Fortunately, times when pregnant women had to give birth in terrible conditions are long in the past. Nowadays, childbirth is considered to be a normal process that can go without any issues for most patients. Nevertheless, there is always room for improvement in the field of labor and delivery setting. In many hospitals women are mistreated and often experience verbal and physical abuse by healthcare providers, which interferes with the already complicated process of childbirth. In other words, in some cases they are forced to endure an unacceptable attitude from doctors and nurses. Moreover, sometimes unnecessary and potentially harmful interventions are also applied to women without their consent.
This issue is undoubtedly can be considered as a problem concerning quality improvement. There is no doubt that some initiatives and protocols have to be implemented in order to prevent such cases. For the best outcomes of childbirth medical staff should behave professionally and not cause harm to women’s health.
Given the importance of prenatal care, it must be taken into account that many changes need to be made in the field of providing high quality maternal healthcare. In addition, new initiatives regarding the practice of informed consent during labor should also be implemented.
Main Problems
Institutional violence has become a public health problem in recent years, as the amount of harassment cases against pregnant women in health facilities has rapidly increased. More American and international researchers are talking about the topic of reproductive harassment, aggression and verbal abuse by hospital staff towards patients.
The birth of a new citizen is positioned as an inherently positive event. Nevertheless, during the time when a woman is pregnant and gives birth to a child, she runs the risk of neglect and even cruelty. Studies indicate that a significant amount of healthy pregnant women encounter at least one painful clinical intervention during labor and delivery (Jewkes & Penn-Kekana, 2015). According to Jewkes and Penn-Kekana, “the mistreatment of women in childbirth has been documented by researchers for over three decades in all global regions” (Jewkes & Penn-Kekana, 2015, para. 1).
Problematic behavior against women is primarily the result of social standards within these contexts, which affect both practice and power perceptions. Such beliefs may create certain impressions that healthcare workers should be in charge of female patients. For this reason, doctors and nurses feel like they have the right to use a variety of rough tactics, including physical and psychological abuse.
Nevertheless, such a practice of disrespect and abuse during prenatal care and childbirth is not only unethical, but it is also a violation of basic human rights. Moreover, aside from harassment, there is another apparent problem; women in labor are not provided with an opportunity to give informed consent to interventions, for example, epidural analgesia.
Such an issue occurs due to a belief that the decision‐making capacity of women during that time may be compromised because of their condition. However, it is evident that all mothers have the right to receive the necessary information regarding their health, treatment, and procedures. All details and risks regarding operations should be carried out in a clear and precise language, as well as in a respectful manner.
There is no doubt that there are many initiatives that could be implemented in order to solve these problems and to increase the quality of healthcare. Nevertheless, it would be difficult to recognize all issues since “although patients seemed open and vocal in their discussions of the quality of care and their experiences of verbal abuse, it could be that they were reluctant to talk about physical abuse, either for fear of retaliation at their local health facility or because they were uncomfortable discussing traumatic or embarrassing events with strangers” (Burrows et al., 2017, p. 9).
Therefore, policymakers must take into account the fact that aside from implementing measures to prevent cases of violence, an opportunity to report on them should also be provided to women.
Solution
There are several modifications that are needed to be carried out in order to provide the necessary service for women in labor. These changes, however, despite the efforts of several international healthcare organizations, has not yet occurred in most American facilities that help pregnant women. The core concept behind improving the quality of delivery healthcare is giving women the right to choose, as well as providing services that are focused on their needs.
Measures that can prevent cases of mistreatment should be based on the results of qualitative research, since further studies are needed to create and evaluate initiatives. Nevertheless, it is evident that such changes are required to be implemented at multiple levels. First of all, it would be essential to note that “professional associations that govern the standards of quality care for healthcare workers need to address the mistreatment through retraining and norms transformation” (Oluoch-Aridi et al., 2018, p. 209).
Therefore, there is an apparent need for new approaches regarding the upgraded staff training, the process of supervision in order to make sure that medical workers follow new guidelines. For example, Burrowes et al. (2017) note that “training on respectful care, offered in the professional ethics modules of the national midwifery curriculum, should be strengthened to include a greater focus on counseling skills and rapport-building” (p. 13). Moreover, it would also be beneficial to motivate medical staff to reflect on their treatment towards patients critically. It would help them to build empathy and create a positive relationship with women in their clinics.
However, it is also essential to remember the need of implementing a flexible approach to this engagement. In cases where doctors would be blamed and forced to undergo a process of critical reflection, they can resist it. For this reason, it would be more beneficial to focus on the general change of policies while also holding individual violators responsible for severe abusive acts.
In order to guarantee that women’s rights are protected from abuse in labor and delivery facilities, hospitals can establish staff supervision. Furthermore, it would also be advantageous to collect feedback from patients on a regular basis. Moreover, the use of anesthesia painkillers should be controlled and even prohibited in cases where a woman’s consent was not received.
Regarding the issue of educating patients on the procedures, researchers stress the importance of delivering detailed information. For example, Wada et al. (2019) note that “for supporting women’s autonomy and informed decision‐making about epidural analgesia for labor pain, healthcare providers need to provide women with sufficient information and obtain consent” (p. 11). In other words, women should be supported during prenatal care and childbirth by informing them of details of their conditions and measures to improve it.
Other initiatives include introducing effective mechanisms that provide the opportunity for women to report cases of violence and receive monetary compensation for violation of their rights. However, such a measure requires campaigns among lawyers, judges, and the public. Aside from this, policymakers can also create mechanisms that can provide a quick and effective response to allegations of this kind of violence. In order to evaluate the success the staff should gather feedback from female patients.
For example, it would be helpful to make a survey for them which will offer evaluating the treatment of the personnel on a scale from “not at all satisfied /very bad” to “completely satisfied /excellent”. A response from women who received healthcare at the birth center will help to determine the result of a quality improvement initiative.
Conclusion
In conclusion, it would appear that while violence still prevails in delivery clinics across the country, it is still possible to carry out initiatives to enhance the quality of healthcare. Several studies indicated how it is extremely important to minimize practices that harm the health of women and children. Through strategic guidelines, as well as implementing public policies and programs, it would be possible to decrease the number of cases of mistreatment.
It is evident that policymakers are capable of ending the violence in medical facilities against women in labor. There is an apparent need to conduct further research on this subject in order to figure out the reasons behind those issues and develop initiatives that can provide an opportunity for women to seek protection from violence in medical facilities.
The process of assisting a woman during her pregnancy and postpartum should not contain invasive procedures and interventions. The reason for this is that without consent, they can be considered unethical. Moreover, such practices can lead to adverse outcomes of care due to patients’ stress. All things considered, these initiatives can certainly improve the quality of delivery care and the overall satisfaction of patients.
References
Burrowes, S., Holcombe, S. J., Jara, D., Carter, D., & Smith, K. (2017). Midwives’ and patients’ perspectives on disrespect and abuse during labor and delivery care in Ethiopia: a qualitative study. BMC Pregnancy and Childbirth, 17(1), 1-14.
Jewkes, R., & Penn-Kekana, L. (2015). Mistreatment of women in childbirth: time for action on this important dimension of violence against women. PLoS Med, 12(6). Web.
Oluoch-Aridi, J., Smith-Oka, V., Milan, E., & Dowd, R. (2018). Exploring mistreatment of women during childbirth in a peri-urban setting in Kenya: experiences and perceptions of women and healthcare providers. Reproductive Health, 15(1), 209.
Wada, K., Charland, L. C., & Bellingham, G. (2019). Can women in labor give informed consent to epidural analgesia? Bioethics, 33(4), 475-486.