Women’s perceptions: positive childbirth experiences, mistreatment and obstetric violence in a tertiary-care hospital in Sri Lanka

Sri Lanka has the best obstetric outcome indices among South Asian countries, but progressive medicalization of childbirth has raised concerns about patient-centered care. Positive birth experience is an important indicator of the quality of maternity care. This study is the first quantitative study conducted in a Sri Lankan hospital to describe obstetric violence during labour in the labour ward in a tertiary care center and to examine its association with sociodemographic factors. A descriptive cross-sectional study was conducted among women who had a vaginal delivery without adverse maternal or fetal outcomes at a tertiary-care teaching hospital in Sri Lanka. A self-administered questionnaire was used to collect data after delivery before discharge from the hospital. Data were collected over three months and were analysed using SPSS version 22. Of 350 participants analysed, 96.8% reported overall satisfaction with the care received. Specific forms of mistreatment perceived by the patients were: denial of preferred birth position (16.3%), painful vaginal examination (15.4%), lack of a birth companion (10.6%), denial of food, fluid and mobility (9.1%), poor communication (5.4%) and being treated as a passive participant (4.6%). No forms of physical abuse were reported. On multivariate analysis, ethnicity was independently associated with painful vaginal examination ( p = 0.035), denial of preferred birth position ( p = 0.024), poor physical condition of facilities ( p = 0.017) and supply constraints ( p = 0.042 and p = 0.048 respectively); non-Sinhalese (minority) women reported more mistreatment than Sinhalese women in each of these categories, except denial of preferred birth position, which was reported more often by Sinhalese women ( p = 0.024). Parity was independently associated with staffing constraints ( p = 0.042). Although most women were satisfied overall, a substantial minority experienced specific, recurring forms of mistreatment, and ethnicity emerged as an independent predictor of several categories of perceived obstetric violence. Obstetric health care providers should also emphasize the ethics of care, in addition to standard care, to provide a pleasant labour experience for every woman in Sri Lanka.