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Background: There is no comprehensive guideline for respectful maternity care (RMC) promotion in Iran. This study aimed to design a RMC guideline based on a multiphase study. Methods: In this multiphase mixed-methods study, recommendations were made for RMC promotion through the data obtained from Phase I (i.e., the quantitative section with a cross-sectional design), Phase II (i.e., the qualitative section with a content analysis method), and Phase III (i.e., focus group discussions with birth attendants as well as opinions of the specialized panel through the Delphi technique). The composed recommendations were then analyzed and finalized by relevant specialists in terms of execution capacity, approvability, and cost-effectiveness within the current context of Iran. Eventually, the resultant guideline were evaluated and approved by two members of the research team specializing in the research area in accordance with the Appraisal of Guideline for Research and Evaluation (AGREE). Results: The results of this multiphase study led to 80 recommendations for RMC promotion. The recommendations were classified as eight areas called recommendations for the pregnancy period, recommendations for the labor period and delivery, recommendations for the neonatal period, occupational recommendations, supervision recommendations, national policy recommendations, recommendations for training students and staff, and general public recommendations. Discussion: Based on the outcomes of disrespect and abuse, it is recommended to provide comprehensive guideline for policymakers and planners to formulate plans through the RMC promotion approach. Healthcare service policymakers can use this guideline to design some interventions to meet women's financial, psychological, and legal needs. Plain language summary: Disrespect and abuse in the delivery room is associated with negative experience of delivery and poor maternal care quality index. Also, disrespect and abuse is the main barrier to achieving maternal health outcomes. In spite of the considerable achievements in maternal and child health, there is still a large number of maternal and neonatal mortality worldwide. It seems that disrespect and abuse is a key potential obstacle hindering access to delivery facilities and skilled care providers. To achieve the sustainable development 2030 goals developed by the World Health Organization (WHO) (Goal 3.1: Ensure health lives and promote well-being for all at all ages: reduce the global maternal mortality ratio to less than 70 per 100,1000 live birth), stakeholders and relevant institutions should consider respectful pregnancy and delivery care services as a key solution to reducing maternal mortality. Nevertheless, there is no comprehensive guideline with regards to respectful maternity care in the WHO or provided by other countries. In this multiphase mixed-methods study, recommendations were made for respectful maternity care promotion through the data obtained from Phase I (i.e., the quantitative section with a cross-sectional design), Phase II (i.e., the qualitative section with a content analysis method), and Phase III (i.e., focus group discussions with birth attendants as well as opinions of the specialized panel through the Delphi technique). The composed recommendations were then analyzed and finalized by relevant specialists in terms of execution capacity, approvability, and cost-effectiveness within the current context of Iran. The results of this multiphase study led to 80 recommendations for RMC promotion. The recommendations were classified as eight areas called recommendations for the pregnancy period, recommendations for the labor period and delivery, recommendations for the neonatal period, occupational recommendations, supervision recommendations, national policy recommendations, recommendations for training students and staff, and general public recommendations. [ABSTRACT FROM AUTHOR]

Background: Disrespect and abuse (D&A) violate the fundamental principles of ethics, human rights, and basic obligations to protect and relieve patients. This study aimed to identify the status of D&A and its relationship with the post-traumatic stress disorder (PTSD) among Iranian women. Methods: This prospective study was conducted on 288 mothers admitted to the maternity wards of three public and three private hospitals in Tabriz. The data collection tools were socio-demographic and obstetric questionnaires as well as D&A (6–18 h postpartum) and PTSD (one month postpartum) scales, which were completed by participants in interviews. Multivariate logistic regression was employed to determine the relationship between PTSD and D&A in adjusting the socio-demographic and obstetric variables. Results: In this study, 74.7% of mothers reported one or multiple types of D&A. According to the diagnostic criteria for PTSD, 16.3% of the participants experienced postpartum PTSD. The mean (± standard deviation) of the PTSD score was reported 7.32 (± 2.0) in the women experiencing D&A, whereas it was 1.0 (± 0.0) in the women having no experiences of D&A. According to the Mann–Whitney U test results, there was a significant relationship between the total and all subscales of PTSD score and D&A (p < 0.001). The multivariate logistic regression results indicated that the likelihood of PTSD was significantly lower in the participants without any D&A experiences than in those with D&A experiences (aOR: 0.06; 95% CI 0.01 to 0.58; p = 0.015). Conclusion: Given the PTSD–D&A relationship, it is recommended to improve maternal care in maternity facilities to prevent any unintended PTSD complications. [ABSTRACT FROM AUTHOR]

