BACKGROUND: Nearly all birthing people in the Dominican Republic (DR) deliver in a hospital, yet maternal and newborn mortality remain high. Respectful maternity care challenges have been reported but not systematically documented. This observational, mixed-methods study assessed birthing people’s and providers’ experiences at a public hospital in the DR, during the COVID-19 pandemic.
METHODS: In May-July 2022, we surveyed postpartum people and providers to adapt the Person-Centered Maternity Care (PCMC) survey. In July-August 2022 we applied the contextually-modified PCMC survey with postpartum people and providers. Possible scores ranged from 0 (poor) to 93 (exceptional). We calculated mean scores and examined associations with socio-demographic factors. A concordance/discordance analysis examined postpartum people’s and providers’ responses. Content analysis of open-ended questions explored PCMC and opportunities for improvement. Results were stratified by nationality (Dominican or Haitian).
RESULTS: Respondents felt the PCMC survey was appropriate for the context but recommended adding questions around contraception, maternal-newborn separation, differential treatment, and c-section decision-making. The mean PCMC score was 60.1 for postpartum people and 62.0 for providers. Being of Haitian origin, speaking Creole at home, being older, and living further from the facility were associated with lower scores (p<.001). Nearly 70% of providers reported birthing people were spoken to in understandable language/terms compared to 29.8% of birthing people. Most providers (91.7%) reported that consent was sought before procedures, compared to 58.1% of birthing people. Fewer Haitians, compared to Dominicans, reported favorably regarding friendly treatment (42% v 83%); ability to ask questions (34% v 66%); consent being sought before procedures (52% v 71%); and being spoken to in understandable language/terms (14% v 63%). Sixty-one percent of Haitians and 44% of Dominicans reported maternal-newborn separation for more than 6 hours. Qualitative responses revealed verbal abuse and the emotional toll of maternal-newborn separation, among other issues. Birthing people suggested improvements relating to family connectedness: companions, providers communicating with families, and keeping the mother-baby dyad together. Providers focused on infrastructure, equipment/supplies, training, and policy.
CONCLUSION: As the first study to apply the PCMC survey in the DR, this study systematically documented challenges and opportunities to improve birth experiences from the perspectives of postpartum people and obstetric providers. Stakeholder-generated and evidence-based recommendations should be prioritized at Hospital Presidente Estrella Ureña. / 2025-01-04T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/45420 |
| Date | 04 January 2023 |
| Creators | Mitchell Balla, Kathleen Theresa |
| Contributors | Scott, Nancy A. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
| Rights | Attribution-NonCommercial 4.0 International, http://creativecommons.org/licenses/by-nc/4.0/ |
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