“Heard or Unheard?” a Qualitative Inquiry Into the Nuanced Experiences of Mothers with Intrapartum Care in Kano, Nigeria

“Heard or Unheard?” a Qualitative Inquiry Into the Nuanced Experiences of Mothers with Intrapartum Care in Kano, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “Heard or Unheard?” a Qualitative Inquiry Into the Nuanced Experiences of Mothers with Intrapartum Care in Kano, Nigeria Amina Suleiman Rajah, Abdulrashid Idris, Umar Yunusa, Muhammad Awwal Ladan, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4796211/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Childbirth experience significantly impacts maternal and neonatal outcomes, with negative experiences leading to consequences such as postpartum depression, self-care neglect, sleeping problems, posttraumatic stress disorder and the reluctance to use health facilities and recommend hospital delivery to other women. Aim: This study aimed to explore maternal experience with intrapartum care in Kano, Nigeria. Methods: A qualitative narrative inquiry approach involving in-depth interviews with 11 postpartum women was utilized. The interviews were transcribed, translated, and thematically analysed to identify patterns and themes related to maternal experiences of intrapartum care. Results: Three main themes emerged: (1) Dignified care during birth, emphasizing positive experiences with midwives and healthcare personnel; (2) Intense pain and search for relief, highlighting the challenging nature of labor; and (3) Inadequate care and neglect, capturing negative experiences with wait times, lack of support, and even verbal abuse. Conclusion: This study highlights the diverse range of maternal experiences during childbirth in Kano, Nigeria, encompassing both positive and negative aspects of intrapartum care. Childbirth Maternal Experience Intrapartum Qualitative Statement of Significance Problem Childbirth experience significantly impacts maternal and neonatal outcomes, with negative experience leading to consequences such as postpartum depression, self-care neglect, sleeping problems, posttraumatic stress disorder and the reluctance to use health facilities and recommend hospital delivery to other women. What is Already Known Evidence from a WHO-led study shows that more than one-third of women have negative experience during childbirth in health facilities, highlighting the need for further exploration in different contexts. What this Paper Adds The qualitative narrative inquiry design allows for an in-depth exploration of women's nuanced experiences, and providing rich, context-specific data to inform interventions aimed at improving the quality of intrapartum care. Introduction Negative maternal experience has been directly linked to the underutilization of health care facilities and the recommendation of such services to others ( 1 – 3 ). Emerging studies have considered intrapartum care satisfaction a critical point of intervention to mitigate the high maternal mortality ratio (MMR) ( 1 , 4 – 6 ). High rates of avoidable maternal and newborn mortality and morbidity in low-income and middle-income countries could be mitigated by improving intrapartum quality of care ( 7 ). Globally, many women have negative experiences during childbirth in health facilities ( 7 ). Studies in countries such as the United States, United Kingdom, and Australia have reported that negative experiences during labour and birth are driving some women to seek alternatives, and for some, this is to birth outside of the mainstream maternity system with no health professional present ( 7 – 11 ). Another multicountry study revealed that 1 in 5 women who attended maternity health facilities had at least one episode of abuse in six European countries—Sweden, Norway, Belgium, Estonia, Iceland and Denmark ( 12 ). Qualitative studies have reported women’s subjective negative experiences during childbirth in some countries ( 13 ). Nonconfrontational measures such as returning home and bypassing certain health facilities and/or healthcare providers or accepting mistreatment were reported by women in response to the abuse ( 14 ). Overwhelmingly, women in Middle Eastern Asian countries experience birth as dehumanizing and disrespectful ( 15 , 16 ). In Guinea, four scenarios in health facilities—verbal abuse, slapping, physical restraint and refusing to help—were used to understand the acceptability of mistreatment among service providers and women ( 14 ). Health care providers are abusive when they feel that women are uncooperative or disobedient or that the lives of their unborn children are at risk during childbirth ( 13 ). In Africa, several studies have revealed considerable reports of negative experiences, with approximately 23.7–98% of women reporting at least one form of maternal abuse ( 13 ). For instance, in Zambia, previous studies among women during labour reported women experiencing verbal abuse and being abandoned during the labour process, thereby deterring some from delivering in health facilities during subsequent pregnancies ( 17 , 18 ). A qualitative study in Tanzania reported abusive events such as verbal abuse, discriminatory treatment, and being ignored ( 19 ). Several studies across Africa have reported other