Respectful newborn care at a selected referral and teaching hospital in Kigali: a mixed method study

Abstract

Background: Respectful Newborn Care (RNC) has recently emerged as a counterpart to the more established Respectful Maternal Care (RMC), focusing on newborns as individuals with human rights. Human rights, including values like dignity, respect, and fairness, apply to all humans regardless of age. RNC is considered a vital component of high-quality care, as compromised care can discourage new parents and their connections from seeking future healthcare at facilities. However, the concept of RNC is still in its infancy in Rwanda. Aim: This study aimed to assess respectful newborn care on the maternity unit of a referral teaching hospital in Kigali.

Method: The research used a mixed-method design, including a descriptive cross-sectional study, focus group discussions, and interviews. The study observed 51 newborns in the labor and delivery room and postnatal ward, conducted focus group discussions with 12 healthcare providers (HCPs), and interviewed eight mothers on the postnatal ward. The observational survey was based on a validated instrument, with modifications to include the World Health Organization's Essential Newborn Care standards on the labor and delivery unit. Data were analyzed using descriptive statistics (SPSS, version 25) for quantitative data and a deductive method and Thematic Analysis for qualitative data collected via audio recordings.

Results: Observations in the labor and delivery room revealed that most HCPs (88.24%) clamped the cord within 1-3 minutes, while 98.04% engaged in skin-to-skin contact (SSC) with the mother, though only for five minutes after birth. Only 3.96% breastfed their newborns within 30 minutes, and 60.78% breastfed within one hour. Some disrespectful care of mothers during childbirth was observed, with only 32.20% allowed their birth position of choice and 52.94% given the choice of a birth companion. Focus group discussions with HCPs defined RNC as timely, evidence-based, protective of the newborn, provided by a skilled attendant, with parental consent, without causing harm, and respectful of the newborn's human rights. Interviews with mothers revealed that RNC should begin during pregnancy and continue after delivery, emphasizing the need for protection, attentiveness, assistance from a pediatrician, and longer skin-to-skin contact with the mother. Newborns should be monitored and checked regularly, similar to mothers, and care provided to the newborn should be near the mother. Mothers should be educated about newborn danger signs, and communication should continue even after discharge. The study identified neglect of standardized newborn care, lack of consistent information, irregular monitoring in postpartum, and a lack of check-ups at discharge as forms of disrespect. Conclusion: The study suggests the need for regular education on RNC for HCPs to make it a routine part of delivering essential newborn care. Additionally, the Ministry of Health could implement health promotion campaigns in Rwandan communities, emphasizing RNC as part of high-quality care.