it tackles how to deal with women during pregnancy and labor. It is a human development course.

1. Harmful Practice in
Obstetrics. A time for
notion
Prof/ Mahmoud Abdel-Aleem.
Professor of obstetrics and Gynecology. Assiut
university.
Respectful/ DisRespectful
Maternity Care.
A time for notion

2. ‫الضرر‬ ‫الحاق‬

3. Introduction

4. • Obstetrics is a subspecialty concerning with the delivery of
medical and surgical care to women before, during, and after
childbirth.
• It is a unique field as it involves pregnancies and childbirth,
occasions considered to be the most intimate and joyful
occasion in a patient’s life.
• Patients often expect that their obstetric journey would end in
the birth of a perfect baby and the mother in equally good
health.

5. • Although pregnancy and labour are physiological events, severe
complications can occur, requiring prompt and accurate response by
the obstetrician in charge.
• A single mistake -even if- simple, could immediately change a happy
occasion into a devastating one, not only to the life of the expecting
parents, but also to the career of the obstetrician.
• Obstetric injuries tend to be severe, often permanent and
emotionally overwhelming, which. Consequently, triggers many years
of court litigation with high amount of monetary compensation.

6. • Globally, every day about 830 women die from pregnancy- or
childbirth- related complications. In 2015, the UN aims to
reduce the global maternal mortality ratio to < 70 /100 000
births.
• A central component of global efforts to reduce maternal
mortality is to ensure that all women have access to skilled
care before, during, and after childbirth.
• Every woman around the world has a right to receive
respectful maternity care.

8. The good news

9. Role of obstetrician.
• Risk of stillbirth or death due to
intrapartum–related complication
can be reduced by about 20 % with
the presence of a skilled birth
attendant
• Percentage of births assisted by a
skilled birth attendant in Egypt,
2011-2016 is "91.5%"

10. Maternal and newborn health indices

11. The bad news

12. Too Little
Too Late
(inadequate
resources, below
evidence-based
standards)
Too Much
Too Soon
(over-medicalisation of
normal pregnancy and
birth and unnecessary use
of non-evidence-based
interventions)
I-
Suboptimal
Medical
Care

13. II. Obstetric violence Year: 2000
• The misuse of women’s body and reproductive processes
by health personnel, which may include:
Dehumanizing
treatment
Loss of
autonomy and
free decision
Pathologization
of natural
processes
An abuse of
medicalization
Negative impact on quality of life

14. Disrespect and abuse (D&A): Year: 2010, 2015
Physical abuse
Sexual AbuseStigma and
Discrimination
Poor rapport
between women
and providers
Health system
conditions and
constraints
Verbal abuse
Failure to meet
professional
standards of care

15. Categories of disrespect and abuse

16. ‫العنف‬

17. ‫ذات‬ ‫طبيه‬ ‫خدمه‬
‫سيئه‬ ‫جوده‬
‫التواصل‬ ‫سوء‬
‫و‬ ‫السيده‬ ‫بين‬
‫الخدمه‬ ‫مقدم‬
‫الصحيه‬

18. Respectful maternity care
(RMC)

19. • Bodies for International human rights have played a critical
role in codifying, setting standards, and monitoring human
rights violations as regards reproductive health and rights.
• The provision and experience of care during and after
pregnancy, including during childbirth is a key issue.
Patient satisfaction is a measurable outcome.
International Human Rights and the Mistreatment of Women during Childbirth
Rajat Khosla*, Christina Zampas*, Joshua P. Vogel, Meghan A. Bohren, Mindy Roseman, and Joanna N. Erdman

20. • RMC is an approach that is best itemized as:
“Evidence-based maternal care in facilities should include care that
is humane and dignified, and delivered with respect for women’s
women’s fundamental rights”
• It integrates (1) professional ethics and considers (2) psychological,
(3) social and (4) cultural aspects of health care delivery as (5)
essential elements of care.
• It is not only a crucial component of quality of care; it is a human
right.

21. • WHO statement emphasized that
“every woman has the right to
have the highest attainable
standard of health, including the
the right to dignified, respectful
respectful care during pregnancy
pregnancy and childbirth.” 2014,
2014, 2016

22. Objective components of RMC
1. Being free from harm and mistreatment: ‫الضرر‬ ‫منع‬
2. Maintaining privacy and confidentiality: ‫الخصوصيه‬
3. Preserving women’s dignity: ‫الكرامه‬ ‫حفظ‬
4. Prospective provision of information and seeking
informed consent: ‫المستنيره‬ ‫المشوره‬
5. Ensuring continuous access to family and community
support: ‫المجتمعي‬ ‫الدعم‬ ‫و‬ ‫الطبيه‬ ‫الخدمه‬ ‫استمرارية‬

23. 6. Enhancing quality of physical environment and resources:
‫الطبيه‬ ‫الخدمه‬ ‫جودة‬
7. Providing equitable maternity care: ‫الطبيه‬ ‫الخدمة‬ ‫توفر‬ ‫عدالة‬
8. Engaging with effective communication: ‫الفعال‬ ‫التواصل‬
9. Respecting women’s choices that strengthens their
capabilities to give birth: ‫المريضه‬ ‫أراء‬ ‫احترام‬
10.Availability of competent and motivated human resources:
‫مدرب‬ ‫طبي‬ ‫فريق‬

24. Examples of RMC

25. What we should do?
• To Review evidence-based high-
quality guidelines for routine
maternity care to identify what
interventions and practices are
promoted or discouraged for
routine care of women at health
facilities.
• Interventions are to be either:
• Recommended
• No recommended.
We are all working together to one end,
some with knowledge and design, and
others without knowing what they do”
Marcus

26. Conclusions

27. • Women have the right to “freedom from harm and ill
treatment”.
• Components of RMC should be a part of teaching curricula
in both undergraduate and postgraduate medical schools.
• In the future, violation of RMC might be a cause of highest
medicolegal liability.