forms of maternal abuse, such as physical abuse (such as being slapped by health-care providers), abandonment of delivering a child alone, and being detained for a long time in a health facility ( 7 , 13 , 18 , 19 ). In Nigeria, few qualitative studies have explored women’s experiences with intrapartum care. A qualitative study conducted in Benue, Nigeria, by Orpin et al. (2018) revealed that the participants perceived incidents such as being shouted at and the use of abusive language as common practices. A study by Amole et al. ( 20 ) in Kano on the prevalence, pattern and determinants of disrespect and abuse during childbirth among recently parturient women revealed that more than half (55.9%) had experienced at least one form of disrespect and abuse during childbirth. The most common forms of abuse were abandonment and nonconfidential care ( 20 ). There is a paucity of empirical data concerning women’s experience with intrapartum care in Nigeria, with a noticeable gap in studies in northern Nigeria. Therefore, the aim of this study was to explore the nuanced maternal experience with intrapartum care in Kano, Nigeria, using qualitative research approaches. Methods This study utilized a qualitative narrative inquiry research design. The CORSEQ guidelines were used for reporting the studies. This study was conducted at Murtala Muhammad Specialist Hospital (MMSH), Kano. The target population for the study was women who delivered at MMSH by spontaneous vaginal delivery successfully and who were in their immediate postpartum period (1–7 days). An interview guide consisting of open-ended questions about maternal experience of intrapartum care was used to conduct an in-depth interview. The interview guide was adapted from a previous study ( 21 ). The guide was pretested at the study site before data collection. The interview guide included questions and probes aimed at eliciting responses centred on maternal experience of intrapartum care in relation to interpersonal care, obstetric analgesia, childbirth positioning and the physical birth environment. Two female research assistants (RN, RM, BNSc) who have experience in qualitative research, along with the female researcher (AR) (RN, RM, MSc. in Nursing) collected the data. They assumed that improved intrapartum care practices can significantly improve maternal health outcomes. Their primary reason for conducting this research was to explore and enhance the quality of maternal care in low-resource settings. Their interest lies in identifying practical, evidence-based strategies that can be widely adopted to improve women's childbirth experiences and outcomes. Prior to beginning the data collection, the purpose of the interviews was explained to the participants. Confidentiality was assured, and informed consent was obtained. The consent form was read in the local language. In depth, one-on-one interviews lasting between 30 and 60 minutes were conducted at a mutually agreed-upon safe place within the hospital and at a convenient time for the participants. A voice recorder was used to capture the data during the sessions. The audio-taped interviews were transcribed within 24 hours of the interviews, but the information was still fresh. Participants with Birth Satisfaction Scale-Revised (BSS-RI) scores of 9–12 (high satisfaction) or 0–4 (low satisfaction) and those with unique or atypical obstetric histories were selected for the interviews. This method was chosen to ensure a wide range of perspectives, enhancing the richness and depth of the data. Participants were recruited based on their responses in a prior quantitative study, as this study is part of a dissertation that employed a mixed methods approach. This allowed the inclusion of women with varied obstetric experience, further ensuring the comprehensiveness and reliability of the findings. The sample size was determined based on the principle of data saturation, ensuring the comprehensive capture of diverse experiences without redundant data collection. Data saturation was confirmed when no new information emerged, which became apparent after the ninth interview. To validate this saturation point, two additional interviews were conducted, confirming that no new insights would be gained. This approach ensures robustness in the data. The respondents were selected purposively using deviant sampling. The criteria for ensuring the trustworthiness of qualitative studies according to Lincoln and Guba ( 22 ) were used in this study. Participants were encouraged to be as objective as possible and to support their statements with relevant examples. Credibility was ensured by presenting the interview transcripts to the participants to confirm the accuracy of the descriptions given during the interview and to ascertain that the transcripts accurately portrayed the participants’ viewpoints. The researcher ensured the quality of the data by conducting regular reflective discussions with the research assistants. These discussions were held after the interviews to discuss key findings and identify themes. Throughout the data collection, the study participants were asked to elaborate on or clarify what they said during the interviews to confirm the accuracy of the information captured and the