Exploring the Perceptions of Women’s and Midwives’ in Indonesia Regarding Autonomy and Respect during Labor and Delivery

[[abstract]]Background: Midwives must understand autonomy and respect in order to identify gaps and challenges in the quality of maternity care. To date, few studies have produced evidence about autonomy and respect as part of the quality of maternity care. Incorporating both the perspectives of women’s and midwives can help to pinpoint which aspects of care need to be strengthened to increase the quality of care.Methods: This was a descriptive comparative study. A convenience sampling method was used to select 130 woman and 68 midwives from two hospitals and four health centres in Kudus Regency, Indonesia. After obtaining informed consent, women’s and midwives filled out questionnaires including one for demographic characteristics. The women’s then responded to the Mother’s Autonomy in Decision Making (MADM) scale and the Mothers on Respect index (MORi). In addition, this study modified the two questionnaires for midwives, creating two new instruments, the Midwives’ Views of Client’s Autonomy in decision making (MVCA) and the Midwives’ Views on Respectful Care (MVRC). Results: Household income was the only factor associated with women’s perceptions of autonomy during labor and delivery. None of the demographic factors influenced women’s perceptions about respectful maternity care. However, age, religion, and work experience did impact midwives’ perceptions of respectful maternity care. Comparing women’s and midwives’ perceptions of autonomy in decision making, the women’s perceived they had been given greater autonomy than the midwives believed they had permitted. Conversely, the 68 midwives felt they had shown more respect for the women’s during labor and delivery than the women’s experienced themselves. Conclusions: Differences in perceptions of women’s autonomy and respectful maternity care between midwives and women’s are a barrier to improving the quality of maternity care. Understanding the differences between women’s and midwives' perspectives is critical to understanding women’s preferences and needs, in order for midwives to know if their performance meets women’s expectations. Prioritizing respectful behavior, concern for women’s autonomy, and a comprehensive strategy for improving quality of maternity care should be implemented in order to empower women’s