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Objective: To analyze the effectiveness of an educational intervention to increase knowledge of Respectful Childbirth among undergraduate nursing students. Materials and Methods: A quasi-experimental study was conducted with second- to sixth-semester undergraduate nursing students. Sociodemographic data were collected, and three theoretical-practical sessions were held. Statistical analysis was performed using STATA; descriptive statistics included means and percentages, and inferential statistics included the chi-square. Results: 50% of the students are dedicated to studying and 50% of them to studying and work. The pretest showed a score of 5.26 with SD 20.4, the posttest 9.46, SD 9.1. Regarding respectful childbirth, the score was 3.8 SD 2.6 with a posttest 9.6 SD 1.09. In the area of pregnancy, the initial score was 7.9 SD 2.11 and the final score 9 with SD 1.68. In labor, the scores were 7.8 and 9.6 respectively with SD 2.57 at the beginning and SD 1.01 at the end. In breastfeeding, the scores were 7.1 and 9.4 SD of 3.4 and 1.3 respectively, for postpartum 4.6 and 9.4, SD 3.4 and 1.3 respectively, and finally, perinatal psychoprophylaxis 0.36 and 9.68 SD of 0.87 and 0.84 respectively. This indicates a significant difference in each of the assessments, as well as in knowledge. Conclusions: The educational intervention showed a significant difference and increased students' knowledge, as well as their concern for respecting women during childbirth, the implementation of dynamic and interactive strategies for students, and the restructuring of academic programs for nursing professionals.
Keywords: Childbirth; Respectful Childbirth; Pregnancy; Perinatal Psychoprophylaxis; Breastfeeding; RespectfulChildbirth; PerinatalPsychoprophylaxis
Formanyyears,childbirthhasbeenmanagedaccordingtoestablishedprotocolsinhospitals.Womenhave beenviewedaspatientswhomustbecaredforina singleposition,withactionsthatmightfacilitatethe descentofthefetusorthebondbetweenmotherand childbeingdiscouraged,whilecesareansectionshave been prioritized and adopted as routine practice in childbirthcare.Asmentioned,itrepresentsanormalized exercise of obstetric violence. The testimonies in her article highlight a cycle of medicalizing interventionsandvariousformsofabusethatamounttoa systematicviolationofwomen’shumanrights.Prado notesthatobstetricviolenceislinkedtostrategiesof powerandcontroloverwomen’sbodies,groundedin biomedicalthinkingthatframeschildbirthasapathological,risky,anduncontrollableevent[1]. However,althoughsexualandreproductiverightsare recognizedbytheInter-AmericanCommissiononHumanRights,obstetricviolencepersists,alongwithan increaseincesareansectionsandafailuretorespect thedecisionofthewomanandherpartnerregarding howtogivebirth,providedthatthepregnancyiswithoutrisk.
Internationally,attentionhasbeendrawntotheimportanceofrespectingsexualandreproductiverights,recognizingsexualandreproductivehealthasanintegral partofhumanrights;however,therecontinuestobe atendencytowardpracticesthatcontributetoobstetricviolenceandmisinformationregardingrespectful childbirthcare[2].
Initsrecommendationsonchildbirthcare,theWHO statesthatduringchildbirth,thewomanisthecentral figureandthathercaremustberespectful, emphasizingfreedomofmovementduringlabor,painmanagementusingnon-invasivetechniques,allowingthe womantochoosethepositioninwhichshefeelsmost comfortableandsafetogivebirthtoherchild,andensuringsheisaccompaniedatalltimesbyatrustedpersonsoshefeelssecure,amongmanyothermeasures. However,whileforsomewomenandtheirpartners, motherhoodisauniqueandunparalleledexperience, formanyothersitisasourceofobstetricviolence[3]. Ontheotherhand,patriarchalsocietyhasestablished aseriesofnormsandexpectationsbetweenmenand womenthathavecreatedakindofsubordinationin whichallmannerofviolentpracticesarecarriedout, rangingfromverbalabusetophysicalabuse,normalizedbyaseriesofinstitutionalizedpracticesthatstrip womenofcontrolovertheirownbodies, transforming them into scientific subjects that construct new discourseswhichcommunicativelyencouragegender- Ingeneralterms,variousacademicstudiesinMexico highlighttheexistenceofapathologizingformofobstetriccarewithintheMexicanhealthcaresystem;but thefailuretorecognizewomen’srightsandthelackof empathyhaveledthesystemtoincreaseunnecessary cesareansections,routineepisiotomies,restrictions onmobility,andtherequirementtoremaininasingle positionalljustifiedbasedonknowledgeofinsufficient scientificvalue[5].