meanings that the participants intended to ascribe. No prior relationship was established between the researchers and the participants before the study commenced. The participants were informed about the researcher's professional background, academic qualifications, and primary aim of the study, but no personal goals or reasons for doing the research were disclosed. The researchers were mindful of adopting a neutral body posture and tone of voice to avoid influencing participant responses. They also ensured qualitative reduction by writing field notes, recording their philosophy and thoughts about intrapartum care prior to commencement of data collection, maintaining a research journal to reduce any preexisting thoughts and to facilitate reflection after interviewing, and having regular meetings with the other members of the research team. The audio recordings were transcribed verbatim and translated from Hausa to English by experts from the Hausa Department of Bayero University, Kano, prior to analysis. The standard “forward-backwards” translation procedure was used to translate the transcriptions from Hausa to English. The forward translations were then back-translated by a bilingual expert who had no knowledge of the wording of the original Hausa version. The initial analysis of the transcripts was performed by the researcher (AR), who engaged in reflection and highlighted key data from the interviews. Notes on body language and nonverbal communication as well as field notes were also analysed along with the data from interviews to better explain the findings. Thematic analysis was adopted to identify patterned meaning across the interviews. Thematic analysis was chosen to remain as close to the meanings in the grounded data as possible. The interviews aimed to capture the real experiences of women regarding intrapartum care and how these experiences influenced and impacted the decisions of the participants. Following the steps of Braun and Clarke for thematic analysis, the researcher (AR) familiarized herself with the data, reading and rereading the transcripts and writing initial thoughts ( 21 ). The researcher then created initial coding manually using Microsoft Word. Interpretative analysis was carried out by using the collated codes, and the data extracts were categorized according to the overarching themes. Subsequently, the identified themes were reviewed and analysed. Data analysis involved line-by-line, open, and axial stages of coding in a constant comparative, iterative manner to capture emergent themes. The researcher constantly reviewed the data to cross-check the validity of the analysis. The identified codes were input into Nvivo, version 14, which grouped the codes and aided in identifying the themes and subthemes from the collected data. Nvivo also helped to ensure the management and grouping of the large amounts of data. Different concepts and data categories were then generated based on the objectives of the study and on the information that was gained through interviews. Different quotes were used to match different themes that emerged from the data. These were grouped into categories. Representative quotes that best captured the idea are presented for illustration. The findings of the study were then returned to the participants to provide feedback related to the accuracy of the data they provided. Ethical approval with reference number NHREC/17/03/2018/SHREC/2022/3255 was obtained from the Health Research Ethics Committee (HREC), Ministry of Health, Kano State. Informed consent was obtained from the respondents to obtain voluntary participation. Confidentiality was guaranteed by storing the data in a safe place, and only the researcher had access to the data. The objectives, methodology, purpose of the study, and the benefits and risks of the study were explained to all study participants before the interviews. Individual personal identifiers, e.g., names, were not collected to ensure the anonymity of the data. Results Table 1 Sociodemographic Characteristics of the Participants (N = 11) (To be placed under results) Participant Code Age (years) Marital Status Parity Highest Educational Qual. Occupation 1 35 Married 11 Secondary Business 2 35 Married 8 Primary Unemployed 3 27 Married 5 Primary Trade 4 20 Married 1 Secondary Tailor 5 23 Married 1 Secondary Unemployed 6 43 Married 11 Primary Agriculture (Poultry) 7 20 Married 1 Primary Tailor 8 28 Married 3 Secondary Tailor 9 20 Married 2 Secondary Unemployed 10 18 Married 1 Islamic Education Unemployed 11 29 Married 3 Tertiary Civil servant Average 27.1 4.2 As shown in Table 1 , the participants were between the ages of 18 and 43 years, with a mean age of 27.1 years. Approximately half (n = 5) of the participants had completed secondary school. The parity of the participants ranged from one to eleven, and the average was 4.2. One-third (n = 4) of the participants were unemployed, and another one-third (n = 4) were involved in entrepreneurship. Almost all the participants (n = 10) were of the Hausa tribe. Themes Identified from the Study The study consisted of in-depth interviews with 11 postpartum women aged between 18 and 43 years. Analysis of the interview transcripts depicting the women’s experience with