the
breastfeeding policies implemented across a number
of the hospitals included in this study. More antenatal
education is required to adequately prepare women for
the change. The main area that women required more
education before the birth was the mechanism of the
breastfeeding and the reasons why breastfeeding was
enforced immediately following the birth.
P100: I do not know how to breast feed my baby and
know how to latch my baby to my breast
C10: This woman’s son was in the nursery and she did not
know what to do with the milk accumulated in her breast.
3.1.3 To be good listener and trust women’s body “the
best was listening to my fears and calm me down”:
Being cared by someone who listened to women’s needs
was a signicant factor in a good birthing experience for
some participants:
P279: “the best was the doctor (F) and the nurse because
they were the only two who listened to my fears and
calmed me down during the birth”.
Women reported feelings of humiliation because no one
listened to them when they were in labour. For example
several women were very upset and described their
experiences:
C31: I was in pain and I almost kissed their hands to check
me up “sit down just sit they said. So I kept bothering
them until they examined me and they found that I was 8
cm dilated.”
Then, P80 supports that:
P80: “I felt ready to push, but the nurse stopped me from
pushing and called me a liar. Then someone came and
examined me and saw my baby’s head clear just sitting
there.”
Another woman described her experience of medical
errors as a consequence of staff not listening to her.
P105: The decision was to do caesarean section and
they start assessing my sensations by pinching me and
I told them that I felt that but the Dr.(M) said to me ‘you
are joking’ and I replied ‘it is not the time for jokes, I am in
the O.R and I am between life and death’. So they started
cutting the incision and I felt the scalpel and the stretching;
and off course I screamed very loudly. Then they said
ne, ne and they gave me complete anaesthesia”.
3.1.4 To provide safe care “I felt safe because I was in
caring hands”
Despite the fact that mothers believed that feeling safe
during labour and birth required a good relationship
with the staff and being informed of the progress, many
women did not have that experience. These women felt
unsafe which lead them to not have a pleasant childbirth
experience.
P171: “the best thing was I gave birth in this hospital which
has better care and safety for patients and informing
patients about their rights”.
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C31: “They documented my blood type as positive while I
am negative, so when I asked for the injection they told me
I do not need it. So, I told them I had an abortion before in
this hospital and I had the injection. Finally, they did blood
test for me. To be honest, I am very scared about my baby
because of the wrong information they have so they may
give my baby the wrong treatment
Feeling safe for many women was associated with
receiving kindness from their caregiver:
P204:the best thing occurred to me during my last bir th
was the treatment of the health team with humanity. I felt
safe in their hands”.
P219: “I felt safe because I was in caring hands. This was
my best birth”.
3.1.5 Caring and helpful staff “they treated me as a
princess”
Participating women repor ted their pleasant childbirth
experience when in the care of helpful, caring staff, and
described how this improved their psychological status
and assisted in their ability to cope with the difculties of
their births:
P120: “the best thing was the help of the staff during
labour and birth.”
P134: “The midwife who took care of me was better than
the doctor (F) who I met. Those midwives knew everything
about my condition better than the doctor herself and they
treated it very well, my regards to them.”
Alternatively, one woman who reported receiving good
care also expressed her feelings when encountering
uncaring staff.
3.1.6 I needed support and cooperation “support during
labour to relieve psychological stress”
Being cared by supportive cooperative staff was a primary
factor in the mothers’ assessment of a better birthing
experience:
P298: the best thing was the medical team continuous
support till the birth complete”
P281:the medical staff team in the birthing room were
very cooperative and understanding”.
Many women reported looking for support and cooperation
from staff and not nding it:
P196: “I waited for 2-3 hours in the waiting area until I
could not tolerate the pain anymore and I was deteriorating
physically and psychologically.
P279: “After all this I have been left in the birthing room
till 4 pm without food or pain killer and with complete
ignorance to all my calls and no kindness”.
Experiencing pain is the rst characteristic for any birth
experience; a number of women reported their needs for
staff support and cooperation in order to gain control over
pain.
P49: “one of the worse things was the labour pain it
was very intense, but it was treated very well and I was
satised”
P45: “the worse thing was the pain and contraction without
analgesics.”
P12: “….I did not have any pain relief or oxygen [nitrous
oxide]”.
Having an induction was not a pleasant experience for
some women and they took the time to express their
feelings about it.
P121: “the worse thing was being induced in my rst
birthing experience but then everything went good with
staff help.”
Having vaginal examination and episiotomy or stitches
are considered by most Saudi women as a sensitive
uncomfortable procedure and one that increases women’s
fears and anxiety.
P305: “they agonize us with vaginal examination.”
P146: “My birth was soft, easy because I did not have any
operation or episiotomy”.
3.1.7 To provide the care with a positive attitude “The staff
treated us very badly, they have bad attitude”:
Many mothers described what they considered to be bad
birth experiences:
P195: “the worse things were the nervousness of the
nurses and doctor (F)”.
