Midwives' respect and disrespect of women during facility-based childbirth in urban Tanzania: a qualitative study.
Midwives' respect and disrespect of women during facility-based childbirth in urban Tanzania: a qualitative study.
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DOI：
10.1186/s12978-017-0447-6
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发表时间：
2018-01-10
影响因子：
3.4
通讯作者：
Shimpuku Y
中科院分区：
文献类型：
--
作者：
Shimoda K;Horiuchi S;Leshabari S;Shimpuku Y
在过去的二十年里，坦桑尼亚的设施分娩只增加了10%，部分原因是医疗保健提供者在分娩期间对妇女的不尊重和虐待。虽然许多研究已经证实了妇女在分娩期间由医疗保健提供者进行D&A的经验，但很少有人关注助产士在实际护理期间如何进行D&A。本研究的目的是描述从实际观察的尊重和不尊重的照顾助产士在其劳动期间在坦桑尼亚城市的两所医院的妇女。这项描述性定性研究涉及坦桑尼亚城市的两个卫生设施的自然观察。有目的地招募了14名助产士，对24名分娩中的妇女进行一对一的跟踪护理，从入院到第四阶段分娩。观察他们的助产护理进行了分析，使用内容分析。所有14名助产士都表现出尊重和不尊重的护理，以及以前关于妇女经历的报告中没有解释的一些做法。对于尊重的护理，确定了五个类别：1）助产士和妇女之间的积极互动，2）尊重妇女的隐私，3）提供安全和及时的助产护理，4）积极参与妇女的分娩过程，5）鼓励母婴关系。对于不尊重的护理，确认了五类：1）身体虐待，2）心理虐待，3）非保密护理，4）未经同意的护理，以及5）放弃护理。另外两个类别出现了无优先级和无组织的护理和助产管理：1）缺乏问责制和2）不道德的临床实践。在坦桑尼亚城市的两个保健设施中，观察到助产士的护理既有尊重的，也有不尊重的。观察到几种未报告的身体和心理虐待。薄弱的护理和助产管理被认为是一个贡献者的D&A的妇女。为了促进对妇女的尊重，任职前和在职培训、改善工作条件和环境、增强孕妇权能以及加强卫生政策至关重要。
Over the last two decades, facility-based childbirths in Tanzania have only minimally increased by 10% partly because of healthcare providers’ disrespect and abuse (D&A) of women during childbirth. Although numerous studies have substantiated women’s experience of D&A during childbirth by healthcare providers, few have focused on how D&A occurred during the midwives’ actual care. This study aimed to describe from actual observations the respectful and disrespectful care received by women from midwives during their labor period in two hospitals in urban Tanzania. This descriptive qualitative study involved naturalistic observation of two health facilities in urban Tanzania. Fourteen midwives were purposively recruited for the one-on-one shadowing of their care of 24 women in labor from admission to the fourth stage of labor. Observations of their midwifery care were analyzed using content analysis. All the 14 midwives showed both respectful and disrespectful care and some practices that have not been explicated in previous reports of women’s experiences. For respectful care, five categories were identified: 1) positive interactions between midwives and women, 2) respect for women’s privacy, 3) provision of safe and timely midwifery care for delivery, 4) active engagement in women’s labor process, and 5) encouragement of the mother-baby relationship. For disrespectful care, five categories were recognized: 1) physical abuse, 2) psychological abuse, 3) non-confidential care, 4) non-consented care, and 5) abandonment of care. Two additional categories emerged from the unprioritized and disorganized nursing and midwifery management: 1) lack of accountability and 2) unethical clinical practices. Both respectful care and disrespectful care of midwives were observed in the two health facilities in urban Tanzania. Several types of physical and psychological abuse that have not been reported were observed. Weak nursing and midwifery management was found to be a contributor to the D&A of women. To promote respectful care of women, pre-service and in-service trainings, improvement of working conditions and environment, empowering pregnant women, and strengthening health policies are crucial.
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DOI：
10.1097/qai.0000000000000378
发表时间：
2014-12-01
期刊：
Journal of acquired immune deficiency syndromes (1999)
影响因子：
--
作者：
Sando D;Kendall T;Lyatuu G;Ratcliffe H;McDonald K;Mwanyika-Sando M;Emil F;Chalamilla G;Langer A
通讯作者：
Langer A
影响因子：
3.2
作者：
Creswell, JW;Miller, DL
通讯作者：
Miller, DL
影响因子：
2.7
作者：
Moyer, Cheryl A.;Adongo, Philip B.;Engmann, Cyril M.
通讯作者：
Engmann, Cyril M.
影响因子：
10.8
作者：
Mannava P;Durrant K;Fisher J;Chersich M;Luchters S
通讯作者：
Luchters S
影响因子：
3.1
作者：
Warren, Charlotte E.;Njue, Rebecca;Abuya, Timothy
通讯作者：
Abuya, Timothy