School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK.
Reprod Health. 2019 Jul 25;16(1):116. doi: 10.1186/s12978-019-0773-y.
In the past decade, the negative impact of disrespectful maternity care on women's utilisation and experiences of facility-based delivery has been well documented. Less is known about midwives' perspectives on these labour ward dynamics. Yet efforts to provide care that satisfies women's psycho-socio-cultural needs rest on midwives' capacity and willingness to provide it. We performed a systematic review of the emerging literature documenting midwives' perspectives to explore the broader drivers of (dis)respectful care during facility-based delivery in the sub-Saharan African context.
Seven databases (CINAHL, PsychINFO, PsychArticles, Embase, Global Health, Maternity and Infant Care and PubMed) were systematically searched from 1990 to May 2018. Primary qualitative studies with a substantial focus on the interpersonal aspects of care were eligible if they captured midwives' voices and perspectives. Study quality was independently assessed by two reviewers and PRISMA guidelines were followed. The results and findings from each study were synthesised using an existing conceptual framework of the drivers of disrespectful care.
Eleven papers from six countries were included and six main themes were identified. 'Power and control' and 'Maintaining midwives' status' reflected midwives' focus on the micro-level interactions of the mother-midwife dyad. Meso-level drivers of disrespectful care were: the constraints of the 'Work environment and resources'; concerns about 'Midwives' position in the health systems hierarchy'; and the impact of 'Midwives' conceptualisations of respectful maternity care'. An emerging theme outlined the 'Impact on midwives' of (dis)respectful care.
We used a theoretically informed conceptual framework to move beyond the micro-level and interrogate the social, cultural and historical factors that underpin (dis)respectful care. Controlling women was a key theme, echoing women's experiences, but midwives paid less attention to the social inequalities that distress women. The synthesis highlighted midwives' low status in the health system hierarchy, while organisational cultures of blame and a lack of consideration for them as professionals effectively constitute disrespect and abuse of these health workers. Broader, interdisciplinary perspectives on the wider drivers of midwives' disrespectful attitudes and behaviours are crucial if efforts to improve the maternity care environment - for women and midwives - are to succeed.
在过去的十年中，不尊重产妇护理对妇女利用和体验基于设施的分娩的负面影响已得到充分证明。关于助产士对这些产房动态的看法知之甚少。然而，提供满足妇女心理社会文化需求的护理的努力取决于助产士提供这种护理的能力和意愿。我们对新兴文献进行了系统回顾，记录了助产士的观点，以探讨在撒哈拉以南非洲背景下基于设施的分娩中（不）尊重护理的更广泛驱动因素。
从 1990 年到 2018 年 5 月，我们系统地搜索了七个数据库（CINAHL、PsychINFO、PsychArticles、Embase、全球健康、产妇和婴儿护理以及 PubMed）。如果主要定性研究主要关注护理的人际方面，并且捕捉到助产士的声音和观点，则符合条件。两名审查员独立评估研究质量，并遵循 PRISMA 指南。使用不尊重护理的驱动因素的现有概念框架，对每项研究的结果和发现进行综合。
从六个国家/地区的 11 篇论文中确定了六个主要主题。“权力和控制”和“维护助产士的地位”反映了助产士对母婴二人组微观层面互动的关注。不尊重护理的中观驱动因素包括：“工作环境和资源的限制”；对“助产士在卫生系统等级制度中的地位”的关注；以及“助产士对尊重产妇护理的概念化”的影响。一个新出现的主题概述了“（不）尊重护理对助产士的影响”。
我们使用理论上的概念框架超越了微观层面，探讨了构成（不）尊重护理的社会、文化和历史因素。控制妇女是一个关键主题，与妇女的经历相呼应，但助产士对困扰妇女的社会不平等关注较少。综合分析突出了助产士在卫生系统等级制度中的地位低下，而指责文化和对他们作为专业人员的缺乏考虑实际上构成了对这些卫生工作者的不尊重和虐待。如果要成功改善产妇护理环境（为妇女和助产士），就必须从更广泛的、跨学科的角度看待助产士不尊重态度和行为的更广泛驱动因素。