Therefore,theimportanceofprovidingdignifiedcare andtreatmentduringchildbirthliesinthebenefitsthat boththewoman,herchild,andherpartnerwillderive fromit;consequently,since2000,publicpolicieshave beendevelopedtopromotehumanizedchildbirth.In Brazil, the Prenatal Humanization Program was created,whosepoliciespromoteaccesstoobstetricand gynecological care, as well as the reorganization of healthdepartmentstooffermothersmultidisciplinary childbirth support that addresses any need. [6] AnotherexampleisEcuador,whichhasestablishedthe MaCFHF(MotherandChild-FriendlyHealthFacilities) regulations,settingguidelinesforthecertificationof healthfacilitiesprovidingmaternalandneonatalcare. The goal is to improve the quality of care, promote humanizedchildbirth,andencouragebreastfeeding, therebycontributingtothereductionofmaternaland neonatalmorbidityandmortality.[7] Similarly, in Mexico, models of care for women duringpregnancy,childbirth,andthepostpartumperiod weredeveloped,aswellashumanizedchildbirth,the modelofobstetricpsychoprophylaxiseducation,and the Baby-Friendly Hospital Initiative, among others. Effortshavebeenmadetoincorporatethesemodels into hospitals, and they have received favorable responsesfromhealthcarepersonnel;however,establishingthistypeofcarehasnotbeeneasy,asunnecessarycesareansectionscontinuetobeperformed[8]. TheWorldHealthOrganization(WHO)definesRespectfulChildbirthascareorganizedtoprovideallwomen withservicesthatupholdtheirdignity, privacy, and confidentiality;arefreefromharmandabuse;andallowforinformedchoiceandcontinuousemotionalsupportfromacompanionoftheirchoiceduringlaborand delivery[9].
RespectfulChildbirthalsoreferstotherecognitionof therightsthatwomenandnewbornshaveatbirth,includingduringpregnancyandthepostpartumperiod, andhumanizationreferstotheprocessofre-examining and restoring the principles and values inherent to humanbeingssimplybyvirtueofbeingpeople,and puttingthemintopracticeduringchildbirthcare[9]. With regard to humanized or respectful care during childbirth,itisdescribedasamodelofchildbirthcare thattakesintoaccounttheopinions,needs,andemotionalwell-beingofthewomanandherfamily,placing heratthecenterofherownchildbirthexperience.[9]. Fromtheglobaltothelocallevel,thereisalegalframework that supports humanized childbirth, as establishedinthefirstarticleoftheUniversalDeclaration ofHumanRights,whichstates:“Allhumanbeingsare born free and equal in dignity and rights. They are endowedwithreasonandconscienceandshouldact towardsoneanotherinaspiritofbrotherhood.”Inthis context,humanizedchildbirthoffersthetoolstofoster fraternalbehavioramongthemother,herfamily,and thenursingstaff.[10] TheWorldHealthOrganization(WHO)emphasizesthat thisshouldbean“experienceofcare”;forthisreason, itsuggestsensuringqualitycareduringlabor, delivery,andthepostpartumperiod,therebyachievingbetteroutcomescenteredonthewomanandherfamily. Thisincludesgivingbirthtoahealthybabyinasafe clinicalandpsychologicalenvironment,withtheemotionalsupportofapartnerandkind,technicallycompetentclinicalstaff. Thisconcepttakesintoaccount thatmostwomendesireaphysiologicallabor,tofeel capableofbringingtheirchildintotheworld,andto havecontrolovertheirbodiesthroughparticipation indecision-making,includingwhenmedicalinterventionsareneededordesired,sotheycanbeactiveparticipantsinthatmoment[11].