P116: “the worse thing was the treatment by the midwife
or nurse. It was bad to the extent that she told me if you
have any problem go out of the hospital”.
C18: “the staff are treating us very badly, they have a bad
attitude”
The experience of being treated badly during labour and
birth affected women’s ability to cope. Some women were
unable to overcome this experience:
C28: a woman said after a quiet period “the doctor treated
me badly and kept saying “come on come on open your
legs stop (Dalaa) [this word means acting like a kid or
speaking softly]”.
P273: “Everyone I met treated me with respect except the
vaccination nurse, she had a very bad manner and had
religious racism and no kindness”.
Several women who experienced staff with bad attitude
reported that this situation prevented them from speaking
out for themselves and their babies.
P89: “after she took the baby from me she threw him on
cot, he was hurt and cried and I could not say anything
because I was tired”.
C12:this woman was very upset because the nurse
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forced her to breastfeed her twin. “I was scared and cried
as the nurse pinched and hit my thigh in a funny way to
make me breastfeed but I did not like the way the nurse
treated me”.
3.2 Hospital rules and policies and childbirth
experience:
Childbirth experiences in Saudi Arabia are inuenced by
what is offered and allowed in the hospital in which the
woman chooses to give birth. For example, having the
husband or family member attending the birth is not a
choice offered to women in some hospitals in Saudi Arabia.
On the other hand, establishing a new policy such as
BFI (Breastfeeding initiation) required better explanation
to women in order to prevent any misunderstanding or
misinterpretation.
3.2.1 Family Company I thank everyone who assists in
spreading this culture”:
For some women having their husband or a family
member during labour and birth was an essential element
to improving their birthing experience.
P11: “the worse thing was not allowing someone to stay
with the patient [woman] although this is the time when
they are desperate to have someone with them”.
P84: “allow husbands of women to attend the labour, and
this should be optional”.
P161: “:the best thing happened during my birth experience
and I thank everyone who assists in spreading this concept
which is allowing my husband to be with me in birthing
room, because him being beside me helped me a lot and
made my birth easier.”
C24: “They did not allow my mother until the doctor came
and allowed her
3.2.2 Breast feeding initiative BFI policy “the worse thing
was leaving the baby with the mother all the time”
Participating women were not happy with the ‘rooming in’
policy introduced by the hospital to support and encourage
breastfeeding (BFI). Women expressed their needs for
family company during their hospital stay to help them to
take care of the baby.
P49: “I was not expecting to care of my daughter because
I was in a very bad condition, I was not able to control
myself how can I provide care to my daughter”.
P214: “the worse thing was leaving the baby with the
mother all the time, and not helping the mother changing
the baby, because the mother needs someone to help”.
C26: a primi (caesarean section) woman was so confused
and very overwhelmed….She said “I am very depressed
from the pregnancy and birth, I need someone with me I
am primi and gave birth caesarean section”.
On the other side, women were unaware that this policy
has been done for a purpose and interpreted this as
neglect on the nurses’ behalf. This issue caused an
inconvenience for the women and affected their birthing
experiences.
C30: the important thing is their limited care to the
baby”.
P309: “…Also they did not care of the baby after birth but
leaving that to the mother while she is tired
P12:…Nurses refuse to provide mums with milk for
babies although they knew there is no milk still in their
breasts.”
P38: “Looking for the nursery for healthy baby to take
them from mothers after birth, so she can rest for at least
three hours”.
4. Discussion
Women were willing to share their birth experiences and
were not hesitant to make the most of this opportunity to
reect on what could be changed to improve experiences
for other women. The relationship between women and
maternity care providers was reported as the dominant
factor that inuences Saudi mothers’ satisfaction with
the maternity care they received. The most empowering
experience for these women was to be cared for by staff
with a positive attitude, someone who provided continuous
support, who showed respect for the person and who
could be trusted to ensure their safety. This nding has
been supported by a number of studies which reported
that positive, trusting and cooperative relationships
between women and maternity care providers were the
greatest inuence in women feeling empowered when
giving birth (23). The pain associated with labour and
birth can be very difcult experiences for women who are
feeling vulnerable and unsafe. Women’s ability to manage
pain during labour is negatively inuenced when feeling
unsupported and unsafe (24, 25).
Women reported feeling dissatised with their birth
experiences as a result of lacking trust in the maternity
care providers who did not give them the respect they
deserved. Respect was not shown when staff did not
provide them with necessary information on their care and
the reasons this care was required, and or not listening to
their needs or ignoring their distress. This is evidenced
when some participating women took the opportunity
to ask the researcher questions about their birth or the
condition of their baby. Educating women regarding what to
expect during pregnancy, labour, birth and breast feeding,
and explaining the role of each member of the maternity
care team is a crucial element in the development of a
respectful trusting relationship which in turn leads to safe
maternity care. The need to be able to trust maternity care
providers is closely linked with the degree of respect that
was shown to women by the staff (25-28).
