Humanised care and a change in practice in a hospital in Benin

Objective: to describe the process of introduction and implementation of humanised care (humanised childbirth); to determine how the practice of humanised care affects midwives, obstetricians, and other service providers in the hospital; and to determine the factors influencing the change in practice. Design: a qualitative study with grounded theory approach. A semi-structured, in-depth individual interview was conducted for data collection with open coding and a constant comparative analysis until the saturation of concepts. Setting: mothers’ and children’s hospital functioning as a top referral centre in Benin. Participants: 16 hospital staff, including 6 midwives. Findings: humanised care was initiated by midwives with hesitation and difficulties. Midwives and obstetricians learned that a supportive environment for women could produce a positive birth outcome without medication. Communication between the midwives and women and their families improved with a higher level of appreciation of the care provided by the midwives among the women and their families. Humanised care appears to affect the professional value of midwives, their levels of job satisfaction, and their personal motivation for work towards improving their performance. A positive influence on obstetricians and other staff was observed. These individuals were inspired to make changes in hospital culture to improve care, to avoid unnecessary interventions, and to improve communication. Important factors in achieving favourable results were the leadership and commitment of the hospital management team and the recognition and support they extended towards the hospital staff, especially the midwives. Key conclusions and implications for practice: a system of humanised care that stresses improved communication between the women giving birth, their families, and care providers, based on respect for women’s dignity and liberty, and avoidance of unnecessary intervention can be promoted with proper managerial support. This system can promote favourable changes in hospital practice, which are helpful in motivating midwives in resource-limited settings.