Background
Methods
Study area
Study methods
Data collection procedure
Data analysis
Results
Codes | Categories | Themes |
---|---|---|
- Repeated examination and examination without finding notification - Ignoring or undermining pain - Being told bad news - Inconsistent information - Shouting and insulting - Restraining for long | - Being infantilized - Undermine woman’s feeling and experiences | Losing control of the childbirth process |
- Shifts bring difference - Disallowed to have companionship - Admitted against consensus - No assistance near by | - Obliged to do self-care - Care against will - Privacy as time dependent - Humilating/degrading | |
- Declined to be examined - Care provider preference - Noticed institution difference - Short stay at health facility | - Not willing to use the service again - Projecting the outcome - Fear of being hurt related to negligence and incompetence - Felt ok for stayed short in institution | Reactions of care recipients to the care received during labour and delivery |
- Unhygienic latrine - Staff work burden | - Scarcity of running water - Staff shortage | Resource scarcity as contributor to disrespectful and abusive care |
Losing control of the childbirth process
Providers sometimes force women to stay at health institution to prevent home delivery. Women visiting health facilities for routine antenatal care follow up are forced to stay at health institution without their consent.A woman from the urban area said, “I was examined and told my labour is at early stage … at that point my baby was on the way out but I was restricted to stay in my left side …I told my care provider I am urged to push down and requested for help …he said I just examined you (you are not yet ready) and ignored me and continued playing with his mobile phone ...the urge to push down was irresistible, I then turned on my back by myself and gave birth…then the care provider tried to assist, my child was not crying immediately … I think it was suffocated for long as the provider ignored my call (and delayed the process)…luckily my baby survived but I was not happy with the care.”Another woman who had twins in her first birth by caesarean section said, “I was threatened by the care providers when I could not obey their order to move around in the post-operative period because I had severe pain post cesarean section. The provider shouted at me… get up … with no support and while in pain”.
Women reported some providers were incompetent and negligent. Women also reported observing junior care providers being guided by senior care providers to perform certain procedure…junior providers take longer time to perform tasks and often left unsupervised by senior care providers. Women admitted to hospital also complained lack of support for basic physiologic needs during long labor hours because family members are not allowed to accompany them, which left some women to stay in uncomfortable conditions soaked with blood and urine.A woman from the urban area said, “I was kept at the health institution without having labour pain or any indication it may start soon…they did several examinations and I was sent home after one-day admission because my labour did not start. One month later, I was again admitted to the facility because the presentation of my baby was not normal (it was breach presentation)…I believe the position changed from normal to abnormal due to the repeated abdominal examinations they did previously”.
Women has no control over their own situation and often felt infantilized. The response of health providers to women’s agony in labour pain was unsympathetic and sometimes overlooked.. Women in labour also suffer from lack of privacy. Having a group of providers standing round a labouring woman is terrifying for her; even worse is when providers seat on the foot of the bed. Providers’ behavior became worse at night shifts while they were also few in number:A woman said, “she had bleeding, no one was around... bleeding became profuse …when the provider reached and examined her, she was weak and her blood pressure was very low. I was treated with three bags of intravenous fluid, which was immediately followed by blood transfusion. Providers ignored me and were chatting a lot among themselves… and fail to react timely in case of emergency.”
Women are often left to worry about the outcome of their pregnancy and often with fear of having a bad outcome. Women are highly sensitive and could be easily disturbed with any negative words from providers, intentional or unintentional, about the progress of either their labour or the status of the baby. Bad news cause stress and discomfort to women in labour. Provider’s approach to disclose bad news such as the absence of the baby’s heartbeat was considered rude.A woman said, “I was asked to change bed without being properly cleaned and my blood still dripping on the floor…the providers behavior get worse during night shift … I will not give birth again in health institutions”.
Reactions of care recipients to the care during labour and delivery
Participants from the rural area said, “health providers were caring during labour and delivery …it was similar to the care you can get at home”… “These days, St. Mary was with them (to the providers, they were so good)… everything has been smooth”.Another woman from a rural area said,“(This woman initially said the care she received during labour and delivery was good …but later in the discussion, after hesitating a bit), she said, she was restricted to lie on one side and when she felt discomfort and tried to change position…, the response from the care provider was bad..., the provider threaten to collide me to the wall...I hate them(providers), they made my labour and delivery process stressful. I really hate them; they put me in stress the whole day…the provider later simply brought a pair of scissor, which was terrifying, and cut me...I thought of never going to the health facility again … it is better to give birth at home with dignity…(after a little pause)…however, after everything went well, I changed my mind…had it been at home, giving birth to such big baby could have been disastrous…I could have lost my life(showing a sad face).A woman from the urban group who gave birth to her first child said, “The care providers hurt us psychologically. They came and did vaginal examinations repeatedly as simple as anything but it is a big trauma to us”,(expressed her emotion by increasing her voice and showing anger on her face)…I really felt pain after the examination…I tried to repeated vaginal examinations…only to receive an insult…“shut up” you conceived for your own and now you joke on us…they were not also well organized and often did not communicate well to one another…so the same examination is done repeatedly unnecessarily”
Resource scarcity as contributor to disrespectful and abusive care
A woman who was giving birth her first child said,” I got my episiotomy sutured after hours of waiting because they had no needles ready to suture.”A woman from an urban area who delivered her first child said, “I was left alone on a couch for 7 hours with instruction to remain in the same position, which was inconvenient and very cold without no beddings. Then after …they forced me stand up and move…I was not strong enough yet. What annoyed me most was they made me collect my blood stained linens and clothes.A multipara woman from the urban group said, “I gave birth in the middle of the night (around 3 A.M.) and was left on the same couch on which I delivered until 8 A.M.in the morning…there was no bed to transfer me on after delivery. I spent hours in uncomfortable position and I got back pain.”