Having family members to provide support during labour
and birth and post-natally is one of the choices available
for women in most maternity settings within developed
countries. The attendance of family during labour and
birth choice was incorporated into hospitals’ policies
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because of its strong relationship with the women
feeling empowered, in control of their birth and being
more satised with their birth experience. This positive
relationship was evidenced by a number of studies
conducted worldwide (25, 27, 29). For Saudi women, it
was a different stor y as they reported their dissatisfaction
and loss of control as a result of not having the choice to
have a family member attending their labour and birth.
Only 22% of public hospitals in Jeddah one of the biggest
cities in KSA allow a companion to attend labour and
birth (2). Nevertheless, participating women highlighted
their needs for family support through labour and birth as
this would help them feel safe, satised and in control.
Consequently, women must have the choice to have a
family member throughout their labour and birth. To do so
maternity policies in KSA required some modication and
updating according to women’s preferences and latest
evidence regarding having family company during labour
and birth.
Moreover, women misunderstood the application of
the BFI ten steps policy as recommended by WHO
within public Saudi hospitals (30). They interpreted the
implementation of the policy as maternity caregiver
neglect and carelessness, which was accentuated in
women’s words describing their experiences. Having
their babies with them 24 hours and the fact that there
is no bottle feeding provided to babies are the reasons
causing women’s misinterpretation and dissatisfaction
with birthing experiences. Changing this policy is not the
answer. However, women need to be informed about this
policy early during pregnancy, and they must be educated
why and how the application of this policy is important
(30). This information can be delivered to pregnant
women during antenatal education sessions, which will
prepare them to accept the care delivered to them later
and protect the staff from being misinterpreted.
This study is the rst to explore women’s birthing
experiences in public hospitals in Saudi Arabia. Women
have highlighted their needs for better, more satisfying
birthing experiences. The overarching need for all women
is to be cared for by supportive cooperative positive
maternity care providers who deliver safe birth care. In
addition to the staff support, women were looking for family
support throughout labour and birth as this is not currently
an option for them in most public hospitals in Saudi Arabia
while it was one of the major women’s claims. Furthermore,
women showed their demand for more information about
labour and bir th, that could be fullled with frequent
accessible affordable antenatal educational classes.
This demand also requires continuous explanation and
consultation from the staff during labour and birth. This
research sets off the base for further research reporting
Saudi women’s perspectives, voices and experiences
regarding maternity care they receive.
The limitation of this study is that the sample excludes
women who do not read or write Arabic. Also, while this
study was conducted within three large public maternity
hospitals that have high birth rate, this is limiting the
representativeness of the sample of the study.
Conclusion
Maternity care policy makers and maternity care
providers in Saudi Arabia have to consider empowering
childbearing women and ensuring safe motherhood. This
can be accomplished by reviewing and updating maternity
policies with women’s preferences and latest up to date
research evidence. This study provides ndings that
focus on empowering women throughout labour and birth
with the staff and family support, adequate education
and explanation, and availability of choices. The main
updates that this study could add are introducing ante-
natal educational classes during pregnancy, explaining
and consulting women about everything.
Acknowledgements and Disclosures
The authors wish to acknowledge and thank every woman
who spent her time writing or conversing with researcher
and sharing her birthing experience.
References
1. Nigenda G, Langer A, Kuchaisit C, Romero M, Rojas
G, Al-Osimy M, et al. Womens’ opinions on antenatal
care in developing countries: results of a study in Cuba,
Thailand, Saudi Arabia and Argentina. BMC Public Health.
2003;3:17.
2. Altaweli RF, McCourt C, Baron M. Childbirth care
practices in public sector facilities in Jeddah, Saudi Arabia:
A descriptive study. Midwifery. 2014;30(7):899-909.
3. Anonymous. QLD:Maternity services review. Australian
Nursing Journal. 2004;12(3):8.
4. Bruinsma F, Brown S, Darcy M-A. Having a baby in
Victoria 1989-2000: women’s views of public and private
models of care. Australian and New Zealand Journal of
Public Health. 2003;27(1):20-6.
5. Brown S, Lumley J. Satisfaction with care in labor
and birth: A survey of 790 Australian women. Birth.
1994;21(1).
6. Bhattacharya S, Tucker J. Maternal Health Services.
International Encyclopedia of Public Health. 2008:210-
21.
7. Newnham E. Midwifery directions: the Australian
Maternity services Review. Health Sociology Review.
2010;19(2):245-59.
8. Hundley V, Penney G, Fitzmaurice A, van Teijlingen E,
Graham W. A comparison of data obtained from service
providers and service users to assess the quality of
maternity care. Midwifery. 2002;18(2):126-35.
