{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,18]],"date-time":"2026-01-18T23:52:40Z","timestamp":1768780360211,"version":"3.49.0"},"reference-count":26,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2020,7,13]],"date-time":"2020-07-13T00:00:00Z","timestamp":1594598400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Facility-based delivery is an important strategy to prevent poor labor outcomes, and midwives are at the center of maternal care. However, disrespectful and abusive maternal care by midwives is prevalent and leads to poor antenatal care utilization and increased numbers of home deliveries. The objective of the study was to assess the views of women about the care they received during labor and childbirth and describe the interactions between the women and the midwives. This was a qualitative study using in-depth interviews with women who had delivered in midwife obstetric units at a district hospital in Tshwane District, South Africa. Twenty-six women aged 18\u201341 years, and had delivered within the previous six months were selected, using purposive sampling. A thematic content analysis approach and NVivo11 computer software were used to identify emergent themes. Most women had had negative experiences of the maternity services they had received during labor and childbirth. Shouting and rude remarks by midwives caused tension between the midwives and the women and had created a major barrier for communication. The abuse and disrespect that the women were subjected to had created a hostile and uncaring environment for them. They felt stressed, fearful, and anxious throughout labor and childbirth. In response to the hostile environment, they employed manipulative tactics such as pushing before time in the hope of getting attention. These acts resulted in punitive responses from the midwives who joined forces against them, reprimanded, or ignored them. Good interactions, described as being respectful, approachable, and polite, and the sharing of information yielded positive experiences of maternity care. The state of maternity services rendered during labor and childbirth is counterproductive to the existing plan of increasing early antenatal care bookings and presentation to the facilities for labor and childbirth. There is a need to retrain midwives in the respectful care of women during labor and childbirth to facilitate a change in their attitudes.<\/jats:p>","DOI":"10.3390\/ijerph17145035","type":"journal-article","created":{"date-parts":[[2020,7,14]],"date-time":"2020-07-14T09:30:49Z","timestamp":1594719049000},"page":"5035","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Women\u2019s Views of and Responses to Maternity Services Rendered during Labor and Childbirth in Maternity Units in a Semi-Rural District in South Africa"],"prefix":"10.3390","volume":"17","author":[{"given":"Elizabeth","family":"Zitha","sequence":"first","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Ga-Rankuwa 0208, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mathilda M.","family":"Mokgatle","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, School of Public Health, Sefako Makgatho Health Sciences University, Pretoria, Ga-Rankuwa 0208, South Africa"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,7,13]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4102\/curationis.v33i3.2","article-title":"Midwives\u2019 experiences of managing women in labour in the Limpopo Province of South Africa","volume":"33","author":"Maputle","year":"2010","journal-title":"Curationis"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1016\/S0140-6736(14)60930-2","article-title":"Improvement of maternal and newborn health through midwifery","volume":"384","author":"Campbell","year":"2014","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1016\/j.midw.2013.12.014","article-title":"Narratives of distress about birth in South African public maternity settings: A qualitative study","volume":"30","author":"Chadwick","year":"2014","journal-title":"Midwifery"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"McMahon, S.A., George, A.S., Chebet, J.J., Mosha, I.H., Mpembeni, R.N., and Winch, P.J. (2014). Experiences of and responses to disrespectful maternity care and abuse during childbirth; a qualitative study with women and men in Morogoro Region, Tanzania. BMC Pregnancy Childbirth, 14.","DOI":"10.1186\/1471-2393-14-268"},{"key":"ref_5","unstructured":"World Health Organization (2015). The Prevention and Elimination of Disrespect and Abuse during Facility-Based Childbirth, World Health Organization."},{"key":"ref_6","unstructured":"National Committee on Confidential Enquiries into Maternal Deaths (2018). Saving Mothers 2014-2016: Seventh Triennial Report on Confidential Enquiries into Maternal Deaths in South Africa: Executive Summary."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5","DOI":"10.4314\/sacq.v54i1.1","article-title":"Eliminating abusive \u2018care\u2019: A criminal law response to obstetric violence in South Africa","volume":"54","author":"Pickles","year":"2015","journal-title":"S. Afr. Crime Q."