Maternal & Reproductive Care Values

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Midwife or obstetrician: Pregnancy, birth options and what each involves.
• Nurse: Care during and after birth.
• Perinatal mental health professional: Mood, anxiety and support, where available.
• Social worker: Practical support, leave and costs.
• Bereavement or perinatal palliative care team: Support after a loss or a serious diagnosis, where available.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, Kenya and Uganda, India, Brazil, Iran, China and Chinese women living in other countries, Australia, Ireland, United States, Canada. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

Service as described:

Describes a service when the source was written. Whether it still runs is not verified.

Availability not verified:

Whether this is available today was not checked.

• Global · Guidance · 2018

  WHO's 2018 intrapartum care guideline recommends a companion of choice for all women throughout labor and childbirth.

  Limits: Guidance, not outcomes

  What others could learn: A care team could ask early who a woman wants with her in labor and record it in the birth plan. Facilities could also plan privacy and support for women who have no companion, rather than leaving accompaniment to family alone.

  Conditions, limits and source

  Conditions that matter:

  The remarks define the companion as any person the woman chooses (family, friend, community member, traditional birth attendant or doula) and say wishes must be respected, including those who prefer no companion. Shared labor wards need dividers or curtains. Facilities should arrange support where a companion is hard to find or requires payment.

  Cannot be inferred:

  Does not show that any country or facility permits companions today. The pooled trials include support people who were not chosen by the woman, so they do not isolate the effect of choice. Not evidence of what women in any one setting prefer.

  Limits:

  Normative guideline, not an implementation study. The supporting Cochrane review (26 trials, 15,858 women) is rated by WHO as low to moderate certainty for most outcomes. WHO notes governments are often reluctant to implement companionship despite the evidence.

  Source: World Health Organization, WHO recommendations: intrapartum care for a positive childbirth experience (Section 3.1.3 'Companionship during labour and childbirth', Recommendation 3, printed p. 29 (PDF p. 38)). Where: Global (WHO guideline). Population: Women in labor and childbirth in any facility setting. Published 2018-02-14; retrieved 2026-10-11.

• Kenya and Uganda · Reported experience · 2021

  In interviews with 75 women and 59 men in Kenya and Uganda after a stillbirth, parents described unmet needs linked to poor communication, environmental barriers and unsupportive facility policies and practices.

  Limits: Abstract only

  What others could learn: Parents' accounts locate unmet need in communication and facility routines that a service can change. A setting could ask bereaved parents what they were told and offered, then review spaces and policies that make support hard.

  Conditions, limits and source

  Conditions that matter:

  Facilities in two countries, urban and rural. After discharge, parents turned to communities and often met stigma, blame and isolation (abstract). The authors call for context-appropriate and culturally appropriate interventions on communication and on health system and community support.

  Cannot be inferred:

  Not representative of Kenya, Uganda or any one facility. Does not show how common these experiences are, what an effective intervention looks like, or what parents in other African settings report.

  Limits:

  Abstract only: no PMC record was found and the publisher site was not reachable. The abstract does not name the facilities or say which practices (for example seeing or holding the baby, or where women were cared for) parents found unsupportive. Online first 2020-08-16; issue date January 2021.

  Source: BJOG (Mills TA, Ayebare E, Mukhwana R, et al.); abstract via PubMed, Parents' experiences of care and support after stillbirth in rural and urban maternity facilities: a qualitative study in Kenya and Uganda (Abstract, Results). Where: Kenya and Uganda (Nairobi, Western Kenya, Kampala, Central Uganda). Population: Women (n=75) and men (n=59) whose baby was stillborn up to 1 year earlier and who received care in the study facilities. Published 2021-01; retrieved 2026-10-11.

• India · Service described in 2024

  A 2024 review found India's LaQshya labor room quality program, launched in 2017, covers 76% of WHO's 352 maternal and newborn quality measures but lacks comprehensive assessment of mistreatment and childbirth support.

  Limits: Service as described

  What others could learn: A quality program tracks respectful care and childbirth support only if its tools include them. A setting could audit its labor-room checklists for whether they capture consent, companionship and mistreatment, not only clinical process.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract: institutional structures, external validation, certification, performance incentives, quality circles and rapid improvement cycles. Leadership, staff mentoring, digital infrastructure and stakeholder engagement drive assessment. The authors suggest stronger district governance and tailored training on respectful maternity care.

