Respectful Maternity Care: Perspectives of Midwives at Mulago Hospital, Kampala, Uganda.

Abstract

Introduction Lack of RMC among pregnant women, especially intrapartum period has emerged as a serious contributor to pregnant women refusing to access maternity services hence poor maternal and child health outcomes. This has both direct and indirect negative effects to maternal and neonatal health. Although a number of studies have been done on women regarding RMC, little is known on providers’ perspectives. Therefore, this study seeks to explore midwives perspectives on RMC. Objectives This study aimed at exploring midwives’ understanding of the concept RMC, enablers and barriers of RMC at Mulago National Referral Hospital, Kampala. Methods This was a qualitative descriptive study among midwives working in labor wards of Mulago National Referral Hospital. Twenty midwives were recruited by purposive sampling method. The actual sample size was determined by the principle of saturation. Data was collected using in-depth interviews guided by an interview guide and then later the same midwives who were interviewed were observed using labour and delivery observation checklist to elicit if they were practicing RMC. Indepth-interview data was analyzed using content analysis by Graneheim &Lundman, 2004 and labour and delivery data was analyzed by thematic analysis by Maguire & Delahunt, 2017. Results Three themes emerged in the in-depth interviews (IDIs); midwives understanding of RMC, enablers of RMC, and barriers to RMC. Midwives understood RMC as follows; friendly interaction with clients, respect of clients’ rights, giving detailed information to clients and use of necessary equipment and tools during care. However, during observations, a few were able to put them into practice while majority did not. Midwives identified enablers of RMC as; availability of equipment, sundries, and medicines, professionalism, collaborative care, and supportive health care system. Having such enablers in place facilitated them to provide RMC to clients, and absence of these enablers acted as barriers to provision of RMC. Conclusion Midwives were only aware of four out of the seven components of RMC by WHO; and not all of them were putting them into practice. Implementation of RMC requires collaborative effort amongst the health care system, healthcare providers and the clients since they contribute to xiii

the facilitators or barriers. Therefore, strategies to promote RMC should be a collaborative effort by all the stakeholders including; healthcare workers, health facility administration, policy makers and community. Key words Respectful Maternity Care, maternity services, midwife