9. Hundley V, Rennie AM, Fitzmaurice A, Graham W, van
Teijlingen E, Penney G. A national survey of women’s
views of their maternity care in Scotland. Midwifery.
2000;16(4):303-13.
10. Mander R, Melender H-L. Choice in maternity: rhetoric,
reality and resistance. Midwifery. 2009;25(6):637-48.
ORIGINAL CONTRIBUTION/CLINICAL INVESTIGATION
MIDDLE EAST JOURNAL OF NURSING December2009/ January2010
18
MIDDLE EAST JOURNA L OF NURSING VOLUME 10 ISSU E 1 MARCH 2016
11. Ny P, Plantin L, Karlsson ED, Dykes A. Middle
Eastern mothers in Sweden, their experiences of the
maternal health service and their partner’s involvement.
Reproductive Health. 2007;4(9).
12. Hildingsson I, Thomas JE. Women’s perspectives
on maternity services in Sweden: processes, problems,
and solutions. Journal of Midwifery & Women’s Health.
2007;52(2):126-33.
13. Miller AC, Shriver TE. Women’s childbirth
preferences and practices in the United States. Social
Science & Medicine. 2012;75(4):709-16.
14. Oweis A. Jordanian mother’s report of their
childbirth experience: Findings from a questionnaire
survey. International Journal of Nursing Practice.
2009;15(6):525-33.
15. Mohammad KI, Ala KK, Mohammad AI, Gamble
J, Creedy D. Jordanian women’s dissatisfaction
with childbirth care. International Nursing Review.
2014;61(2):278-84.
16. Hatamleh R, Shaban IA, Homer C. Evaluating
the Experience of Jordanian Women With Maternity
Care Services. Health Care for Women International.
2012;34(6):499-512.
17. Guest M, Stamp G. South Australian rural women’s
views of their pregnancy, birthing and postnatal care.
Rural Remote Health. 2009;9(3):1101.
18. Ministry of Health. Health statistics year book 1432/
2011. In: statistics Gao, editor. 2012.
19. Creswell JW, Plano Clark VL. Designing and
Conducting Mixed Methods Research. Thousand Oaks:
Sage Publication; 2007.
20. Braun V, Clarke V. Using thematic analysis in
Psychology. Qualitative Research in Psychology.
2006;3:77-101.
21. Guba E, Lincoln Y. Fourth generation evaluation.
London: Sage; 1989.
22. Prion S, Adamson K A. Making Sense of Methods
and Measurement: Rigor in Qualitative Research.
Clinical Simulation in Nursing. 2014;10(2):e107-e8.
23. Goodman P, Mackey M, Tavakoli A. Factors related
to childbirth satisfaction. Journal of Advanced Nursing.
2004;46(2):212-9.
24. Hodnett ED. Pain and women’s satisfaction with the
experience of childbirth: a systematic review. American
Journal of Obstetrics and Gynecology. 2002;186(5).
25. Fleming SEMNRNPCNS, Smart DD, Eide PP. Grand
Multiparous Women’s Perceptions of Birthing, Nursing
Care, and Childbirth Technology. Journal of Perinatal
Education Spring. 2011;20(2):108-17.
26. Goberna-Tricas J, Banus-Gimenez MR, Palacio-
Tauste A. Satisfaction with pregnancy and birth services:
the quality of maternity care services as experienced by
women. Midwifery. 2011;27:e231-e7.
27. Corbett CAAMSNFNPc, Callister LCPRNF. Giving
Birth: The Voices of Women in Tamil Nadu, India. MCN,
American Journal of Maternal Child Nursing September/
October. 2012;37(5):298-305.
28. Meyer S. Control in childbirth: a concept analysis
and synthesis Journal of Advanced Nursing.
2012;69(1):218-28.
29. Khresheh RRN, Barclay L. The lived experience of
Jordanian women who recieved family support during
labor. The American Journal of Maternal/Child Nursing.
2010;35(1):47-51.
30. Division of child health and development. Evidence
for the ten steps to successful breastfeeding: World
Health Organization; 1998.
ORIGINAL CONTRIBUTION/CLINICAL INVESTIGATION
... One Saudi woman reported "they started cutting the incision and I felt the scalpel and the stretching; of course, I screamed very loudly. Finally, they said fine and gave me complete anesthesia" (48). Another study from Iran indicated women being induced artificially without the provision of adequate pain relief (40). ...
... A study on verbal and non-verbal abuses in public urban facilities in Iraq found that almost half of participants were dissatisfied with the provider's assessments, explanations of diagnosis, and untailored treatments (52). Women in Saudi Arabia expressed their providers did not provide information before injections or stitches nor explain aftercare (48). Others were not offered options or alternatives in childbirth, such as in Lebanon where women felt they were robbed of the opportunity to make informed-choices about their c-sections (26,53). ...
