Maathru Samman Pants: An initiative towards "Respectful Maternity Care".

Respectful maternity care is the new approach under National Health Mission providing services towards improved satisfaction of pregnant women while in the health facility. Maathru Samman Pants is a new transformational initiative respecting both the psychological and physiological concerns of the pregnant woman and her family during labor. Maathru Samman Pant is a pant with vulval opening which is appropriate in size to perform procedures like per vaginal examination, episiotomy, forceps, ventouse application, bladder catheterization, and delivery of baby and placenta with flap on the front and the back for privacy in various positions. This short communication outlines the background, features, benefits, and future directions of Maathru Samman Pants. I emphasize the need for dignified obstetric care, ensuring that all women receive high-quality, equitable, and respectful maternity care in all health facilities. To the present published literature, Maathru Samman Pants is the first of its kind in India for pregnant woman in normal labor. Innovation is vital to address patient needs in present tumultuous environment. Respectful maternity care standards need to be the designed in continuum with patient's perspectives. Therefore, I call on health system across various states to introduce Maathru Samman Pants, like Andhra Pradesh, thereby ensuring the respect of women's basic human right of dignity which is beyond the prevention of mortality and morbidity. The implications of this innovation (Maathru Samman Pants) should not be limited to India only; rather, it should be contemplated by the other health facilities worldwide.

Introduction

Respectful maternity care (RMC) is the new concept introduced under LaQshya to provide dignified care to pregnant women while in the health facility. Few of its components are visual privacy, choices, freedom from ill treatment, and birth companion.[1] The RMC is not only prevention and elimination of disrespect and abuse during childbirth in health facilities. It is a much wider view of providing services towards improved satisfaction of women with their birth experience.[234]

Under the National Health Mission (NHM), there have been multiple initiatives taken to decrease maternal and infant mortality across India. One of the key initiatives is LaQshya, Labour Room Quality Improvement Initiative Guideline, which provide guidelines to improve intrapartum and immediate post-partum care which takes place in the labor room and maternity operation theatre.[5] On the continuum of maternal health care, this is a new transformational initiative respecting both the psychological and physiological concerns of the pregnant woman and her family during labor.[6]

The Imperative of Maathru Samman Pants

Background

Pregnancy is a physiological condition where an expectant mother anticipates the utmost care and empathy. The entire process of labor and vaginal birth time varies, on an average, it is 8 to 13 h.[7] As a practice in public health facilities, the pregnant woman usually go through the process of labor in their own clothes which are often unhygienic as the majority of pregnant women are not prepared with necessary requirements for labor and childbirth.[8] This may lead to anxiety and shame to the pregnant woman. In addition, the pregnant woman is often uncomfortable in labor room in the presence of a man other than husband like male doctors, sanitary workers, and others. This practice of pregnant woman going through childbirth in the absence of personalized delivery attire is not a positive thing.

There are studies documenting the use and importance of sterile pants in a different surgeries/operations.[910] A possible reason for not identifying the need of the sterile pants during childbirth may be the relatively higher client volumes. However, few Muslim countries provide sterile covered attire as an honor to the pregnant woman during childbirth.[11] There are different aspects of the health system in other countries which does not provide covered maternity pants. The first may be the high cost and second demand from the woman, families, and communities. A possible reason for this discrepancy may be the relatively higher client volumes in hospitals or high cost, which may impede providers’ ability to offer more patient-centric care. Innovation of maternity pants titled “Maathru Samman Pant (MSP)”[12] is an approach towards dignified obstetric care ensuring that all women receive high-quality, equitable, and respectful maternity care in government health facilities.

Current status

The Maternal Mortality Ratio (MMR) of Andhra Pradesh is 74 per 100,000 live births as per RGI-SRS (2014--16). This is better compared with the national figure of MMR 130 per 100,000 live births.[13] The significant decline in MMR of Andhra Pradesh has been due to the efforts of health system providing continuous innovative strategies for maternal health. Andhra Pradesh is near to achieve the sustainable development goals of MMR 70 per 100,000. Andhra Pradesh is the first Indian state to adopt a new concept of Maathru Samman Pant. The budget for Maathru Samman Dress is approved by National Health Mission as documented in record of proceedings 2019_20 Andhra Pradesh.[14]

Features

Maathru Samman Pants is a pant, covers both legs from waist to ankle. There is a vulval opening which is appropriate in size to perform procedures like per vaginal examination, episiotomy, forceps, ventouse application, bladder catheterization, and delivery of baby and placenta. The flap on the front of the pant covers the opening during supine position that is when the pregnant woman is on labor table. The flap on the back of the pant is to cover the opening during walking and standing in labor room or ward. The pants have minimal space for contaminants to hide like button, zips, etc.

Benefits

Maathru Samman Pants provide multiple benefits for pregnant woman during childbirth. It provides privacy to pregnant women while waiting in the labor room by avoiding exposure of other parts of women. It also provides comfort and safety to pregnant women while doctors perform procedures and childbirth by providing sterile cover. It assists in avoiding the hassle of dressing and undressing after each per vaginal examination and different procedure. It reduces the time for preparation to do procedures and childbirth. It helps in the prevention of infections to mother by using washed and autoclaved pants in the labor room. In addition, it prevents the risk of infections to newborn by stopping exposure to unsterile environment. It prevents exposure to cold as the majority of the labor rooms have provision for air conditioners. The pregnant women will feel comfortable while health personnel attend to other patients in the same the labor room. If properly used it could aid in preventing of the spread of fecal matter to birth canal during the birthing process. It will eliminate embarrassment in front of birth companion and others and will increase the satisfaction of client towards hospital services. It will enhance the confidence of pregnant woman during child birth and build the trust of the pregnant woman towards health system. It provides a shy free environment to the pregnant woman and ultimately provides high quality respectful intranatal care.

Feasibility

There are various factors making Maathru Samman Pants feasible for implementation in the Indian healthcare system. The cloth material used is easily available in the market. The cloth material used is commonly used in government hospitals in the majority of states. The hospitals can be supplied with Maathru Samman Pants as per delivery loads per day. The Maathru Samman Pants can be easily washed and autoclaved with facilities available in the government hospitals with existing human resource. They are easy to maintain and reusable. They are easy to be worn by the pregnant woman and do not require any special help.

Future Directions

Innovation is vital to address patient needs in present tumultuous environment. Health system is slow to embrace it, and there is variation in adoption of innovation across states. The author believe that this article may provide a new perspective on respectful maternity care in the context of Maathru Samman Pants designed to provide dignity to pregnant woman in labor rooms. Gathering feedback will remain a crucial element, in order to maximize the use of Maathru Samman Pants, and improvise it. Scaling up of Maathru Samman Pants is recommended for all health facility, thereby eliminating shy environment, rationalized within the context of providing respectful maternity care.

Conclusion

Over the last decades, the standards of maternity care have rapidly expanded. However, the field is still in its infancy to address patient's thoughts. This article has highlighted the need for one of most essential aspects of respectful maternity care that is privacy and shy free environment for pregnant woman in labor room. To the present published literature, Maathru Samman Pants is the first of its kind in India for pregnant woman in normal labor. Respectful maternity care standards need to be the designed in continuum with patient's perspectives. Thus, Maathru Samman Pants presents an opportunity to ensure the respect of women's basic human right of dignity which is beyond the prevention of mortality and morbidity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.