Respectful Care Is Quality Care

In this May 23, 2012 photo, chief midwife Maria Antoneta Cabral Barbosa holds a newborn baby boy she has just delivered by fl
In this May 23, 2012 photo, chief midwife Maria Antoneta Cabral Barbosa holds a newborn baby boy she has just delivered by flashlight, at the regional hospital in Gabu, Guinea-Bissau. In Guinea-Bissau, one of the deadliest places in the world to give birth, a woman has a 1 in 19 chance of maternal death, compared to about 1 in 2,100 in the United States. Experts say women are increasingly heading to medical centers when things go awry, but logistical, financial, and cultural barriers are still keeping many pregnant women from seeking help in time. (AP Photo/Rebecca Blackwell)

In teaching nurses and midwives in the developing world to care for their patients, a core tenet is that respectful care is quality care. While trainers may repeatedly emphasize this point in classrooms from Afghanistan to Zambia, it often takes a personal experience for a health-care provider to fully understand its true meaning.

While leading a training in Pakistan, a group of midwifery students and I visited a labor ward for a lesson in the importance of keeping newborns with their mothers after birth. While there, we met a woman who was laboring alone without the support of a friend or loved one and was obviously frightened. Her own mother died tragically during childbirth, but her mother-in-law was in a waiting area, so we asked her to join the expecting mother to ease her nerves. Before long, the woman gave birth to a healthy baby boy, who was immediately placed on his mother's chest.

This perfect newborn did the "baby crawl," inching his way up until he found the mother's breast and latched on to nurse. Through an interpreter, we learned from the tearful mother-in-law that the woman had been so frightened, because when she gave birth to her first child, she had done so alone, and the boy had been taken from her. For 24 hours she cried, "Where is my baby? Please bring me my baby."

The simple act of having a support person by her side and being able to bond with her newborn son completely changed the birth experience for this woman. The same could be said of the students in the training. They had never seen a baby begin to nurse within the first few minutes of birth, and they, too, were in tears.

Around the globe, health-care workers are being trained in respectful, humanized care, because all patients, regardless of economic status or geographic location, deserve to be treated with reverence and consideration. The concept of "safe motherhood" isn't just about ensuring a woman's physical safety or preventing her death or disability. It is respect for a woman's basic human rights, including her autonomy, dignity, feelings, choices, and preferences, including companionship during maternity care.

Unfortunately, there is still a huge gap between the maternal care a pregnant woman should receive and what she actually experiences. International nongovernmental organizations, like Jhpiego and the U.S. government's flagship Maternal and Child Health Integrated Program (MCHIP), are among those taking the lead in educating health providers on the importance of humanizing care. Frontline health-care workers are being taught what this type of care involves and how best to provide it in their patients. Trainings focus on the partnership between the woman and the health-care worker and include concepts that might seem obvious, such as greeting the patient warmly, draping them for privacy, explaining what they are doing, and allowing them to ask questions, to more complex guidelines on confidentiality, but the principle remains the same: Have respect, empathy and consideration for your patients.

In Tanzania, researchers found that the strongest predictor of whether a woman chose to give birth in a health facility was not cost, distance to the facility, or available transportation; it was provider attitude. I saw this situation play out firsthand in a small, rural health center in Cambodia, where I met a midwife who was delivering many times the number of babies as midwifes in similarly sized centers in the area. When I asked that clinic why so many women were coming there, I was told that women passed by other centers to reach this one because of this particular midwife. She is considered a good midwife who really listens to women and respects them.

Health-care providers are entrusted with the safety, health, and well-being of their patients. As such, providers must be taught to show respect and compassion through their words and actions so that every woman is given the care she so richly deserves.

Catherine A. Carr, CNM, DrPH, is Senior Maternal Health Advisor for Jhpiego/MCHIP-Maternal and Child Health Integrated Program.