... Women reported sharing their labor room with other birthing women and receiving frequent unwanted visits from an overload of unknown staff (27,34,56). Across all incomecontexts (i.e., Sudan, Jordan, and Saudi Arabia), women's privacy was interfered with by a large number of students (31,48,57). ...
Article
Full-text available
Background Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region. Aim This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC. Methods A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR. Findings and Discussion This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV. Conclusion In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
... Overwhelmingly, women in Jordan and other Middle Eastern countries experience birth as dehumanising and disrespectful [1][2][3][4]. Studies report that there is little rapport between women and health professionals, that women lack information about the facilities they will birth in or the procedures that will be used, and women do not always give their consent for procedures [2,3,5,6]. ...
... Typically, women labour in bed, alone with no access to a support person [2,5] or privacy [3,7], and receive limited support from health professionals [6]. This phenomenon of mistreatment by health professionals is not isolated to the Arab world [8][9][10] and has garnered the attention of the World Health Organization (WHO) and Safer Motherhood [11]. ...
... Health professionals in Jordan blamed women for the way they treated them during labour and birth and described them as uninformed and uncooperative [1]. This impacts on women and as reported in the introduction studies of birth in Jordan and other Middle Eastern countries consistently show how distressed women are at the dehumanised care they experience [2,3,5], ...
Preprint
Full-text available
Background: Overwhelmingly, women in Middle Eastern countries experience birth as dehumanising and disrespectful. Aim: To examine Jordanian women’s experiences and constructions of labour and birth in different settings (home, public and private hospitals in Jordan, and Australian public hospitals), over time and across generations. Method: A qualitative interpretive design was used. Data were collected by face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan (12 had given birth in the last five years and eight had birthed over 15 years ago) while seven were living in Australia (with birthing experience in both Jordan and Australia). Interview data were transcribed verbatim and analysed thematically. Results: Women’s birth experiences differed across settings and generations and were represented in the four themes: ‘Home birth: a place of comfort’; ‘Public Hospital: it’s what you do’; ‘Private Hospital: buying control’ and ‘Australian maternity care: a mixed experience’. In each theme, the concepts: Pain, Privacy, the Personal and to a lesser extent, Purity (cleanliness), were present but experienced in different ways depending on the setting (home, public or private hospital) and the country. Conclusions: The findings demonstrate how meanings attributed to labour and birth, particularly the experience of pain, are produced and reproduced in different settings, providing insights not only into the medical and institutional management of birth, but also the social context influencing decision-making around birth in Jordan and other Middle Eastern countries. In the public hospital environment in Jordan, women were treated in a dehumanised way with no privacy, no support for people and no access to the pain relief they wanted. This was in stark contrast to women birthing at home only one generation before. Change is urgently needed to offer humanised birth in the Jordanian maternity system
... Among the rapid social and cultural changes throughout the Middle East, including Saudi Arabia, is that young women in particular are increasingly concerned with beauty, body image, and vegetarian diets to support good health, putting them at increased risk of having vitamin B12 insufficiency [27]. Research has revealed that at the time of the birth of their first child, approximately 80% of Saudi women have an average age of 20-25 years [28] and around 50% have a college education degree [28,29]. ...
... Research has revealed that 80% of Saudi women have an average age of 20-25 years at the time of the birth of their first child [28]. Past research data also revealed that about half of Saudi women have a college education degree at the time of the birth of their first child [28,29]. The current study participants were females from 19 to 30 years old. ...
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Full-text available
Abstract: Vitamin B12 insufficiency is a global health issue among women of childbearing age, yet few studies have investigated its prevalence and risk factors among healthy Middle Eastern populations. This cross-sectional study included 346 Saudi women aged 19–30 years and enrolled at King Saud University, Riyadh, Saudi Arabia. A series of questionnaires were administered to record the study participants’ sociodemographic status, medical history, dietary intake, and physical activity. Participants’ anthropometric data were also recorded and their fasting blood samples were analyzed. The rate of vitamin B12 insufficiency (≤220 pmol/L) was approximately 6% among the study participants. After adjusting for confounding factors, it was observed that the risk factors for vitamin B12 insufficiency included daily sitting time ≥ 7 h, low income (<10,000 Saudi riyal) and increasing age. The recommended dietary allowance of vitamin B12 (>2.4 mcg/day) has been shown to confer reasonable protection against vitamin B12 insufficiency. These study findings highlight that a combination of increased physical activity and dietary vitamin B12 intake above the current recommended dietary allowance may help improve the serum vitamin B12 levels of young women of childbearing age, especially those with a low socioeconomic status. Timely detection and protection against vitamin B12 insufficiency in this subpopulation are important to prevent maternal and fetal health risks.