Inlightoftheseobservations,inFebruary2018,the WHOissuedfifty-sixrecommendationsforRespectful Childbirth care, which are aimed not only at reducingunnecessaryinterventionsbutalsoatimproving women’sexperiences,empoweringthemtomakedecisionsduringlaboranddelivery,andhumanizingthe process.[11].
Therefore, Respectful Childbirth recognizes that all women have the right to experience childbirth as a personalandpositiveevent. Forthisreason,several hospitalsinsomecountriesareimplementingthepracticeofRespectfulChildbirth,asitispartofthelaws concerningwomen’srighttodignifiedandrespectful care during pregnancy, childbirth, postpartum, and newborncare,intendingtostandardizethismodelof careinallhospitalsworldwide.[12].
Forthisreason,thegoalisforstudentstogainknowledgeaboutRespectfulChildbirthintheirclassrooms andthroughtheireducationalprograms.Thiscaresystemaimstosupportthewoman,herchild,and/orher partneratalltimestoachieveasuccessfulchildbirthexperienceandpromotethebenefitsoftheparent-child bond;Therefore,theaimistoanalyzetheeffectiveness ofaneducationalinterventiontoincreaseknowledge ofRespectfulChildbirthamongundergraduatenursing students.
A quantitative study was conducted using a quasiexperimentaldesignwith50studentsintheirsecond throughsixthsemestersoftheBachelorofNursingprogram. locatedinPachuca,Hidalgo,amongstudents intheir2nd,3rd,5th,and6thsemestersoftheBachelorofNursingprogramin2024. Thesamplingwas non-probabilisticandbasedontheinclusioncharacteristics...
Thesamplingwasnon-probabilisticandbasedonthe inclusionofconsecutivecases,asthestudentsselected werethosewhowereavailableatthetimetoparticipateinthisresearchstudy.
DatawereenteredintothestatisticalsoftwareSTATA 18.Fordescriptivestatistics,meansandpercentages wereused,andforinferentialstatistics,thechi-square testwasusedtocomparetheresultsobtained.
• RegularstudentsenrolledatATENEOUniversity inHumanitiesandHealthSciences,Pachuca,Hidalgo.
• Studentsarecurrentlyenrolledinthe2nd,3rd, 5th,or6thsemesteroftheBachelorofNursing program.
• Studentswhohavesignedtheinformedconsent form.
• Nogenderdistinction
• Studentswhohavepreviouslyattendedacourse onrespectfulchildbirth.
• Students are currently enrolled in a different semester.
• Incompletepre-testinformation.
• Studentswhodonotattendatleast90%ofthe educationalprogram’ssessions.
• Studentswhodecidetowithdrawfromtheprogram.
ThestudywassubmittedforreviewtotheEthics and Research Committee of the Institute of
Age 25.5SD:6.3 23.4SD:3.9
Women 40(80%) 14(93.3%) Men 10(20%) 1(6.67%)
Single 39(78%) 11(73.33%) Married 9(18%) 3(20%) Cohabitation 2(4%) 1(6.67%)
Study 25(50%) 8(53.33%)
Health Sciences, UAEH, which issued a favorableopinionunderofficialdocumentnumber 226/2024.
The study was approved by the Nursing CoordinationOfficeatATENEOUniversity. Beforeimplementingtheinterventionprogram,aninitialmeetingwas heldwiththeCoordinatoroftheBachelorofNursing program, followed by meetings with students from eachsemester.Duringthesemeetings,theobjectives, methodology, and benefits of the project were explainedtothestudents,whothensignedtheinformed consentformalongwiththeirwitnesses.Inaddition, duringthesamemeeting,thesociodemographicdata collectionform—whichispartofthepretestadministeredbeforetheintervention—wasadministeredtothe students.SeeAppendix3.