care rendered to them during labor and delivery and their concept of care revealed three ( 3 ) main themes: ( 1 ) Dignified care during birth, ( 2 ) Intense pain and search for relief, and ( 3 ) Inadequate Care and Neglect. ( Table 2 should be placed on page 12 immediately after the heading Themes Identified from the Study) Table 2 Development of Themes Themes Subthemes Codes Dignified care during birth An overall positive birth Experience Women being grateful Women being satisfied Reception on arrival She stayed with me the whole time Encouragement to “push” Emotional and physical support The midwife being central to the woman’s birth experience The caring midwife Presence of health personnel during delivery Cordial relationship Good rapport Did not get tired May Allah bless them Cleaned me Nice, Kind, Calm Lovely, Caring, Compassionate Funny, Personal Respect, Warm, Attentive, Happy, Honest, Warm reception, Pampered, Patience, Encouraged, consoling, skilled, impressed, appreciate, bless, welcoming, safe, comfortable, helped, playful, joyful, smiling, laugh, reassuring, calm, entertaining, attention, bless, Good care Intense pain and search for relief It was painful Discomforting experience Don’t have words to describe Most painful experience of my life Praying to God The pain was unbearable Labour pain likened to death No remedy Allah’s name for pain reduction Crying, Screaming, Shouting, Painful, terrible, traumatized, Complaining, distressing, displeasing, Stressed Inadequate Care and Neglect She left me alone Waiting for a long time before consultation Absent midwife Negative birth experience Alone, ignored, badly treated, no help, harassed, shamed, unkind, not attended to, intimidating, shouting, insulted, bullied, wicked, unkind, annoyed, angry, calling, Theme One: Dignified Care During Birth This theme reflects the positive experiences and feelings of gratitude and satisfaction expressed by women during their birthing process. It emphasizes the essential role of the midwife and healthcare personnel in providing comprehensive support, both emotionally and physically, throughout the journey of childbirth. This theme also captures participant contributions that emphasize the astonishing attitudes of health care providers. The majority of the participants expressed that the health care providers, especially the midwives, were kind, caring and very supportive. The majority of the participants also expressed their appreciation for the midwives’ reassurance and encouragement during labour and delivery. Additionally, the majority of the participants opined that a midwife was present with them during the whole delivery period. Some even expressed that they had more than one midwife attend to them during delivery. Theme Two: Intense Pain and Search for Relief This theme relates to women’s divergent experience of labour and delivery. Most women felt that their experience could not be put into words. The majority opined that the experience was very painful and distressing and unlike anything they had ever experienced in their lives. Theme Three: Inadequate Care and Neglect This theme reflects the common thread among the subthemes, highlighting the negative experiences and challenges faced by individuals in the context of healthcare. It conveys a sense of dissatisfaction and the perception of insufficient attention or support received from healthcare providers. A few of the participants reflected on the negative experience they had on arrival at the hospital. One of the participants reported experiencing verbal abuse, bullying and intimidation from health care providers. Similarly, another participant reflected that she did not have anyone with her during delivery, which affected her experience. ( Table 3 should be placed on page 14 after the heading Theme Three: Inadequate Care and Neglect, just before discussion). Table 3 Quotations of Participants Theme Quotations Theme One: Dignified care during birth “The reception was beyond my imagination, I was pampered and they showed me respect. They encouraged me. The midwife kept consoling me, telling me sorry, that it will soon be over. The staff are very skilled, I am so impressed. That made me very happy.” (Participant 6) “I had a very good reception on arrival, I was not harassed or shamed by anyone. (Participant 5)” “I was well received on arrival, the midwife immediately asked me to come in and gave me a bed to lie on. She checked me and told me that the baby is on his way. I really appreciated that, I felt respected” (Participant 9) “When I came to the hospital, the staff attended to me very well, although, there has been rumors spreading around about how unkind and harsh the staff are, but honestly, I did not experience this at all. I was well received, they were very caring and nice. And I am so grateful. May Allah bless them abundantly .” (Participant 11) “What impressed me the most was that they did not get tired, whenever I called, they will come, when I call again, they will still come. I have even gotten so close to some of them.” (Participant 4) “Honestly, they are very kind. All the staff I met were very kind. Although, I have not known them for a long time, I can say that they are very kind. I didn’t meet one person that