  Cannot be inferred:

  Does not show how many facilities are certified, whether women get companions or respectful care in practice, or any change in outcomes. Says nothing about experience in a given state or facility.

  Limits:

  A review of what a program measures, not an outcome evaluation. The authors note limited prior studies. The abstract reports governance issues, understaffing, unclear directives, competency gaps and staff reluctance as constraints on the program.

  Source: BMC Pregnancy and Childbirth (Singh S, Hasan Z, Sharma D, et al.); abstract via PubMed; text via PMC (PMC10993574), Appraising LaQshya's potential in measuring quality of care for mothers and newborns: a comprehensive review of India's Labor Room Quality Improvement Initiative (Abstract, Results). Where: India. Population: Women and newborns receiving intrapartum care in facilities within the LaQshya program. Published 2024-04-04; retrieved 2026-10-11.

• Brazil · Measured outcome · 2022

  In a Brazilian survey of 10,540 postpartum women from 606 Stork Network services, cesarean delivery and black or brown skin color were each associated with less positive reports of staff reception.

  Limits: Abstract only

  What others could learn: Reception can be broken into things a service can ask about: staff introducing themselves by name and role, using the woman's name, her understanding of information, feeling respected, and needs met. A setting could report such items by race and mode of birth to find gaps.

  Conditions, limits and source

  Conditions that matter:

  Women's reports after birth in network-affiliated services. Skin color is self-identified. The abstract does not test why differences arose.

  Cannot be inferred:

  Not proof of discrimination by staff in any service. Does not explain why cesarean birth or skin color relate to less positive reception reports, and does not cover services outside the network or births outside it. Says nothing about consent, companions or choice of birth position.

  Limits:

  Abstract only; the Portuguese full text was not retrieved. The abstract does not give the survey year, response rate, or how the 606 services were chosen, so national representativeness is not established. Statistical associations, not causal findings. Reception is the authors' latent measure built from five indicators. Equating the Stork Network with Rede Cegonha follows common usage, not the abstract.

  Source: Cadernos de Saude Publica (Nunes AL, Thomaz EBAF, Pinho JRO, et al.); abstract via PubMed, Childbirth care in health services affiliated with the Stork Network in Brazil: the users' perspective (English title as indexed by PubMed; article in Portuguese) (Abstract, Results). Where: Brazil. Population: Postpartum women (n=10,540) who gave birth in services affiliated with the Stork Network. Published 2022-05-25; retrieved 2026-10-11.

• Iran · Measured outcome · 2025

  In four Tehran teaching hospitals, an educational intervention for midwives was followed by a mistreatment measure about 10 points lower in intervention hospitals, while it rose about 7 points in control hospitals.

  What others could learn: A short, scenario-based midwife training on respectful care was followed by lower reported mistreatment in this study. A setting could pair training with measurement of mothers' own reports before and after, as here.

  Conditions, limits and source

  Conditions that matter:

  Per the full text: 40 midwives in the intervention hospitals attended two 8-hour workshops built on midwives' own experiences. The authors say the intervention should run alongside other strategies, including specialized personnel, staff motivation and educating mothers about their rights.

  Cannot be inferred:

  Not representative of Iran or of other hospitals. Does not show lasting change, effects on clinical outcomes, or which workshop element mattered. Mistreatment measures are mothers' reports, not observed care.

  Limits:

  Per the authors: follow-up coincided with the COVID-19 pandemic, which may explain the rise in control hospitals; the effect was evaluated once; no field observation, so results rest on mothers' reports. Four hospitals in one city. The source gives conflicting dates for data collection (abstract and methods: follow-up June 2021; discussion: March to June 2020). The follow-up survey covered vaginal births only. The companionship and mobility item did not change.

  Source: Reproductive Health (Tajvar M, Alipour S, Atashbahar O, et al.); abstract via PubMed; text via PMC (PMC11907772), Promoting respectful maternity care: a quasi-experimental study on the effectiveness of an educational intervention in Iranian hospitals (Abstract, Results). Where: Iran (Tehran). Population: Women who had recently given birth (n=357 before, n=383 after) and midwives in delivery departments. Published 2025-03-13; retrieved 2026-10-11.

• China and Chinese women living in other countries · Measured outcome · 2023

  A 2023 systematic review of 16 quantitative studies of Chinese women found conflicting evidence on whether "doing-the-month" postpartum confinement practices are associated with postpartum depression.