... Overwhelmingly, women in Jordan and other Middle Eastern countries experience birth as dehumanising and disrespectful [1][2][3][4]. Studies report that there is little rapport between women and health professionals, that women lack information about the facilities where they will birth or the procedures that will be used, and women do not always give their consent for procedures [2,3,5,6]. Typically, women labour in bed, alone with no access to a support person [2,5] or privacy [3,7], and receive limited support, or even abuse from health professionals [6]. ...
... Studies report that there is little rapport between women and health professionals, that women lack information about the facilities where they will birth or the procedures that will be used, and women do not always give their consent for procedures [2,3,5,6]. Typically, women labour in bed, alone with no access to a support person [2,5] or privacy [3,7], and receive limited support, or even abuse from health professionals [6]. ...
Article
Full-text available
Background: Overwhelmingly, women in Middle Eastern countries experience birth as dehumanising and disrespectful. Women's stories can be a very powerful way of informing health services about the impact of the care they receive and can promote practice change. The aim of this study is to examine Jordanian women's experiences and constructions of labour and birth in different settings (home, public and private hospitals in Jordan, and Australian public hospitals), over time and across generations. Method: A qualitative interpretive design was used. Data were collected by face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan (12 had given birth in the last five years and eight had birthed over 15 years ago) while seven were living in Australia (with birthing experience in both Jordan and Australia). Interview data were transcribed verbatim and analysed thematically. Results: Women's birth experiences differed across settings and generations and were represented in the four themes: 'Birth at home: a place of comfort and control'; 'Public Hospital: you should not have to suffer'; 'Private Hospital: buying control' and 'Australian maternity care: a mixed experience'. In each theme, the concepts: Pain, Privacy, the Personal and to a lesser extent, Purity (cleanliness), were present but experienced in different ways depending on the setting (home, public or private hospital) and the country. Conclusions: The findings demonstrate how meanings attributed to labour and birth, particularly the experience of pain, are produced in different settings, providing insights into the institutional management and social context of birth in Jordan and other Middle Eastern countries. In the public hospital environment in Jordan, women had no support and were treated disrespectfully. This was in stark contrast to women birthing at home only one generation before. Change is urgently needed to offer humanised birth in the Jordanian maternity system.
... Most of these studies were conducted in maternity wards. [35][36][37] Based on WHO, some of unacceptable maltreatments that pregnant women are subjected to, include verbal and physical abuses, disrespecting, breaching privacy, discrimination, stigma, negligence and abandonment. [38] Nevertheless, there is a study that was performed in Ankara, Turkey on 153 nursing students which aimed to explore the ethical issues that students observed during their clinical practice. ...
Article
Aims: The aim of this study was to evaluate the impact of domestic violence on depression among females' students of Imam Abdulrahman bin Faisal University in the Kingdom of Saudi Arabia. Settings and design: A cross-sectional study conducted from 2019 to 2020. Methods and material: An electronic questionnaire containing biographical data, 2 nd edition of Beck Depression Inventory (BDI), and The NorVold Abuse Questionnaire (NorAQ) was sent to the participants. Statistical analysis used: Data were analyzed using SPSS version 24 with a statistical significance set at P < 0.05. Tests of significance measured using independent t test and Chi-square test. Results: The study included 214 female medical students and 11 interns aged 18 to 26 with a mean of 20.66 ± 1.725 years. Most women (92.4%) were single, and the highest responders (30.2%) were second-year students. Based on The NorVold Abuse Questionnaire (NorAQ), the prevalence of violence was 56.9%. The most common form of violence was emotional abuse (50.2%) and the highest combined types of abuse were emotional and physical abuse (14.7%). Based on BDI scale, the prevalence of depression amongst our sample was 32.9%; it was mild in 14.2%, moderate in 15.6% and severe in 3.1%. None of the types of abuse were significantly associated with depression. However, severe depression was highest amongst students/interns with history of emotional or sexual violence. Conclusion: More than half of the participants were subjected to domestic abuse throughout their lives. Emotional abuse was the commonest type followed by physical, sexual, and healthcare abuses, respectively. However, the present study demonstrated no significant association between abuse and depression.
... Considering the complex trajectory of maternity care and the various aspects of women's experiences of their care that are evaluated, this absence may be attributed to the inappropriateness of having a single optimum timing for data collection. Consequently, dependant on the aspect of care being evaluated data collection timings varied from antenatally, 22,30 prior to discharge postnatally, 35,44,54,58,60,64 up to 3 months post-partum, 24,41,76 between 3 months and one year postpartum 20,43 and up to two and a half years postpartum. 42,56,74 The implied meaning of the concept of 'women's experiences of their maternity care' within the retrieved literature is inconsistent. ...