shouted at me or that was unkind or disrespectful. They were very encouraging and it was that encouragement that gave me the courage and strength to push when they asked me to…”( Participant 10) “Yes, they (midwives) really tried, when I was admitted, whenever they came around, they will ask me to stand up and move around, that it will help me deliver faster, and when am tired they ask me to go back to my bed and rest. So, I really appreciated that concern that they showed and that made me feel supported as if I was not all alone. The midwife helped me a lot, I don’t think I would have been able to give birth myself if not for her.” (Participant 3) “Honestly, they really tried. What I appreciated the most was that the midwife stayed with me throughout my labour and even during my delivery. And after delivery, they cleaned me up, cleaned the baby and they advised me to rest.” (Participant 5) “They were very playful and joyful. The midwife was always smiling and trying to make me laugh. After I delivered, whenever anyone of them passes they will look at me and smile. And I really appreciated that. ” (Participant 6) “I had about 2 or 3 midwives with me when I delivered. Even during the labour, they kept checking on me, they will go to their station and then come back and check on me.” (Participant 4) Theme Two: Intense Pain and Search for Relief “A Midwife!!! (Expresses shock) I had 3 midwives attend to my delivery. They paid so much attention to me, one was trying to deliver the baby, one was reassuring and encouraging me and the other one was supporting my abdomen and back” (Participant 8) “It was a very distressing experience. I felt as if my head was being unscrewed from my body. I felt as if my body was not in my body. But with Allah’s intervention, the baby was delivered in a short while, but she was delivered dead. (Starts crying) “(Participant 1). “It was a very displeasing experience (Laughs gently). The pains started slowly, after a while we came to the hospital, I spent over 48 hours in labour before delivery. After a while they informed me that I was going to have a surgery to deliver my baby. But later they gave me a pill, and put it under my tongue, then strong contractions started. It did not take long after that, and I delivered my baby” (Participant 4) “It was painful but not as painful as I thought it will be. The labour itself was not very painful, but the delivery, Hmnn…. (Sighs) I don’t even have words. It was the most painful experience of my life. I was lucky, I didn’t have a long labour, and it was very fast.” (Participant 7) “Hmnn… I don’t even have words to describe what I felt. I was so stressed and in so much pain. There are no words to describe what happened to me .” (Participant 10) “I spent 2 days sleeping on the cold hard ground before I was able to see the doctor. Despite sleeping at the hospital the first day, the line was still too long and so I was not able to see the doctor, it was after the 2nd day that I was lucky enough to be on the line.” (Participant 3) “The way I was received was bad, I waited for a long time before seeing the doctor, I came to the hospital around Zuhr prayer (1 pm), but I was not attended to until around 12 midnight.” (Participant 1) “…what annoyed me the most and made me very unhappy was that, when I finally got to see the doctor, he just started shouting at me, he was so angry, that why was I coming to the hospital now, when I am almost due for delivery. Why didn’t I come early, He was not a Hausa man, he was shouting, raising his voice in English and the other doctor there was translating it to me in Hausa. I was trying to explain that I did not do my Antenatal here, that I was referred because of a problem, but He did not listen to me at all. I did not understand why he was angry, or is it a crime to do antenatal in any other hospital other than Murtala?” (Participant 3) Theme Three: Inadequate Care and Neglect “The midwife was not with me when I gave birth, I was all alone and they did not allow my relatives to stay with me. I felt the baby coming out and I kept shouting and calling on the staff, before they came, my baby was already out. I kept calling and calling before they came. To add to that, there was no power at that time, so everywhere was dark. I held on to the bed rails and just kept shouting” (Participant 1) “The way I was received was bad, I waited for a long time before seeing the doctor, I came to the hospital around Zuhr prayer (1 pm), but I was not attended to until around 12 midnight.” (Participant 1) “I spent 2 days sleeping on the cold hard ground before I was able to see the doctor. Despite sleeping at the hospital the first day, the line was still too long and so I was not able to see the doctor, it was after the 2nd day that I was lucky enough to be on the line.” (Participant 3) “…what annoyed me the most and made me very unhappy was that, when I finally got to see the doctor, he just started shouting at me, he was so angry, that why was I coming to the hospital now, when I am almost due for delivery. Why didn’t I come early, He was not a Hausa man, he was shouting, raising his voice in English and the other doctor there was translating it to me in Hausa. I was trying to explain that I did not