Background
Methods
Setting
Selection of participants
Women participants
Provider participants
Data collection
Demographic and childbirth history questionnaire
Interviews
Data analysis
Results
Sample description
Women
Socio-Demographic and Live Birth Characteristics | Sample N N(%) | Colca Canyon n(%) | Arequipa n(%) |
---|---|---|---|
Total Sample | 20 (100.0) | 10 (50.0) | 10 (50.0) |
Age | |||
18–29 years old | 11 (55.0) | 7 (70.0) | 4 (40.0) |
30–39 years old | 7 (35.0) | 3 (30.0) | 4 (40.0) |
40 and older | 2 (10.0) | 0 (0.0) | 2 (20.0) |
Educational Attainment | |||
Elementary School | 1 (5.0) | 1 (10.0) | 0 (0.0) |
Middle School | 2 (10.0) | 0 (0.0) | 2 (20.0) |
High School | 16 (80.0) | 9 (90.0) | 7 (70.0) |
University | 1 (5.0) | 0 (0.0) | 1 (10.0) |
Monthly Income (Soles) | |||
200–600 soles | 9 (45.0) | 6 (60.0) | 3 (30.0) |
601–1000 soles | 7 (35.0) | 4 (40.0) | 3 (30.0) |
1001–1700 soles | 3 (15.0) | 0 (0.0) | 3 (30.0) |
1701 soles or more | 1 (10.0) | 0 (0.0) | 1 (10.0) |
Occupation | |||
Housewife | 16 (80.0) | 6 (60.0) | 10 (100.0) |
Student | 1 (5.0) | 1 (10.0) | 0 (0.0) |
Other | 3 (15.0) | 3 (30.0) | 0 (0.0) |
Most Recent Birth | |||
< 1 year ago | 11 (55.0) | 3 (30.0) | 8 (80.0) |
> 1 year ago | 9 (45.0) | 7 (70.0) | 2 (20.0) |
Parity (total number of births)a | |||
1–2 births | 14 (70.0) | 7 (70) | 7 (70) |
3–4 births | 5 (25.0) | 3 (30) | 2 (20) |
5 or more | 1 (5.0) | 0 (0) | 1 (10) |
Distance to Nearest Birth Facility (minutes of travel) | |||
< 30 min | 14 (70.0) | 8 (80.0) | 6 (60.0) |
> 30 min | 6 (30.0) | 2 (20.0) | 4 (40.0) |
Parity by Facility Typea | |||
Total Sample | 44 (100.0) | 21 (100.0) | 23 (100.0) |
MINSA Clinics | 12 (27.0) | 8 (38.0) | 4 (17.0) |
Government Hospital | 29 (66.0) | 13 (62.0) | 16 (70.0) |
Private Hospital | 1 (2.0) | 0 (0.0) | 1 (4.0) |
Home | 2 (5.0) | 0 (0.0) | 2 (9.0) |
Providers
Themes
INTERVIEW THEMES | ||
---|---|---|
DOMAINS | Women | Providers |
Women’s current experiences during facility-based births | Patient advocacy & companionship | NAa |
Respectful maternity care | NAa | |
Provision of childbirth care | NAa | Facilitators that improved provision of care |
NAa | Barriers that interfered with provision of care | |
NAa | Justification of disrespectful care | |
Beliefs about childbirth among women and providers | Norms within childbirth care expected among mothers | Perceived difficulties with patients expected among providers |
Patient blame | NAa | |
Future health-seeking behavior | Plans for future safe childbirth | NAa |
Resilience of mothers | NAa |
Domain: Women’s current experiences during facility-based births
“Well, I have talked with many people that gave birth in clinics where they said they let their family members come in, they can receive visits, even where the father can be with the mother so that he can give emotional support. Not with government insurance [facilities]. To me that is very bad because when I was alone, my sister wanted to accompany me because I was scared. The first-time moms always have that feeling but they did not let her. They made her wait and made me wait somewhere else. There was no one to help me, so the worst part is that they take me away from my family member that I feel safe with and they complicate the situation.” –mother, Colca Canyon
“ … the treatment was not very good. Luckily, I had a family member that worked there [doctor] and tried to minimize that [negative treatment] because in reality, I am not going to lie, they treat everyone [badly]. And I do not like that. They see that we are pregnant, and they should be more careful during childbirth. Well, they helped me and then they would not treat me like that, but they were a bit more aggressive with the other patients.” –mother, Arequipa
“In the first [pregnancy]...they came and then would insert [their hand] and I would say it hurts and they would say deal with it, and they would insert [their hand] anyways. But in the second they would tell me, ‘I am only going to touch you only once, do not worry, you will continue to advance.” And they would try to motivate me, they would not touch me inappropriately a lot. But in the first one horrible, and every half hour, I think. –mother, Colca Canyon
“… I was upset because there were no doctors, because they would not tell me what happened to my baby and no one would tell me anything. They would just say he was in observation, but they would not even say ‘miss, if you want more information … ’ or my husband could have gone, I do not know. We [woman and husband] would ask, but only the interns would come, and they are different [from the doctors].” –mother, Arequipa
“… Since I was young–I was 17–there were some nurses that were surprised … they would not yell but it made them uncomfortable that I was too young. That is how it felt, that is how I felt. I felt, like uncomfortable also because of the way they looked at me. I do not know, they would tell me things … but then like I said I did not feel regret or anything, but uncomfortable.” –mother, Arequipa
“Over here [Colca Canyon] traditionally, after the birth, we do not touch any water. But in Arequipa they force you and they do not understand you. You have to bathe even with cesarean and everything … so in that part they are not understanding.” –mother, Colca Canyon
Domain: provision of childbirth care
“Many times, we have had patients tell us that the care we give them here [smaller urban MINSA clinic] is better than those who attend births in [national public] hospital. Here there is more trust, they have seen their providers many times. They even know them by name, while at the hospital they don’t know anyone, and the care has to be rushed. In that sense there have been a lot of patients that prefer being here and not a hospital. And well sometimes we have patients whose births get complicated and they absolutely refuse to go to a hospital.” –Midwife, Arequipa
