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Correlation among experience of person-centered maternity care, provision of care and women's satisfaction: Cross sectional study in Colombo, Sri Lanka.

ABSTRACT: Person-centered maternity care (PCMC) is defined as care which is respectful of and responsive to women's and families' preferences, needs, and values. In this cross-sectional study we aimed to evaluate the correlations among the degree of PCMC implementation, key indicators of provision of care, and women's satisfaction with maternity care in Sri Lanka. Degree of PCMC implementation was assessed using a validated questionnaire. Provision of good key practices was measured with the World Health Organization (WHO) Bologna Score, whose items include: 1) companionship in childbirth; 2) use of partogram; 3) absence of labor stimulation; 4) childbirth in non-supine position; 5) skin-to-skin contact. Women's overall satisfaction was assessed on a 1-10 Likert scale. Among 400 women giving birth vaginally, 207 (51.8%) had at least one clinical risk factor and 52 (13.0%) at least one complication. The PCMC implementation mean score was 42.3 (95%CI 41.3-43.4), out of a maximum score of 90. Overall, while 367 (91.8%) women were monitored with a partogram, and 293 (73.3%) delivered non-supine, only 19 (4.8%) did not receive labour stimulation, only 38 (9.5%) had a companion at childbirth, and 165 (41.3%) had skin-to-skin contact immediately after birth. The median total satisfaction score was 7 (IQR 5-9). PCMC implementation had a moderate correlation with women's satisfaction (r = 0.58), while Bologna score had a very low correlation both with satisfaction (r = 0.12), and PCMC (r = 0.20). Factors significantly associated with higher PCMC score were number of pregnancies (p = 0.015), ethnicity (p<0.001), presence of a companion at childbirth (p = 0.037); absence of labor stimulation (p = 0.019); delivery in non-supine position (p = 0.016); and skin-to-skin contact (p = 0.005). Study findings indicate evidence of poor-quality care across several domains of mistreatment in childbirth in Sri Lanka. In addition, patient satisfaction as an indicator of quality care is inadequate to inform health systems reform.

SUBMITTER: Rishard M

PROVIDER: S-EPMC8031099 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:IntroductionPeri-urban settings have high maternal mortality and the quality of care received in different types of health facilities is varied. Yet few studies have explored the construct of person-centered maternity care (PCMC) within peri-urban settings. Understanding women's experience of maternity care in peri-urban settings will allow health facility managers and policy makers to improve services in these settings. This study examines factors associated with PCMC in a peri-urban setting in Kenya.Methods and materialsWe analyzed data from a cross-sectional study with 307 women aged 18-49 years who had delivered a baby within the preceding six weeks. Women were recruited from public (n = 118), private (n = 76), and faith based (n = 113) health facilities. We measured PCMC using the 30-item validated PCMC scale which evaluates women's experiences of dignified and respectful care, supportive care, and communication and autonomy. Factors associated with PCMC were evaluated using multilevel models, with women nested within facilities.ResultsThe average PCMC score was 58.2 (SD = 13.66) out of 90. Controlling for other factors, literate women had, on average, about 6-point higher PCMC scores than women who were not literate (β = 5.758, p = 0.006). Women whose first antenatal care (ANC) visit was in the second (β = -5.030, p = 0.006) and third trimester (β = -7.288, p = 0.003) had lower PCMC scores than those whose first ANC were in the first trimester. Women who were assisted by an unskilled attendant or an auxiliary nurse/midwife at birth had lower PCMC than those assisted by a nurse, midwife or clinical officer (β = -8.962, p = 0.016). Women who were interviewed by phone (β = -7.535, p = 0.006) had lower PCMC scores than those interviewed in person.ConclusionsFactors associated with PCMC include literacy, ANC timing and duration, and delivery provider. There is a need to improve PCMC in these settings as part of broader quality improvement activities to improve maternal and neonatal health.

Project description:BackgroundLow risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women's experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience.MethodsThe study is a cross-sectional survey of 4192 women who had natural birth from March-June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women's experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used.ResultsIn this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes' postpartum guidance. Negative satisfaction was seen with perineal pain and edema.ConclusionWomen in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact.

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Correlation among experience of person-centered maternity care, provision of care and women's satisfaction: Cross sectional study in Colombo, Sri Lanka.

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