do my Antenatal here, that I was referred because of a problem, but He did not listen to me at all. I did not understand why he was angry, or is it a crime to do antenatal in any other hospital other than Murtala?” (Participant 3) Discussion The findings of the study showed that the majority of the participants had good reception upon arrival at the hospital, and they also expressed that the health care providers, especially the midwives, were kind, caring and very supportive. Paradoxically, the majority of participants reported having good and positive experiences with midwives. This study aligns with research from Ghana, where respectful communication played a significant role in fostering a positive birth experience. This emphasizes the importance of going beyond technical competence and creating a supportive environment ( 23 ). While our findings showcase positive interactions, they also exist in a larger context where studies reveal widespread disrespect and abuse in childbirth care across sub-Saharan Africa. This paradox underscores the critical need for continued efforts to ensure that respectful maternity practices become the norm, not the exception. Contrary to the findings of this study, a qualitative review identified sub-Saharan Africa as one of the main areas where disrespectful childbirth care continues ( 24 ). Likewise, in Ghana, some participants said they were being shouted at by harsh and intolerant nurses/midwives ( 25 ). A similar study in Australia also revealed that women cited negative experiences surrounding their maternity care experience, such as feelings of isolation, conflicting advice, feeling ignored, and minimal to no continuity, in contrast to the euphoric feelings of birth, immense support, guidance, and encouragement ( 26 ). Similarly, the findings of this study contrast with the qualitative meta-synthesis of the expectations and experiences of women in sub‑Saharan African low- and low- to middle-income countries, which revealed that women still encounter disrespectful care in health facilities in LLMICs, including physical and verbal abuse, discrimination, and lack of privacy ( 27 ). Another noteworthy finding of this study was that most women felt that their experience could not be put into words. The majority opined that the experience was very painful and distressing and unlike anything they had ever experienced in their lives. This finding was validated by research conducted in Uganda, which showed that women described their experience as prolonged and exhaustive labour pains with moments of confusion, inability to move, backs being felt in pieces and feelings of despair ( 27 , 28 ). While the majority of participants expressed gratitude for the kindness and support they received from midwives, some harbored preconceived negative notions, highlighting the multifaceted nature of patient-provider interactions in childbirth settings. These findings underscore the importance of dignified care at birth and emphasize the pivotal role of healthcare providers in fostering a supportive environment for women undergoing childbirth. Moreover, the discrepancy between positive experiences reported by participants and the literature on disrespectful maternity care in sub-Saharan Africa prompts further reflection on the cultural and contextual factors influencing intrapartum care experiences in low-resource settings. Moving forward, it is imperative to leverage these insights to inform targeted interventions aimed at enhancing the quality of intrapartum care delivery in Kano and similar settings. Strategies should prioritize improving patient-provider communication during the antenatal period, addressing gaps in health literacy, and promoting respectful and compassionate care practices. By embracing a holistic approach to maternal healthcare research, we can drive meaningful advancements in intrapartum care and contribute to positive birth experiences for women in Kano and beyond. Conclusion This study provides valuable insights into maternal experience with intrapartum care in Kano, Nigeria. The study revealed that most women felt that their experience with childbirth cannot be put into words, and the majority opined that the experience was very painful and distressing and unlike anything they had ever experienced in their lives. While there are positive aspects, there are areas for improvement. This research calls for a holistic approach that prioritizes respectful care, pain management, informed mothers, and well-equipped healthcare providers. By creating a truly supportive environment, we can ensure positive childbirth experiences for all women. Suggestions for Further Research Further research in the field of intrapartum care should focus on longitudinal studies to investigate the enduring effects of childbirth experiences on maternal and neonatal health outcomes over time. Additionally, there is a need for comparative research to explore disparities in intrapartum care experiences across different healthcare settings and demographics, shedding light on factors influencing the quality of care provided. Intervention studies, including training programs for healthcare providers and community engagement initiatives, are also warranted to evaluate the