“And I know them [patients] because I have lived here. It gives me that confidence, I feel comfortable going to them. Like when I am not working, I am just another person in the village. I go around, I go to the plaza and I talk to the women, I laugh a bit, and everything is nice.” –Midwife, Colca Canyon
“The truth is that the infrastructure is not adequate. I would like to have equipment here in the room that would allow me to give a more accurate diagnostic and that limits me. At my previous job we used ultrasound equipment and so I could determine any disease or risk factor with more certainty and address it directly. Instead, when I give that task to another provider … sometimes it does not coincide, and the margin of error is large and there could be a more serious complication.” –Physician, Arequipa
“… there are few midwives here and sometimes there are many births at the same time. So sometimes there is time [to attend and establish support] but other times there is not. That is a weakness because some of the patients sometimes feel alone. They do not feel that accompaniment by us [providers].” –Midwife, Arequipa
“They are not always happy, one here or there because we scold them and sometimes the explanation is not there, but it is because we get desperate that they are not pushing correctly or sometimes they drink their [traditional] teas … They do not push how they are supposed to, they do not listen. The women worry more about their pain and not their baby and I give them attitude because my older daughter is [disabled] because of problems with childbirth and cesarean … So with my prior experiences, I make sure that the baby does not suffer and comes out healthy.” –Midwife, Colca Canyon
Domain: beliefs about childbirth among women and providers
“It was the nurse’s job [to support], and yes she treated all of us poorly. I saw the others [women] that came in and we all felt like that.” –mother, Arequipa
“… we know they do not care about others pain; it is like they are rocks. They do not feel anything, and they are indifferent, that is what I felt.” –mother, Colca Canyon
“If we pay, we need the same attention as everyone else, not that they put us aside because we do not belong because it is a government insurance facility … Sometimes the women I gave birth with would say, ‘on the contrary [treatment] should be better because we are paying.” –mother, Colca Canyon
“I would ask [about the baby] and no one knew. [I would say,] ‘Miss, what is going on? They will not bring him.’ And they would just tell me that they would ask … And since I was still bad, I tried to go but halfway down the hall I could not walk anymore and so I had to go back because I did not even know how far [the baby] was. Another whole day passed, and I was able to walk and when I went to the neonatal area [the nurses yelled] ‘Miss, what happened? You are supposed to bring diapers for your child and come to feed him!’ But no one told me! I am not a psychic and I asked [providers about the status of the child]. It is not like I was just thrown on the bed.” –mother, Arequipa
“They told me I had to do it [cooperate] for the baby. If not, if I didn't do my part, the baby was going to die, or he could be traumatized. So that was a real difficulty for me [pause] … I don't know psychologically. They worked me psychologically.” -mother, Colca Canyon
“… it is important to educate the pregnant mothers because sometimes they come from other zones, they come from Puno, Cusco, they come with their beliefs and traditions. So, we are missing the education. Sometimes nowadays, they get there, and we do not have time to orient them or do their prenatal check-ups.” –Midwife, Arequipa
“Then sometimes they don't push. I say, look I'm doing my job, we're all doing our job, if your wife doesn't push, if your baby is born bad, it's no longer my responsibility, it's no longer the doctor's fault, it's nobody's fault, just hers and then he [the husband] says, ‘Push!’ … Other times the husband says, ‘Don't scold her, don’t yell at her.’ Then I tell him, run outside, I throw out the husband.” -Midwife, Colca Canyon
Domain: future health-seeking behavior
“It scares me to give birth at home again, Miss because … What if she doesn’t come out, Miss? She could suffer asphyxia, or the membrane could rupture, and she could drown inside. It is more secure with the doctors even if they complain.” –mother, Arequipa
“The treatment of the patient; for example, for me I just pray. I do not want to go to the hospital for many reasons: disease and there are so many things that you see over there that I do not want to go. Oh well, I go for my children. I have gone to the hospital for the three of them because here [rural village] the midwife sends you to Chivay or Arequipa depending on your state for the safety of the baby.” –mother, Colca Canyon
“I was traumatized because they would just yell, ‘push, push!’ and I did not know how to push and oh! It traumatized me more … the first time yes, it made me want to say no more children! But, look, here we are [laughs, then pauses and looks down at her breastfeeding infant].” –mother, Colca Canyon
“This time [recent birth] I tried not to complain too much, I put up with the pain, endured, and I knew how to control myself. They [providers] gave me more support and would tell me what to do without yelling because sometimes you don’t control your pain and sometimes in that moment you don’t know what to do and you get desperate and that is when sometimes the midwife can grab you and tell you something, something disrespectful.” -mother, Arequipa