Abstract
Respectful maternity care (RMC) is a vital aspect of midwifery practice and care that incorporates a holistic approach of prioritising the physical, emotional, cultural and psychological needs of women during pregnancy, childbirth and the postpartum period. The World Health Organization mandates that all childbearing women receive high-quality, dignified and RMC with freedom from disrespect, abuse and mistreatment. In line with goal three of the Sustainable Development Goals, RMC contributes to ensuring healthy lives while promoting the well-being of all at all ages. About 88% of births in Namibia occur in health facilities assisted by skilled providers; of these, 69% are midwives. However, several studies conducted in Namibia reported evidence of women being mistreated by midwives. There is no documented evidence of a structured interventional programme for midwives in Namibia to promote RMC. This study aimed to develop, implement and evaluate a professional ethics educational programme for midwives in the promotion of RMC in Namibia. To achieve the purpose, a qualitative, exploratory, descriptive, and contextual research design was employed.
The objectives were to conduct a meta-synthesis of qualitative research about midwives’ and women’s experiences with RMC around the globe, develop and describe a conceptual framework for a professional ethics educational programme based on the results of the meta-synthesis, develop a professional ethics educational programme as a framework of reference for midwives to promote RMC in their home setting of Namibia, identify and engage experts in the field of healthcare ethics and midwifery education to evaluate and validate the professional ethics educational programme, and implement and evaluate the professional ethics educational programme for midwives to promote RMC and facilitate quality of care. The study was conducted over five phases.
Phase 1 was a meta-synthesis of literature about women and midwives’ global views, perceptions and experiences with RMC. Primary published studies written in English between the years 2010 and 2023 were included in the synthesis. Fifteen studies were selected to be included in the review and themes were developed through line-by-line coding. Five themes emerged from the synthesis, namely: commitment to women’s rights, excellence in midwifery knowledge and skills, a facilitative built environment, optimising the interpersonal dimension, and the development of midwives’ and women’s resourcefulness.
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In Phase 2, a conceptual framework was developed from the meta-synthesis results in Phase 1 using the survey list: Who is the agent? Who is the recipient? What is the procedure? What is the context? What are the dynamics? What is the outcome? The conceptual framework was developed from the researcher’s thinking map, concepts were identified, and relationships between the concepts were defined. The facilitation of midwives’ empowerment to be resourceful and resilient to empower women and promote RMC was implemented in three phases: the relationship phase, the working phase and the termination phase.
In Phase 3, the researcher developed the professional ethics educational programme based on the conceptual framework developed in Phase 2. Additionally, practice guidelines for the programme’s implementation were also developed. The programme aimed to empower midwives to enhance their knowledge and skills to be resourceful and resilient and promote RMC. The purpose was achieved through five sessions delivered over two full days through an interactive workshop. In Phase 4, the newly developed programme and the guidelines for implementation were evaluated and validated by experts in the field of healthcare ethics and midwifery education. Finally, in Phase 5, the programme was implemented through a two-day interactive workshop with midwives and subsequently evaluated by midwives who attended and participated in the workshop through a focus group discussion facilitated by the researcher.
The expected outcomes of the study were empowered midwives who are resourceful and resilient to empower women and promote RMC. Measures of trustworthiness were adhered to, and ethical principles were applied and upheld throughout the research process. The original contribution of the study was the conceptual framework, the developed and validated educational programme and practice guidelines for midwives to promote RMC.