Respectful Care: A new term for the family-centered approach that women have been requesting

 

One of the strategies to reduce maternal mortality worldwide is to encourage the use of health facilities during birth by paying attention to the way women are treated in those facilities – with an emphasis on care with support and dignity.  It’s called “respectful care,” and although it’s a new buzzword in the maternal health community, the idea is anything but new. Women have been asking for this for decades, even if not in those very words.

The care that a woman receives during labor affects both mother and child – physically and emotionally – well beyond her delivery day. The birthing environment – which is in large part influenced by interactions with staff – determines whether or not a woman feels heard, supported, and safe during the experience.

A happy family in Russia after a delivery in a health facility supporting family-centered care.
A happy family in Russia after a delivery in a health facility supporting family-centered care.

When JSI began working in reproductive, maternal, newborn and child health (RMNCH) in Eastern Europe and Eurasia about 15 years ago, the birthing experience relied heavily on an overly medicalized approach that was wrought with fear and anxiety. Despite universal access to health care, fear of poor treatment and a lack of respect led women to choose ‘natural’ childbirth at home. Even though almost all deliveries were being attended by an obstetrician-gynecologist or a midwife, maternal mortality remained at 30 per 100,000 women – an outcome that lagged even many less developed countries.

JSI projects (Georgia SUSTAIN, Russia IBP-MCH, Ukraine Together for Health) responded with a focus on the humanization of child birth with respectful, women- and family-centered maternity care at the core of all interventions. Maternity hospitals were opened to relatives and friends, and the presence and support of a partner during labor and delivery was actively encouraged. Previously women were forced to deliver on their back, their arms strapped to the bed, but now women are allowed to move around and labor and deliver in the position they found most comfortable. The entire birthing experience has been transformed to one based on dignity and support.

Maternity hospitals create a supportive environment for mothers-to-be in Russia. We heard many stories of how much women, and their families, appreciated the new approach:

From a letter written by a woman who delivered in a Donetsk, Ukraine, maternity hospital: “I knew that I was HIV positive, and I was afraid that my baby and I would be treated as inferior. But I was wrong! They talked to me, they helped my morale, and I think my child was treated with the best attention…I have no words to express how thankful I am to the entire health care staff, from doctors to hospital attendants. Friends, you have helped me so much… thank you!”

“I didn’t part with my son from the moment of birth until we were discharged from the maternity,” said another new mother in Russia. “And it was so pleasant to have my husband and my daughters beside me!”

These pilot programs in Eastern Europe made it clear that “respectful care” is desirable and successful. Yet we continue to see that the absence of this client-centered or family-centered style of maternity care is as much a barrier to women throughout the world who might otherwise seek facility-based and skilled care as other more well-documented factors such as cost and access to transport.

At last the maternal health community is advocating for what women have asked for all along. Let this serve as a reminder that the most effective medical interventions are often the most simple – listening goes a long way.

Learn more about the Georgia Sustaining Family Planning and Maternal and Child Health Services (Sustain), Russia Institutionalizing Best Practices in Maternal and Child Health (IBP-MCH), and Ukraine Together for Health: Improving Family Planning and Reproductive Health in Ukraine Projects.

**This article was originally published on May 20, 2015 by Global Health Council