RESPECTFUL MATERNITY CARE in obs and gyne.pptx

Rmc

1. RESPECTFUL MATERNITY CARE DR INDRANIL DAS JULY 2021 MODERATORS: PROF GOWRI DORAIRAJAN DR ASHWINI V

2. INTRODUCTION DEFINITION : Respectful Maternity care is an approach that focusses on the interpersonal aspect of maternity care that emphasizes the fundamental rights of mother , newborn and families, including protecting the mother and baby from pain. It also recognizes that all parturient need and deserve respectful care and protection of the women’s right to choice and preferences

3. CLINICAL PHYSIOLOGY OF RMC During delivery and performing life-saving operations, women’s pregnancy experience is rarely considered We routinely separate them from families The focus is on uterus birth canal, overlooking her uncertainties RMC is based on respect for women’s basic human rights, including respect for her autonomy, dignity, feelings, choices, religions , preferences including companionship

4. NEED FOR RESPECTFUL MATERNITY CARE Over recent decades , facility delivery rates have increased as women are increasingly intencivized to utilize facility for child birth Ensuring universal access to safe,acceptable , good quality sexual and reproductive healthcare , global rates of maternal morbidity and mortality has reduced Growing body of research on woman’s experience during pregnancy and childbirth shows many women across globe experience disrespectful, abusiveve and neglectful treatment ………….constituting violation of trust

5. Though disrespectful, abusive treatment can occur anytime during pregnancy, childbirth and postpartum, women are particularly vulnerable during childbirth Such practice may have direct adverse consequences for both mother and infant Abuse, disrespect or neglect during childbirth amounts to violation of woman’s fundamental human rights , as described in internationally adopted human rights standardsand principles

6. SEVEN CHARTERS OF RESPECTFUL MATERNITY CARE PHYSICAL ABUSE NON CONSENTED CARE NON CONFIDENTIAL CARE NON DIGNIFIED CARE DISCRIMINATION BASED ON SPECIFIC ATTRIBUTES ABANDONMENT OR DENIAL OF CARE DETENTION OF FACILITIES

7. PHYSICAL ABUSE Includes a range of violations e.g. pinching, hitting, slapping At times, providers try to justify as being for benefit of patient This violates woman’s basic human rights and autonomy and traumatize already vulnerable woman and deter them from utilizing skilled care and returning to facility to deliver

8. Non-consented care Often processes and procedures are not fully explained to women Precedures such as insertion of PPIUCD were performed without woman’s consent has been reported Women’s choice of birth companion and birth position are not always respected

9. NON CONFIDENTIAL CARE Occurs frequently under resourced health facility Hard to talk about privacy in busy labour wards when women have to share beds Screens and curtains not always available

10. Non dignified care Verbal abuse is one of the most frequent type of disrespect ecperienced at childbirth Women are often shouted at or scolded, insulted , or blamed for negative pregnancy outcomes during facility based child birth

11. Discrimination based on specific attributes Many women report discrimination due to various patient attributions like socio-economic status and ethnicity

12. Denial of care Acts of omission are also forms of disrespect and abuse Failure to organize, protect and fulfil a patients rights is a form of mistreatment Abandonment or denial of care is a prevalent form of abuse globally

13. Detention of facilities Detention in facilities is a grave violation that impacts negatively the mother, baby and family Threat to detention can deter women from accessing skill care in facility In Nigeria, several women delivered with traditional birth attenders mentioning cost as a reson for decision

14. What can be avoided or promoted The healthcare that disempowers woman and separates from her family during labour and birth to be avoided Being impersonal , centered on profession and not on woman to be avoided RMC respects woman’s beliefs, traditions and cultures while empowering her and family to be active participants during birth Should also have the right to information , privacy and freedom of movement during labour

15. WHO antepartum care guidelines for positive experience 2016 ANC model aims to provide anc with respectful, individualized, person centered care at each contact 8 contacts, not visits Case note carried by women Midwife lead continuity of care model ANC home visits

16. WHO 2016 ANC MODEL First trimester : contact 1 – upto 12 weeks Second trimester : contact 2 – 20 weeks contact 3 – 26 weeks Third trimester: contact 4 – 30 weeks contact 5 – 34 weeks contact 6 – 36 weeks contact 7 – 38 weeks contact 8 – 40 weeks

17. Recommendations on anc 49 recommendations groped into 5 topic areas Nutritional interventions ( 14 ) Maternal and fetal assessment ( 13 ) Preventive measures (7 ) Interventions for common physiological symptoms ( 6 ) Health system interventions to improve the utilizations and quality of ANC ( 9 )

18. Anc standard recommendation High protein diet is not recommended Multiple micronutrient supplementation is not recommended No recommendation of vitamin C, E or pyridoxine or routine vitamin D Assess for anaemia, asymptomatic bacteriuria, partner violence, hyperglycemia Screening for tobacco , alcohol, HIV

19. Who intrapartum care for a positive childbirth experience It highlights the importance of woman centred care to optimize her experience through a holistic , human right based approach Women are encouraged for delivery at facility, but disrespectful and undignified care violates her human rights and also hinders to access intrapartum services Respectful maternity care

20. Intrapartum who recommendations Effective communication Companionship during labour and childbirth Information regarding non establishment of standard latent labour duration and that it varies among women 5 cm and above as active labour Digital examination at interval of 4 hours Do not routinely augment

21. Contd … Oral fluids and food for low risk Not to shorten labour with spasmolytics or iv fluids Not to insist on lithotomy Intermittent auscultation is recommended , not continuous CTG Restrictive episiotomy Routine perineal shaving and enema administration not recommended

22. Contd … Epidural analgesia is recommended who wants pain relief Relaxation techniques At second stage, adoption of birth position as per patients choice to be encouraged Fundal pressure is not recommended

23. INDIAN INITIATIVES- LaQshya Guidelines Ensures RMC is provided at all levels One of the short term targets – 80% of labour room and ot quality circles are oriented to latest lr protocols,quality Improvement processes and RMC

24. Goal of rmc To address the higher rates of maternal mortality and morbidity Create space for empathy and consideration of positive experience while treating pregnant and birthing people Impart positive experience Follow uniform standards of antenatal, intranatal and postnatal care as per WHO recommendations

25. Thank you