Article
Background: Despite many countries employing the use of national and large scale regional surveys to explore women's experiences of their maternity care, with the results informing national maternity policy and practice, the concept itself is ambiguous and ill-defined having not been subject of a structured concept development endeavour. Aim: The aim of this review is to report on an in-depth analysis conducted on the concept of 'women's experiences of their maternity care'. Methods: Using the principle-based method of concept analysis by Penrod and Hupcey (2005), the concept of 'women's experiences of their maternity care' was analysed under the epistemological, pragmatic, linguistic and logical principles. The final dataset included 87 items of literature published between 1990 and 2017 retrieved from a systematic search of the MEDLINE, CINAHL, EMBASE and PSYCinfo databases. Findings: The epistemological principle identified that a theoretical definition of the concept is elusive with a variety of implicit meanings. The pragmatic principle supports the utility of the concept in scientific literature, however the lack of a theoretical definition has led to inconsistent use of the concept, as highlighted by the linguistic principle. Furthermore, the logical principle highlighted that as the concept lacks definition blurring is identifiable when theoretically positioned with related concepts. Conclusion: The outcome of this concept analysis is a theoretical definition of a previously undefined concept. This definition highlights the subjective nature of the concept, its dependency upon a woman's individual needs, expectations and circumstances and the influence of the organisation and delivery of maternity care.
... Antenatal care is delivered mainly by physicians with no clear policy reinforcing continuity of care ( MOH, 2012 ). Partners and children are not encouraged to attend appointments of the birth ( Jahlan et al., 2016 ). ...
Article
Objective: Effective antenatal care is important for the health and wellbeing of pregnant women and infants. However, in Saudi Arabia, attendance rates are low, increasing the risk of negative birth outcomes. The aim of this research is to understand the beliefs of pregnant women and health professionals about the factors leading to these low attendance rates. Methodology: A qualitative exploratory study-using semi structured face-to-face interviews. Interviews were conducted exploring (a) attitudes to the use of antenatal care by pregnant Saudi women, (b) beliefs of women regarding the value of antenatal care and (c) perceived barriers to attendance. Setting: Data were collected from three hospitals in two regions of Saudi Arabia. Participants: Women at any stage of their pregnancy attending for antenatal care or ultrasound, women attending postnatal clinic, and health professionals (obstetricians) who support women during pregnancy and birth. Findings: Although mothers viewed antenatal care as important for maternal and infant health, several barriers to attending care were identified by mothers and professionals. These factors were classified into three themes: physical barriers (e.g., lack of transport), low maternal education, and inadequate healthcare facilities (including negative staff attitudes and poor communication). These factors were exacerbated by the beliefs of partners and family. Notably, the theme of low maternal education was raised only by health professionals, whilst the theme of staff attitudes and communication was raised only by mothers. Key conclusions: Barriers to antenatal care exist at the personal, social, socioeconomic and health services level. Some health professionals may be unaware of the importance of their communication style. Interventions to improve attendance must be multifaceted rather than focussing on individual women alone. Implications for practice: Barriers for women attending antenatal healthcare must be addressed in order to increase attendance rates. Specific practice-based interventions may involve changing the time or location of services and exploring changes to staff communication with women.
... Antenatal care is delivered mainly by physicians with no clear policy reinforcing continuity of care ( MOH, 2012 ). Partners and children are not encouraged to attend appointments of the birth ( Jahlan et al., 2016 ). ...
Article
Background: Privacy is related to a person's sense of self and the need to be respected and it is a key factor that contributes to women's satisfaction with their birth experiences. Aim: To examine the meaning of privacy for Jordanian women during labour and birth. Method: A qualitative interpretive design was used. Data were collected through face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan while seven were living in Australia (with birthing experience in both Jordan and Australia). Thematic analysis was used to analyse the data. Results: The phrase 'there is no privacy' captured women's experience of birth in Jordanian public hospitals and in some private hospital settings. Women in public hospitals in Jordan had to share a room during their labour with no screening. This experience meant that they were, "lying there for everyone to see", "not even covered by a sheet" and with doctors and others coming in and out of their room. This experience contrasted with birth experienced in Australia. Conclusions: This study explicates the meaning of privacy to Jordanian women and demonstrates the impact of the lack of privacy during labour and birth. Seeking a birth in a private hospital in Jordan was one of the strategies that women used to gain privacy, although this was not always achieved. Some strategies were identified to facilitate privacy, such as being covered by a sheet; however, even simple practices are difficult to change in a patriarchal, medically dominated maternity system.
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Thematic analysis is a poorly demarcated, rarely acknowledged, yet widely used qualitative analytic method within psychology. In this paper, we argue that it offers an accessible and theoretically flexible approach to analysing qualitative data. We outline what thematic analysis is, locating it in relation to other qualitative analytic methods that search for themes or patterns, and in relation to different epistemological and ontological positions. We then provide clear guidelines to those wanting to start thematic analysis, or conduct it in a more deliberate and rigorous way, and consider potential pitfalls in conducting thematic analysis. Finally, we outline the disadvantages and advantages of thematic analysis. We conclude by advocating thematic analysis as a useful and flexible method for qualitative research in and beyond psychology.