  What others could learn: Evidence neither confirms nor refutes that these practices help or harm mood. A care team could ask what a woman and her family plan for the first weeks, who will help, and which parts matter to her, instead of assuming benefit or harm. Support from family seemed to matter in the studies.

  Conditions, limits and source

  Conditions that matter:

  Per the full text, the reviewed studies point to the presence of family support, satisfaction with it, and who the main caregiver is, as well as to individual practices. Results differed by practice and by study.

  Cannot be inferred:

  Does not show what any family wants, or that practices are right or wrong. Not a finding for all Chinese women or a rule for any region of China. Does not describe how any hospital or clinic accommodates the practices.

  Limits:

  Per the authors: English-language and quantitative studies only; mostly cross-sectional, so causation is unclear; participants mostly recruited from maternal and child departments or postpartum rehabilitation centers. Outcome is postpartum depression only. The abstract frames the practice as lacking proven benefit; that is the authors' view, and the review did not measure what the practices mean to women.

  Source: PLoS One (Yang X, Qiu M, Yang Y, et al.); abstract via PubMed; text via PMC (PMC10615300), Maternal postnatal confinement practices and postpartum depression in Chinese populations: A systematic review (Abstract, Conclusion). Where: China and Chinese women living in other countries. Population: Postpartum women in China and Chinese women who migrated to other countries (16 included studies). Published 2023-10-30; retrieved 2026-10-11.

• Australia · Reported experience · 2024

  Consultations in 18 Aboriginal and Torres Strait Islander communities (54 community members, 159 health professionals) yielded five stillbirth care priorities, including family-centered care, cultural safety and Birthing on Country principles. Themes drew on 135 interviewed participants in four regions.

  What others could learn: A service could ask families how they want to be involved after a stillbirth, include Indigenous staff and community-controlled organizations in designing care, and co-design resources with communities rather than adapt generic ones.

  Conditions, limits and source

  Conditions that matter:

  Indigenous researchers led the work under a cultural protection protocol, using yarning methods. The authors call for co-designed, culturally appropriate and community-acceptable resources.

  Cannot be inferred:

  Does not speak for all Aboriginal and Torres Strait Islander peoples, who are diverse. Does not show that these approaches reduce stillbirth or improve bereavement outcomes, or describe a service in operation.

  Limits:

  Community consultation themes, not measured outcomes. The counts of 54 community members and 159 health professionals describe all consultations; the reported analysis uses 135 participants in four regions. The abstract names four of five focus areas; the full text adds learning through stories. The authors report COVID-19 travel limits and some virtual consultations. Consultations ran 2019 to 2022.

  Source: Frontiers in Public Health (Massi L, Lewis C, Stewart S, et al.); abstract via PubMed; text via PMC (PMC11059953), Looking after bubba for all our mob: Aboriginal and Torres Strait Islander community experiences and perceptions of stillbirth (Abstract, Results). Where: Australia (analysis from Far North Queensland, South Australia, Victoria and Western Australia; consultations in 18 communities). Population: Aboriginal and Torres Strait Islander community members (n=54) and health professionals (n=159). Published 2024-04-16; retrieved 2026-10-11.

• Ireland · Reported experience · 2016

  In interviews with 20 chaplains covering 85% of Irish maternity units, 60% were formally accredited, one had specialist perinatal bereavement training, and 55% provided follow-up bereavement care after stillbirth.

  Limits: Abstract only · Service as described

  What others could learn: Spiritual care after stillbirth is one strand of bereavement support and varies with who is available and trained. A hospital could record who offers it, whether chaplains work from a shared plan with midwives, and what training and support chaplains receive.

  Conditions, limits and source

  Conditions that matter:

  Per the abstract, 7 of 20 chaplains (35%) did not feel part of the multidisciplinary team, and the authors recommend ongoing education and greater support for chaplains.

  Cannot be inferred:

  Says nothing about what parents wanted, were offered or accepted, or about quality or outcomes of spiritual care. Not evidence of current Irish services, and not a statement of what any faith community requires.

  Limits:

  Abstract only. Chaplains' own reports; no parents were interviewed. Published online June 2014, issue June 2016, with fieldwork dates not in the abstract, so it may not describe current services.

  Source: BMJ Supportive & Palliative Care (Nuzum D, Meaney S, O'Donoghue K); abstract via PubMed, The provision of spiritual and pastoral care following stillbirth in Ireland: a mixed methods study (Abstract, Results). Where: Ireland. Population: Hospital chaplains (n=20) from 17 maternity units who care for parents after stillbirth. Published 2016-06; retrieved 2026-10-11.

