Edwards-Bailey, Laura
(2024)
Exploring respectful maternity care during pregnancy and childbirth: A mothers’ and birthing persons’ perspective following a UK hospital birth.
DClinPsy thesis, University of Nottingham.
Abstract
Background
Childbirth is a significant life-event; however, approximately 45.5% of global births are experienced as traumatic by mothers/birthing people. To promote positive and empowering births, the World Health Organisation published the model of Intrapartum Care in 2018. Delivery of Respectful Maternity Care (RMC) and establishing Psychologically Safe Environments were proposed. However, understanding of these concepts is limited, calling for further research with birthing people to “describe their vision for respectful care and experiences”.
Literature exploring birthing experiences is often limited to homogeneous samples of white middle-class mothers despite worse birthing outcomes for ethnic minorities and those from lower socioeconomic backgrounds; and focuses specifically on birth rather than the whole pregnancy experience. Considering this alongside recent reports of unsafe care, lacking respect, kindness and compassion in UK maternity services, this study aimed to explore the meaning of RMC and psychological safety amongst a heterogeneous sample of mothers/birthing people.
Method
A qualitative design, using semi-structured interviews was adopted. Individuals who had given birth in a UK hospital since 2018 at 37+ weeks were invited to complete an online screening questionnaire, measuring study eligibility. Birthing experience was rated on a 5-point Likert scale (very positive - very negative), alongside collating demographics (e.g., ethnicity and deprivation). Purposive sampling was applied to select a range of participants based on these factors, addressing existing literature gaps. Fifteen mothers/birthing people were interviewed. Initially, inductive reflexive thematic analysis was conducted, followed by deductive thematic analysis with existing models of RMC guiding a coding framework.
Analysis
Four themes, with three corresponding sub-themes, were constructed inductively: “You can’t feel respected if you don’t feel safe”: Familiarity is key; Respectful control: “That’s exactly what I wanted, but she didn’t ask first”; Overlooked and Unmet Needs: “They just didn’t see me as an individual”; and “Respect has to be earnt, it’s a two-way process”. Companionship from birthing partners and/or midwives enhanced safety due to trust, whilst a lack of attentiveness and availability of staff left individuals feeling uncared for and disrespected. Physical hospital environments were seen as an externalisation of respect for the birthing process, mirroring positive or negative experiences of care. Showing awareness of poorer minority outcomes and exploring psychological well-being demonstrated respect through openness and desire to change. All deductive codes were used, mostly mapping onto inductive themes, with “Effective communication” and “Companion of choice” discovered most frequently.
Discussion
To the best of the author's knowledge, this study is the first to explore RMC and psychological safety throughout pregnancy and birth from a mother’s/birthing person's perspective in a UK hospital setting. Global definitions of RMC do not incorporate nuances and individual needs. Maternity services should acknowledge disparity in birthing outcomes for minority groups, and offer tailored resources to symbolise acceptance, consequently enhancing safety and respect.
Impact on Clinical Psychology
Acknowledging and supporting psychological well-being throughout pregnancy and birth is required. Incorporating this into birth planning and preparation may offer opportunity to increase birth satisfaction, highlighting a potential role for clinical psychology within multi-disciplinary maternity care.
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