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bohren, M.A., Vogel, J.P., Hunter, E.C., Lutsiv, O., Makh, S.K., Souza, J.P., Aguiar, C., Coneglian, F.S., Diniz, A.L.A., and Tun\u00e7alp, \u00d6. (2015). The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review. PLoS Med., 12.","DOI":"10.1371\/journal.pmed.1001847"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4102\/curationis.v36i1.320","article-title":"Mothers\u2019 expectations of midwives\u2019 care during labour in a public hospital in Gauteng","volume":"36","author":"Sengane","year":"2013","journal-title":"Curationis"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Miltenburg, A.S., Lambermon, F., Hamelink, C., and Meguid, T. (2016). Maternity care and Human Rights: What do women think?. BMC Int. Health Hum. Rights, 16.","DOI":"10.1186\/s12914-016-0091-1"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1016\/S0140-6736(14)60789-3","article-title":"Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care","volume":"384","author":"Renfrew","year":"2014","journal-title":"Lancet"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Rosen, H.E., Lynam, P.F., Carr, C., Reis, V., Ricca, J., Bazant, E.S., and Bartlett, L.A. (2015). Direct observation of respectful maternity care in five countries: A cross-sectional study of health facilities in East and Southern Africa. BMC Pregnancy Childbirth, 15.","DOI":"10.1186\/s12884-015-0728-4"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1186\/s12978-017-0411-5","article-title":"It does matter where you come from: Mothers\u2019 experiences of childbirth in midwife obstetric units, Tshwane, South Africa","volume":"14","author":"Oosthuizen","year":"2017","journal-title":"Reprod. Health"},{"key":"ref_14","unstructured":"National Department of Health (2018). Guidelines for Maternity Care in South Africa: A Manual for Clinics, Community Health Care Centres and District Hospitals, National Committee on Confidential Enquiries into Maternal Deaths."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Orpin, J., Puthussery, S., Davidson, R., and Burden, B. (2018). Women\u2019s experiences of disrespect and abuse in maternity care facilities in Benue State, Nigeria. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-018-1847-5"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12978-017-0447-6","article-title":"Midwives\u2019 respect and disrespect of women during facility-based childbirth in urban Tanzania: A qualitative study","volume":"15","author":"Shimoda","year":"2018","journal-title":"Reprod. Health"},{"key":"ref_17","unstructured":"Brink, H., Van der Walt, C., and Van Rensburg, G. (2012). Fundamentals of Research Methodology for Health Care Professionals, Juta and Company Ltd."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1080\/13645579.2017.1281601","article-title":"Comparing focus groups and individual interviews: Findings from a randomized study","volume":"20","author":"Guest","year":"2017","journal-title":"Int. J. Soc. Res. Methodol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"915","DOI":"10.2471\/BLT.14.137869","article-title":"Defining disrespect and abuse of women in childbirth: A research, policy and rights agenda","volume":"92","author":"Freedman","year":"2014","journal-title":"Bull. World Health Organ."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1016\/j.midw.2015.02.004","article-title":"Barriers and facilitators to accessing skilled birth attendants in Afar region, Ethiopia","volume":"31","author":"King","year":"2015","journal-title":"Midwifery"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"110","DOI":"10.1186\/s12939-014-0110-6","article-title":"Exploring inequities in skilled care at birth among migrant population in a metropolitan city Addis Ababa, Ethiopia; a qualitative study","volume":"13","author":"Mirkuzie","year":"2014","journal-title":"Int. J. Equity Health"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"262","DOI":"10.1016\/j.midw.2013.05.006","article-title":"\u2018They treat you like you are not a human being\u2019: Maltreatment during labour and delivery in rural northern Ghana","volume":"30","author":"Moyer","year":"2014","journal-title":"Midwifery"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e26","DOI":"10.1093\/heapol\/czu079","article-title":"Disrespectful and abusive treatment during facility delivery in Tanzania: A facility and community survey","volume":"33","author":"Kruk","year":"2014","journal-title":"Health Policy Plan."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1186\/s12978-015-0024-9","article-title":"Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia","volume":"12","author":"Asefa","year":"2015","journal-title":"Reprod. Health"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1016\/j.srhc.2014.09.010","article-title":"The delivery room: Is it a safe place? A hermeneutic analysis of women\u2019s negative birth experiences","volume":"5","author":"Nilsson","year":"2014","journal-title":"Sex. Reprod. Healthc."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s12978-019-0668-y","article-title":"An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: A mixed methods study","volume":"16","author":"Sharma","year":"2019","journal-title":"Reprod. Health"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/5035\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:51:01Z","timestamp":1760176261000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/14\/5035"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,13]]},"references-count":26,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2020,7]]}},"alternative-id":["ijerph17145035"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17145035","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,13]]}}}