ToassessthelevelofknowledgeregardingRespectful Childbirth,aquestionnairewasdesignedandevaluatedbyexperts.ItutilizedaLikertscale,whichensured thatstudentsprovidedresponsesreflectingtheirunderstandingofthetopic.Toassessthevalidityoftheinstrument,anexpertreviewwasconductedtoevaluate itsrelevance,determiningwhetherthequestionnaire isappropriateforthestudy’sobjective,aswellasits wording,toassessthequalityofthequestions’phrasing,language,whichincludesassessingthecomprehensibilityofthequestions;facevalidity,todetermine whetherthequestionnairemeasureswhatitsresearch objective actually intends to measure; and content, whichinvolvesevaluatingallelementsincludedinthe questionnairetoensuretheyfallwithinthescopeof thesubjectunderstudy.Correctionsweremadebased
50(100%) 15(30%) 14(28%) 10(20%) 11(22%) 23.2SD:4.5 27.3SD:7.8 29.8SD:7.3
9(64.29%) 7(70%) 10(90.9%) 5(35.71%) 3(30%) 1(9.09%)
12(85.71%) 8(80%) 8(72.73%) 2(14.29%) 2(20%) 2(18.18%) 0 0 1(9.09%)
9(64.29%) 3(30%) 5(45.45%) 25(50%) 7(46.67%) 5(35.71%) 7(70%) 6(54.55%) 0 0 0
ontheevaluationoftheinstrumentandthescientificallygroundedobservationsprovidedbytheexpert panel;Theprofessionalswhoevaluatedtheinstrument heldaBachelor’sdegreeinNursingastheirprimary qualification,withspecializationsinPerinatalNursing attheMaster’sandDoctorallevels;theyareconsidered expertsinthefieldastheyhavededicatedtheirstudiesandworktoRespectfulChildbirthcare, prenatal education,andnursinginstruction.
Theinstrumentwasdividedintotwodimensions.The firstdimensionincludedpersonalinformation, with sevenitemstobeanswered,suchasname,student age,gender,maritalstatus,semester,phonenumber, andwhetherthestudenthadreceivedtrainingonHumanizedChildbirth.Theseconddimensionassessed thestudent’slevelofknowledgeregardingRespectful Childbirth, which consisted of six categories and 19 questionsclassifiedaccordingtoeachcategory:background,respectfulchildbirth,pregnancy,labor,breastfeeding,postpartumperiod,andperinatalpsychoprophylaxis.
Subsequently,apilotstudywasconducted,whichinvolvedadministeringthequestionnairetonursingstudents,withauthorizationobtainedfromthenursing departmentofanotheruniversity.
Acourseworkprogramwasdesignedusingaconstructivist approach and divided into six thematic areas. Threevirtualeducationalsessionswereheld,eachlasting480minutes,whichweredeliveredtostudentsin their2nd, 3rd, 5th, and6thsemestersoftheBachelorofNursingprogramatUniversityofHidalgoMexico. Thesestudentstookapretestbeforethesessionsbegan;duringthesessions,studentswereassessedon sixkeypointsandcompletedapost-testquestionnaire toevaluatetheirlevelofknowledgeregardingRespectfulChildbirth.Thescoreforeachquestionallowsfor theclassificationofthestudent’sknowledgeregarding RespectfulChildbirthcare.
The student population at this institution consisted of56studentsenrolledinthe2nd,3rd,5th,and6th semestersoftheBachelorofScienceinNursingprogram;however,50studentsmettheinclusioncriteria. Thefollowingtableshowsthedemographiccharacteristicsoftheparticipants.
Itshouldbenotedthatatotalof56studentsparticipated,2ofwhomdroppedoutduetoworkcommitments,3didnotachieve90%attendance,and1had alreadybeenexposedtoinformationaboutRespectful ChildbirthataclinicinMexicoCity. Therefore, they wereexcludedfromthestudyinaccordancewiththe exclusionandeliminationcriteria.The50studentsin thestudyhadnopriorknowledgeofthesubjectand werethereforeadmittedtotheeducationalintervention.
The following table shows the results of the participants’pre-andpost-tests:
Table 2. Pre-andpost-testevaluationinthestudy population.
Pre-exam 5.26 20.4 Post-exam 9.46 9.1 Significance P<0.05 P<0.05
In the analysis of student assessment, the first test yieldedascoreof5.26withastandarddeviationof20.4, whilethefinaltestyieldedascoreof9.46withastandarddeviationof9.1.Therefore,thereisstatisticalsignificanceineachofthetwopre-andpost-intervention assessmentsregardingknowledgeofRespectfulChildbirth.