Background: Disrespect and abuse (D&A) can violate human rights, affect women's decisions on the type of delivery method, and exacerbate their mental health conditions; therefore, this study aims to: a) assess the status of D&A and respectful maternity care (RMC) during childbirth and their relationships with childbirth experience, socio-demographic and obstetrics characteristics; b) explain women's perceptions of various RMC aspects and determinants during childbirth; and c) present a guideline for promoting of RMC. Methods/design: A mixed methods sequential explanatory design will be used to conduct this study in 3 phases. The first phase is a quantitative study with a longitudinal descriptive-analytical design to identify any D&A and RMC and their relationships with childbirth experience among 334 women who have given birth in public and private hospitals in Tabriz, Iran. The sample will be selected proportional to each population. The second phase is a qualitative study to explore women's perceptions of various RMC aspects and their determinants during childbirth. The conventional content analysis approach will be used to analyze the data. The third phase is focused on developing a guideline to improve the quality of maternity care. The literature review, findings of phase one and two, and focus group discussion (FGDs) with staff in the labour ward and using a Delphi technique will be used to complete the final phase. Discussion: Considering the vulnerability of women during labor and delivery and the effect of D&A on cesarean section rates, a supportive guideline can improve the quality of maternity care and reduce D&A during childbirth, and improve women's childbirth experiences. Ethical code: IR.TBZMED.REC.1398.202. [ABSTRACT FROM AUTHOR]

Background: The absence of Respectful Maternity Care (RMC) deters mothers from seeking maternity care services. Given the importance of RMC and the lack of a standard tool for its assessment in Iran, the present study was conducted to translate and assess the psychometric properties of the RMC questionnaire in Iranian women.Methods: Forward-backward method was used for translating the questionnaire from English into Persian. A total of 265 postpartum women entered the study by simple random sampling from public and private hospitals in Tabriz, Iran. The validity of the questionnaire was confirmed through the face, content and construct validity. Construct validity was assessed through exploratory and confirmatory factor analyses. The internal consistency and test-retest reliability were used to confirm the reliability of the questionnaire. Internal consistency was examined by measuring the Cronbach's alpha in a sample of 20 mothers, and test-retest stability by calculating the Intraclass Correlation Coefficient (ICC) in the same group of mothers, who had completed the questionnaire twice with a two-week interval.Results: The exploratory factor analysis led to the extraction of one factor. Item 12 was eliminated due to its low factor loading. X2/df was less than 5, and RMSEA was less than 0.08, which confirms the validity of this model. The Cronbach's alpha coefficient was obtained as 0.93 and ICC (with 95% confidence interval) as 0.98 (0.96 to 0.99).Conclusion: The results of the study demonstrated that the Iranian RMC scale can be used as a valid and reliable instrument to assess RMC in Iran. [ABSTRACT FROM AUTHOR]

Background: Intrapartum respectful maternity care is defined as a fundamental human right that can affect the mother's experiences. This study aimed to determine the status of respectful maternity care and its relationship with childbirth experience among Iranian women.Methods: This prospective cohort study recruited 334 postpartum women in postpartum wards of two public and four private hospitals in Tabriz, Iran. Quota sampling was used based on the number of births in each hospital. Data were collected through interviews with the use of the following tools: sociodemographic and obstetrics characteristics questionnaire, respectful maternity care scale (6 to 18 h postpartum), and childbirth experience questionnaire (30 to 45 days postpartum). The General Linear Model was used to determine the relationship between respectful maternity care and childbirth experience.Results: The mean respectful maternity care score was 62.58 with a range of 15 to 75, and the total childbirth experience score was 3.29 with a range of 1 to 4. After adjusting for sociodemographic and obstetrics characteristics, a statistically significant direct correlation was found between respectful maternity care and a positive childbirth experience (P < 0.001).Conclusions: The findings reveals a direct relationship between respectful maternity care and positive childbirth experience. Therefore, it is recommended that mangers and policy makers in childbirth facilities reinforce facilitating a respectful maternity care to improve women's child birth experience and prevent potential adverse effects of negative childbirth experiences. [ABSTRACT FROM AUTHOR]