• United States · Measured outcome · 2019

  In an online survey of 2,138 women with a US pregnancy between 2010 and 2016, 17.3% reported at least one type of mistreatment in maternity care; reports differed by place of birth and race.

  What others could learn: A maternity service could ask recent patients, with patient-designed questions, whether they were shouted at, ignored or lost a say in decisions, and review the answers by race and place of birth. Differences by setting are a prompt to examine hospital routines and how disagreements are handled, not a verdict on any setting.

  Conditions, limits and source

  Conditions that matter:

  The items were designed with community agencies, NGOs and clinicians through a participatory process, adapted from a patient-led instrument first used in British Columbia, Canada, and aligned to the WHO typology of mistreatment in maternity care. Recruitment used social networks, community agencies and trained peers who helped participants with data entry. The authors note the United States has no system that collects birth-care experience from all pregnant people.

  Cannot be inferred:

  Not a prevalence estimate for the United States. Does not show why reports differ by race or place of birth, or that community birth itself lowers mistreatment, because women chose their setting and the groups differ in other ways. Says nothing about care after 2016 or about any single facility.

  Limits:

  Voluntary sample that is not population-based. The authors oversampled women of colour and community births (home or freestanding birth center), about 50% of the sample against about 2% of births they cite for the US, and 29.7% of respondents were from New York State. Participants were older, more educated and more often US-born than US mothers in 2016; Hispanic and Asian women were underrepresented. Self-reported, not observed. Survey items are patient-designed and are not reproduced here. Data are from 2016 to 2017.

  Source: Reproductive Health (Vedam S, Stoll K, Taiwo TK, et al.); PMC open access, The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States (Abstract, Results). Where: United States. Population: Women who had at least one pregnancy in the United States between 2010 and 2016 (n=2,138 survey completers of 2,700 eligible), with deliberate oversampling of women of colour and of planned home and birth center births. Published 2019-06-11; retrieved 2026-10-11.

• Canada · Service described in 2025

  Inuit midwives report that the Inuulitsivik service in Nunavik, Quebec, begun in 1986 after 91% of Hudson Coast women had been evacuated for birth, provides care in Inuktitut by Inuit providers.

  Limits: Availability not verified

  What others could learn: Where birth services leave a community, planners could ask who provides care, in what language, and who trains the next midwives. This account ties care in the families' own language to local paid midwifery education, community governance and a defined transfer pathway, and reports that the community experienced routine evacuation for birth as harmful.

  Conditions, limits and source

  Conditions that matter:

  Conditions the authors describe: an Inuit community board governing the health centre; paid local midwifery education since 1986, funded through the clinical budget; registration of Nunavik graduates under Quebec midwifery regulation since 2008; risk review of every pregnancy by a perinatal committee at 32 to 34 weeks; physicians available; air transfer to Montreal averaging about 12 hours, weather permitting. Turnover of southern health workers and limited space and funding are ongoing challenges.

  Cannot be inferred:

  Not an independent evaluation. Does not show that the model transfers to communities without Inuit-led governance, local education or a transfer pathway. Does not compare outcomes with evacuated births in a controlled way. Speaks for one Inuit region, not for Indigenous peoples or midwifery services across Canada.

  Limits:

  Insider account written by the service's own midwives, not an independent evaluation. Outcome figures come from the service's own database, and the authors caution that single-year figures in small populations can be non-representative. Southern midwives and physicians also staff the service. The authors report that resources have not kept pace with population growth and that fewer Inuit midwives have worked since the pandemic. Current operation was not verified.

  Source: International Journal of Circumpolar Health (Moorhouse K, Moorhouse E, Epoo B, et al.; Inuulitsivik Health Centre midwives); PMC open access, What makes Inuulitsivik midwifery successful and sustainable? How an Inuit-led care model brought birth back to our remote arctic communities (Results, section 'Inuit Culture, Values and Worldview', first paragraph; 91% figure in 'Background and context'). Where: Canada (Nunavik, Quebec). Population: Pregnant women and families in the Inuit communities of the Hudson Coast and Hudson Strait (Nunavik population 14,050; 90% Inuit, per the authors). Published 2025-11-06; retrieved 2026-10-11.

• The sourced examples include guidance, reported experience, service description, measured outcome. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.