When María Rendo had her first child in 2007, in a private hospital in Murcia, they took the little one to the nest the first night to, as they told her, keep him under observation. Nothing had happened during childbirth to justify that decision. “No one told me how my baby was, they just told me to sleep. They gave him bottles without my consent and they returned him to me the next day without further ado. It was a painful and absurd separation because my baby was healthy,” says Rendo via WhatsApp. To improve care during childbirth, the immediate postpartum and breastfeeding, it is essential to know how women value the care received. This is what led a group of professionals to begin research in 2023 that would collect the experiences of mothers and the professionals who care for them.
Led by the midwife and researcher Antonio Oliver Roigthe MC-IHAN project, which they have called The voice of mothersis coordinated from the University of Alicante together with the association BFHI (Initiative for the Humanization of Birth and Breastfeeding Assistance) and the Ministry of Health, in collaboration with the HQTQ association (Until You Want). “We know that without the knowledge obtained from mothers we cannot reduce the gap between scientific evidence and real hospital practice,” says Oliver. This gap is closely related to the hospital’s culture of care, which, according to the expert, should have a more focused approach on the needs of mothers and their babies. “You should stop doing unnecessary things that can make breastfeeding difficult or worsen the birth experience and offer support when it is needed,” he says, although he adds that changing the way you care is difficult and requires time and the work of many people.
The BFHI was established by WHO and UNICEF in 1991 to improve the health of mothers and babies, modifying harmful care routines and promoting the implementation of good practices in hospitals. Accreditation as an BFHI hospital indicates, in principle, the obstetric-neonatal quality of the center. However, the lack of data on mothers’ experience hinders the actual evaluation of such practices. Salomé Laredo, president of IHAN, explains that it is not enough for a professional to meet certain requirements and do it in the best possible way, but that we must go one step further: “We must know if these professional efforts really help mothers and their children, and for this we need their opinion, which is the one that really has validity due to its sincerity.”
Although the project is ongoing, some preliminary results have already been published, such as those related to the first skin-to-skin contact between mother and baby, in births without complications, according to which less than 50% of the participants have experienced skin-to-skin contact. with optimal skin with their children after giving birth. Regarding the initiation of breastfeeding, only half of them felt that health professionals had encouraged them to breastfeed and received help during the first hour. Regarding maternal satisfaction with the overall care received, the data depends on the region: according to the information obtained so far, mothers in the Balearic Islands, the Valencian Community and Navarra show greater satisfaction.
Oliver points out that they have also observed, according to MC-BFHI data, that maternal ratings on the quality of care are notably higher in BFHI hospitals or in the process of achieving accreditation. “Mothers treated in BFHI hospitals report more positive experiences of professional breastfeeding support, with significant improvements in aspects such as time dedicated to the mother, timely support, confidence in the support available, accessibility to professionals, treatment respectful and empathy,” explains the researcher.
The intention of the research group is for the project to continue indefinitely, to be able to provide this data “in real time” to professionals and mothers involved in improving birth care —those who want to participate only need to fill out the questionnaire found on the project website—.
Beyond improving practices
Laura Alonso has two children. She describes the birth experience of her first daughter in 2012 as unpleasant, with a lack of information, unkind treatment, interventions without consent and a feeling of neglect. In contrast, that of her second child, three years later, in another hospital, was very positive: she received kind attention, detailed information, her wishes were respected, and she enjoyed a calm environment. “I literally had one birth in hell and another in heaven,” she says.
11,500 mothers have already participated in the research, but, according to Antonio Oliver Roig, more than knowing how many do what, their objective is to understand the needs and challenges they face. “Improving the birth and breastfeeding environment goes beyond just applying practices based on scientific evidence; It also involves promoting care that truly addresses the needs of mothers and their babies,” he points out. That is, the active participation of mothers helps to identify what really matters, evaluate how things are and look for solutions. “Our project is based on the idea that to properly adjust professional services to what mothers and babies really need, we must ask them what they consider important, beyond safety and avoiding complications. Mothers provide us with crucial information about the quality of care they receive, information that is often not recorded.”
“It’s not just about what professionals do, but how they do it,” says Oliver. For example, they must provide information about breastfeeding and, furthermore, this information must be actually useful for those who breastfeed. But it is not enough to offer information on infant feeding; rather, according to the expert, this information must be adapted to what the woman needs and include the difficulties she may encounter and how to solve them. Additionally, the mother should feel respected when she decides what she considers to be best for her and her baby. “In the MC-IHAN project, mothers give us information, not only about what is done, but how it is done.”
The training of professionals: a key aspect
Raquel Rosa Cid has two daughters, ages 7 and 3. She has very good memories of her first birth, which was through an agreed induction without an epidural in public healthcare: “I felt in harmony with the midwife and gynecologist who treated me, it was a quick and humane birth. I screamed, cried and laughed in equal measure.” Already on the ward, she says that she did find an outdated nurse who, when her baby cried, offered her a bottle. Her second daughter was also born after an agreed induction and, although the experience was also good, she says that the memory is tarnished by the first midwife who treated her: “She insisted on breaking the bag and ignored our request to donate the cord stem cells.” umbilical”.
The quality of care provided by professionals depends on many factors and, according to midwife Antonio Oliver Roig, training all hospital staff who interact with mothers is a key aspect. He also points out that we must consider the available resources, the existing protocols or the organization of work, since this means that birth and breastfeeding are not treated equally in all places. “There are many differences between large and small hospitals, from different communities or those under public or private management,” he says. Even the characteristics of the mothers, such as educational level or income level, play a role. “Mothers with less income or education tend to receive poorer quality care,” the researcher points out.
The results of the MC-IHAN study led by Oliver can not only help improve the training of health professionals on what mothers need, but are also key to reviewing how hospitals are working and helping them improve. He gives as an example that, if the data shows that they do not receive enough support after giving birth, hospitals can use this information to create simple guides that help professionals offer better help during these times and mothers learn about resources. that they believe. “By analyzing lots of information from different places, hospitals can see how they are doing compared to others and look for effective ways to improve. “This approach not only improves professional training and practice, but also encourages mothers and families to become more involved in evaluating and improving the care they receive, significantly improving the quality of care during birth and breastfeeding.”
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