Belowisacomparisonofthetestsadministeredbyarea ofknowledgeaccordingtotheassessmentinstrument: Thefollowingtableshowstheresultsbysemesterand subjectareainthecategoryofhistoricalbackground ofchildbirth: Thefollowingtableshowsacomparisonofpre-and post-testsonknowledgeofthetopicof“Pregnancy”by gradelevel: Thefollowingtableshowsacomparisonofpre-and post-testscoresbygradelevelandsubjectareaforthe topic“Labor”: Thefollowingtableshowsthepre-andpost-testcomparisonbygradelevelandsubjectareaforthetopic “Breastfeeding”: Thefollowingtableshowsacomparisonofpre-and post-testscoresbygradelevelandsubjectareaforthe topic“PostpartumPeriod”:
Table 3. Comparisonofpre-andpost-testsbysubjectarea.
Initial 3.8DE:2.6 7.93De:2.11 7.8DE:2.57 7.1DE:3.4 4.6DE:5.03 .36DE:.87 Final 9.6DE:1.09 9DE:1.68 9.6DE:1.01 9.4DE:1.3 9.4DE:2.39 9.68DE:.84 Significance P<0.05 P<0.05 P<0.05 P<0.05 P<0.05 P<0.05
Table 4. Comparisonofpre-andpost-testresultsfromtheeducationalinterventiononknowledge,byschool yearandsubjectarea,inthecategoryofhistoricalbackgroundofchildbirth
Initial 4.7De:2.25 1.42De:1.71 4De:1.4 3.06De:2.3 Final 8.5De:1.38 9.76De:.89 9.6De:1.05 9.6De:1.0 Significance P<0.05 P<0.05 P<0.05 P<0.05
Table 5. Comparisonofpre-andpost-testsbyschooltermandsubjectareainthepregnancycategory.
Initial 7.5SD:1.97 6.1SD:1.78 9.3SD:1.40 9.3SD:1.34 Final 8.6SD:2.10 8.8SD:1.65 9.3SD:1.40 9.3SD:1.34 Significance P<0.05 P<0.05 P<0.05 P<0.05
Table 6. Comparisonofpre-andpost-testscoresbygradelevelandsubjectareainthe“Labor”category.
Initial 6SD:2.87 7.14SD:2.20 9.6SD:1.05 9.3SD:1.34 Final 9.55SD:1.17 9.5SD:1.21 10SD:0 9.6SD:1.00 Significance P<0.05 P<0.05 P<0.05 P<0.05
Table 7. Comparisonofpre-andpost-testscoresbygradelevelandsubjectareainthebreastfeedingcategory.
Initial 5.5SD:3.43 4.6SD:2.91 10SD:0 9.7SD:0.75 Final 9.5SD:1.40 9.2SD:1.52 9.5SD:1.58 9.5SD:1.01 Significance P<0.05 P<0.05 P<0.05 P<0.05
TherehavebeensignificantimprovementsinknowledgeregardingthesubjectareainthePostpartumcategory.
Thefollowingtableshowsacomparisonofpre-and post-courseknowledgelevelsforthesubjectarea“PerinatalPsychoprophylaxis”:
Itwasobservedthatthestudentslackedknowledgeregardingprenataleducationforchildbirthpreparation, andthatthiswastakenintoaccount.
Giventheneedforpregnantwomenandtheirfamilies toexperiencearespectfulchildbirthandfortheirrights tobeupheld,itisnecessarytodiscusskeyaspectsregardingstudents’knowledgeofrespectfulchildbirth. First,thestudydesignimplementedaimstoincrease students’knowledgeofthesubject. In2023, Cárdenasdemonstratedthatattentionshouldbefocused oneducatingstudentsaboutRespectfulChildbirth,as wellasontheirlearningtobringaboutachangeinpatientcare. Thesefindingssupportthesituationthat motivatesnursingstudentstobringaboutchangeand providecareinanempatheticandrespectfulmanner byaddressingwomenbyname,supportinglaborwith wordsofencouragement,andemployingvariouspain managementtechniques[13].