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This article describes the objectives, scope, and organization of maternity services during the antenatal, intranatal, and postnatal periods in developing and developed countries. It also discusses the epidemiology and sociodemographic determinants of maternal mortality and morbidity and reviews some relevant issues such as utilization and financing of maternity services. Finally, it discusses some of the challenges of providing comprehensive maternity services and the implications for health policy.
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Background Dissatisfaction with childbirth care can have a negative impact on a woman's health and well-being, as well as her relationships with her infant.AimTo investigate the prevalence and associated factors of dissatisfaction with intrapartum care by Jordanian women.MethodA descriptive cross-sectional study was used. Participants (n = 320) who were 7 weeks post-partum were recruited from five maternal and child health centres in Irbid city in northern Jordan. Participants provided personal and obstetric information, and completed the Satisfaction with Childbirth Care Scale.ResultsThe majority of women (75.6%) were dissatisfied with their intrapartum care. Dissatisfaction was associated with the attendance of unknown and unwanted persons during childbirth, experiencing labour as more painful than expected, and perceptions of inadequate help from healthcare providers to manage pain during labour.LimitationsFindings are limited to Jordanian women accessing public sector perinatal health services.Conclusion The high percentage of women reporting dissatisfaction with intrapartum care in this study is of concern. Women's perception of pain and expectations of staff during labour and birth need to be addressed through education and improved communication by staff.Implications for Nursing and Health PolicyDevelopment of national evidence-based policies and quality assurance systems would help reduce the rate of obstetric interventions and give greater emphasis to respect for women's preferences during labour and birth.
Article
Objectives To explore reported hospital policies and practices during normal childbirth in maternity wards in Jeddah, Saudi Arabia, to assess and verify whether these practices are evidence-based. Design Quantitative design, in the form of a descriptive questionnaire, based on a tool extracted from the literature. Setting Nine government hospitals in Jeddah, Saudi Arabia. These hospitals have varied ownership, including Ministry of Health (MOH), military, teaching and other government hospitals. Participants Key individuals responsible for the day-to-day running of the maternity ward. Measurements Nine interviews using descriptive structured questionnaire were conducted. Data were analysed using SPSS for Windows (version 16.0). Findings The surveyed hospitals were found to be well equipped to deal with obstetric emergencies, and many follow evidence-based procedures. On average, the Caesarean section rate was found to be 22.4%, but with considerable variances between hospitals. Some unnecessary procedures that are known to be ineffective or harmful and that are not recommended for routine use, including pubic shaving, enemas, episiotomy, electronic foetal monitoring (EFM) and intravenous (IV) infusion, were found to be frequently practiced. Only 22% of the hospitals sampled reported allowing a companion to attend labour and delivery. Key Conclusions Many aspects of recommended EBP were used in the hospitals studied. However, the results of this study clearly indicate that there is wide variation between hospitals in Jeddah, Saudi Arabia in some obstetric practices. Furthermore, the findings suggest that some practices at these hospitals are not supported by evidence as being beneficial for mothers or babies and are positively discouraged under international guidelines. Implications for practice This study has specific implications for obstetricians, midwives and nurses working in maternity Units. It gives an overview of current hospital policies and practices during normal childbirth. It is likely to contribute to improving the health and well-being of women, and have implications for service provision. It could also help in the development of technical information for policy-makers, and health care professionals for normal childbirth care.
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Australian midwifery is at a crossroads, and the 2009 Maternity Services Review and subsequent Report by the Australian federal government have revealed significant issues that were previously obscured. This article outlines the current position of Australian midwifery by examining the recently published Commonwealth Report of the Maternity Services Review, as well as looking at some South Australian Department of Health birth-related policies. The Report recommends important and positive changes for midwifery, but with caveats that may lead to greater restrictions on midwifery practice. The policies, while endorsing possible alternatives for women, also illustrate how birth options are ‘problematised’. Relationships between government, medicine and midwifery are explored throughout the article, illuminating the tension for midwives between aligning with professional and scientific discourses, and those that are woman-centred. Free-standing birth-centres are presented as a possible way forward in order to ease the present dichotomy between ‘scientific’ and ‘experiential’ birthing care.
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Evaluation of women's experiences about the care they receive during childbirth is important to assess the quality of maternity services. We explored the experiences of Jordanian women to examine whether they were satisfied with their childbirth experiences. Semistructured interviews were conducted with 460 women after giving birth. A content analysis was conducted on the qualitative data. Four themes were identified that represented the women's poor experiences of care during childbirth, including seeing childbirth as a dehumanized experience, feeling that childbirth was processed technologically, a lack of human support, and being in an inappropriate childbirth environment. The findings of this study may help policymakers to provide quality care to women during childbirth.