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Abstract
Background. Respectful maternity care is the universal right of childbearing women, but in Nepal there are no midwives to deliver this care and it is provided by skilled birth attendants (SBAs), who may be physicians, certified nurses, auxiliary nurse-midwives or degree-trained nurses.
Aim. To explore how this concept of respectful maternity care was perceived by SBAs in practice.
Design. Focus group discussions were used and the setting was two tertiary level maternity hospitals in Nepal. Ethical approval for the study was obtained from the Nepal Health Research Council. A total of 24 SBAs were recruited voluntarily from the maternity units. Data were analysed using a phenomenographic approach and interpretation was verified by the focus group facilitator and note-taker.
Findings. Five categories, divided into16 sub-categories, present the SBAs' collective description of respectful care.
Conclusions. SBAs understood that respectful care at birth was important, but argued that 'safety comes before comfort'. To achieve safe maternity care, the contribution of relatives is essential, in addition to the provision of medical care.
Implications. Family members need to accompany the woman and her newborn from admission to discharge to provide basic care and this needs to be reviewed. Professional midwives need to be trained, recruited, and deployed in areas where they are most needed and the government needs to regulate the profession and make it legal.
Key words: Maternity care, midwifery, phenomenographic analysis, focus group discussions, evidence-based midwifery
Introduction
The WHO's definition of a skilled birth attendant (SBA) is someone 'trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, birth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns' (WHO, 2004: 1).
In Nepal, there are no midwives to deliver this care and it is provided by SBAs, who may be physicians, certified nurses, auxiliary nurse-midwives, or degree-trained nurses (National Health Sector Support Program, 2012). In addition to basic education, the above professionals can undergo two-month country-specific SBA training, which covers respectful care (Utz et al, 2012; White Ribbon Alliance, 2011). Nepal does not yet have midwives, according to global standards for the role of a midwife (Bogren et al, 2013; van Teijlingen, 2012; International Confederation of Midwives, 2010; Family Health Division, 2006).
Women need access...