effectiveness of targeted interventions aimed at improving intrapartum care quality. Strengths and Limitations The strengths of this study include the utilization of a qualitative narrative inquiry design, allowing for an in-depth exploration of women's nuanced childbirth experiences. Additionally, the rigorous analysis process, including member checking and triangulation of data sources, enhances the credibility and trustworthiness of the findings. This study has several limitations, including potential courteousness bias, as the data were collected from women still admitted to the hospital, which may have led to socially desirable responses. Additionally, the study included only mothers who gave birth through spontaneous vaginal delivery, limiting the generalizability of the findings to all postpartum women. The major limitation is sampling bias, as deviant sampling was used, which may not represent the broader population of postpartum women in Kano, Nigeria. Declarations Conflict of Interest: The authors declare no conflict of interest regarding the submitted manuscript. There are no financial, personal, or professional associations that might pose a conflict or bias in the content of the research. Acknowledgements The authors gratefully acknowledge the staff of Department of Nursing Science, Bayero University, Kano for their unwavering support towards this research. Funding Support: There was no external funding for this research. Author Contribution ASR conceived the study and drafted the protocol, initial design, led the collection and analysis of the data and writing of the draft of the manuscript. IA, UY, MAL and CJM reviewed the protocol and ethics submissions, contributed to the survey design, pilot testing and to the data analysis, interpretation and supervision. All authors contributed to the review and editing of the manuscript. References Getenet AB, Teji Roba K, Seyoum Endale B, Mersha Mamo A, Darghawth R. 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Women’s experiences of disrespect and abuse in maternity care facilities in BenueState, Nigeria. BMC Pregnancy Childbirth. 2018;18(1):1–9. Balde MD, Bangoura A, Diallo BA, Sall O, Balde H, Niakate AS, et al. A qualitative study of women’s and health providers’ attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea. Reprod Health. 2017 Jan;14(1):4. Hussein SAAA, Dahlen HG, Ogunsiji O, Schmied V. Women’s experiences of childbirth in Middle Eastern countries: A narrative review. Midwifery. 2018 Apr;59:100–11. Hussein SAAA, Dahlen HG, Ogunsiji O, Schmied V. Jordanian women’s experiences and constructions of labour and birth in different settings, over time and across generations: a qualitative study. BMC Pregnancy Childbirth [Internet]. 2020 Dec 10;20(1):357. Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03034-3 Smith J, Banay R, Zimmerman E, Caetano V, Musheke M, Kamanga A. Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science. BMC Pregnancy Childbirth [Internet]. 2020;20(1):26. Available from: https://doi.org/10.1186/s12884-019-2579-x Mukanga B, Nyirenda HT, Choka N, Mulenga D, Daka V. Experiences and drivers of verbal abuse among women during labour and delivery in Ndola and Kitwe districts of Zambia. Cogent Med [Internet]. 2021;8(1). Available from: https://doi.org/10.1080/2331205X.2021.1924432 Kujawski S, Mbaruku G, Freedman LP, Ramsey K, Moyo W, Kruk ME. Association Between Disrespect and Abuse During Childbirth and Women’s Confidence in Health Facilities in Tanzania. Matern Child Health J. 2015 Oct;19(10):2243–50. Amole T, Tukur M, Farouk S, Ashimi A. Disrespect and abuse during facility based childbirth: The experience of mothers in Kano, Northern Nigeria. Trop J Obstet Gynaecol [Internet]. 2019;36(1):21. Available from: http://www.tjogonline.com/text.asp?2019/36/1/21/256483 Milton R, Alkali FI, Modibbo F, Sanders J, Mukaddas AS, Kassim A, et al. A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths. BMC Pregnancy Childbirth. 2021;21(1):1–13. Lincoln YS, Guba EG. Naturalistic inquiry. Sage [Internet]. 1985; Available from: oi. org/10.1016/0147-1767(85)90062-8 Danzima NY, Dehghan Nayeri N, Arpi M, Buunaaim ADB, Tijani A. The Lived Experiences of Postpartum Women in Ghana Regarding Nursing Care During Childbirth and Their Concept of Care-A Phenomenological Study. Res Sq [Internet]. 2021;1–16. Available from: https://doi.org/10.21203/rs.3.rs-257786/v1 Lavender T, Bedwell C, Kasengele CT, Kimaro D, Kuzenza F, Lyangenda K, et al. Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania Handling editor Seye Abimbola. BMJ Glob Heal [Internet]. 2021;6:4725. Available from: http://gh.bmj.com/ Afaya A, Dzomeku VM, Baku EA, Afaya RA, Ofori M, Agyeibi S, et al. Women’s experiences of midwifery care immediately before and after caesarean section deliveries at a public Hospital in the Western Region of Ghana. BMC Pregnancy Childbirth. 2020;20(1):1–9. Hargreaves S, Young S, Prior SJ, Ayton J. Exploring Women’s Experiences of Maternity Service Delivery in Regional Tasmania: A Descriptive Qualitative Study. Healthc. 2022;10(10):1–11. Ahmed SAE, Mahimbo A, Dawson A. Quality intrapartum care expectations and experiences of women in sub-Saharan African Low and Low Middle-Income Countries: a qualitative meta-synthesis. BMC Pregnancy Childbirth [Internet]. 