Therefore,thefindingsregardingtheimplementation ofaneducationalinterventionconfirmthatitisofutmostimportanceforstudentstoincreasetheirknowledgeofrespectfulchildbirthandadapttheirclinical practice accordingly [14] [15]. This underscores the importanceofdevelopinganeducationalintervention fornursingstaff,ensuringthatpregnantwomenare caredforbynurseswithknowledgeofrespectfulchildbirth to provide better care [16] [17]. Similarly, it is recognizedthataneducationalinterventionisthecornerstoneofgoodnursingcarepractice; researchon childbirthknowledgefocusesonstudentstoensure theyprovidequalitycare[18][19].Itwasalsodemonstratedthatstudents’knowledgeincreasesbasedon a sound educational framework, such as an educational intervention, although it is true that ongoing trainingcontributestotheincreaseinstudents’knowledge,abilities,andskills.Therefore,aperinataleducationprogramdemonstratedthatitisnecessarytoimprovestudents’attitudestowardchildbirthtoenhance women’sexperiencesandpreventchildbirth-related trauma;currenttraininginperinatalcarelacksacomprehensiveandbiopsychosocialperspectivethatimprovesthequalityofclinicalpracticeduringchildbirth [20].Basedontheresultsofpre-andpost-testsadministeredtoassesstheknowledgelevelofundergraduatenursingstudents,aswellastheimplementation ofaworkshopcourse,itisevidentthatthestudents increasedtheirunderstandingofRespectfulChildbirth, leadingthemtochangetheirperspectivesregarding respectfulcareforwomenandtheirpartnersand/or families.Followingthislineofreasoning,asignificant effectwasevidentinincreasingthelevelofknowledge amonghealthcarepersonnel, indicatingthateducationalinterventionsareeffectivenotonlybecauseof thebodyofknowledgeprovidedbythetrainerbutalso becauseofthecollectivelearningcontributedbyeach participant.Inthisstudy,theactivitiesgeneratedapositivechangeintheparticipants,whichwillbeshared amongprofessionals,fosteringacceptanceandimprovingthequalityofcarefornewbornsinneonatalintensivecareunits[21]
Theeducationalinterventiondemonstratedasignificantdifferenceandincreasedstudents’knowledge, aswellastheircommitmenttorespectingwomenin labor,implementingdynamicandinteractivestrategies,andrestructuringacademicprogramsfornursing professionals.
Withintheframeworkofrespectfulchildbirth,therole ofregisterednursesisessential, particularlyinpublic clinical settings where negligence or a lack of respect for the labor process may occur, which could constituteaviolationofhuman,sexual,andreproductiverights.Therefore,registerednursesmusteducate womenthroughouttheirpregnancy,childbirth,and postpartumperiod,specifyingtheprocedurestobefollowedandprovidingrelaxationtechniquestoalleviate pain,therebypromotingrelaxationforpainrelief.This helpsmaintainfreedomofmovement,encouragesthe presenceofasupportperson,facilitatesfindingthe bestpositionfordelivery,monitorstheconditionof category.
Initial 1.3SD:3.51 Final 8.6SD:3.51 9.2SD:2.67 10SD:0 10SD:0 Significance P<0.05
Table 9. Comparisonofpre-andpost-testsbyschooltermandsubjectareaintheperinatalpsychoprophylaxis category.
Initial 0DE:0 Final 10DE:0 Significance P<0.05
themotherandbaby,thecouple,andthefamily,promotesinterdisciplinarycollaboration,andstreamlines proceduresincaseofcomplications.EducationonRespectfulChildbirthrepresentsacost-effectivetoolfor preventingcomplicationsduringchildbirth,thereby contributingtothereductionofmaternalandperinatal mortalityinthecountryandworldwide;italsooffers benefitsinlaborcare,improvingthequalityoflifefor themother,father,andtheirfamily.
Toeachmemberofmyadvisorycommitteeforthedevelopmentofthiswork,aswellastotheprofessorswho promotethistypeofscientificresearch.Specialthanks to the unwavering support of Dr. Josefina Reynoso VázquezandDr.JesúsCarlosRuvalcabaLedezma.
Theauthorsdeclarethatthereisnoconflictofinterestregardingthepublicationofthisarticle.
Theauthorsdeclarethatnoartificialintelligencewasusedinanyofthesections.