2023;23(1):1–19. Available from: https://doi.org/10.1186/s12884-022-05319-1 Namujju J, Muhindo R, Mselle LT, Waiswa P, Nankumbi J, Muwanguzi P. Childbirth experiences and their derived meaning: a qualitative study among postnatal mothers in Mbale regional referral hospital, Uganda. Reprod Health [Internet]. 2018;15(1):183. Available from: https://doi.org/10.1186/s12978-018-0628-y Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4796211","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":343236490,"identity":"f4175404-ddbd-44b9-aeb0-f1d732e20582","order_by":0,"name":"Amina Suleiman Rajah","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYLACCYYDIIrxMQNDAgMEE6mF2Zh4LQwQLWzSRGnh7z/78INFzR0Gc4ncZ9WFbWkM/Ow5BswFv/C46Ua6sYTEsWcMljPSzW7PbMthkOx5Y8A8sw+PNTfYGCQk2A4zGNxIY7vN21YBZABt4e3BrUP+/DHmHxL/IFqKQVrsCWkxOJDGJiHZBtHCzAt0mIEEUAvPD9xaDIEqLST7DvMYnHnGLD3jXBqPxJlnBYd5G3BrkQM67LbEt8NyBsfTGD8XlCXL8bcnb3zM8weP94GAWYKBgQfGATMOMLbh18L4AVOMgC2jYBSMglEwogAAJY1MoMelF6UAAAAASUVORK5CYII=","orcid":"","institution":"Bayero University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Amina","middleName":"Suleiman","lastName":"Rajah","suffix":""},{"id":343236499,"identity":"4c5e3646-9c74-40e6-b37a-c080a080c05e","order_by":1,"name":"Abdulrashid Idris","email":"","orcid":"","institution":"Bayero University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Abdulrashid","middleName":"","lastName":"Idris","suffix":""},{"id":343236500,"identity":"2a18a86f-6e6c-4772-87f5-cdbc7c77c343","order_by":2,"name":"Umar Yunusa","email":"","orcid":"","institution":"Bayero University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Umar","middleName":"","lastName":"Yunusa","suffix":""},{"id":343236501,"identity":"8f1a9c1f-cc0d-4cf4-a8ee-7a6ea5afc3c1","order_by":3,"name":"Muhammad Awwal Ladan","email":"","orcid":"","institution":"Bayero University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Awwal","lastName":"Ladan","suffix":""},{"id":343236502,"identity":"c67d009c-fb12-4395-ae73-05c116a18815","order_by":4,"name":"Chioma Judith Mba","email":"","orcid":"","institution":"Bayero University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chioma","middleName":"Judith","lastName":"Mba","suffix":""}],"badges":[],"createdAt":"2024-07-24 14:39:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4796211/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4796211/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109641834,"identity":"75a32206-98b9-4ea9-aa1d-0d55863011da","added_by":"auto","created_at":"2026-05-20 14:11:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":243304,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4796211/v1/9f402ca8-2943-41c7-9976-12c079026239.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003e“Heard or Unheard?” a Qualitative Inquiry Into the Nuanced Experiences of Mothers with Intrapartum Care in Kano, Nigeria\u003c/p\u003e","fulltext":[{"header":"Statement of Significance","content":"\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eProblem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eChildbirth experience significantly impacts maternal and neonatal outcomes, with negative experience leading to consequences such as postpartum depression, self-care neglect, sleeping problems, posttraumatic stress disorder and the reluctance to use health facilities and recommend hospital delivery to other women.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat is Already Known\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eEvidence from a WHO-led study shows that more than one-third of women have negative experience during childbirth in health facilities, highlighting the need for further exploration in different contexts.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eWhat this Paper Adds\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"100%\" valign=\"top\"\u003e\n \u003cp\u003eThe qualitative narrative inquiry design allows for an in-depth exploration of women\u0026apos;s nuanced experiences, and providing rich, context-specific data to inform interventions aimed at improving the quality of intrapartum care.\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Introduction","content":"\u003cp\u003eNegative maternal experience has been directly linked to the underutilization of health care facilities and the recommendation of such services to others (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Emerging studies have considered intrapartum care satisfaction a critical point of intervention to mitigate the high maternal mortality ratio (MMR) (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). High rates of avoidable maternal and newborn mortality and morbidity in low-income and middle-income countries could be mitigated by improving intrapartum quality of care (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eGlobally, many women have negative experiences during childbirth in health facilities (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Studies in countries such as the United States, United Kingdom, and Australia have reported that negative experiences during labour and birth are driving some women to seek alternatives, and for some, this is to birth outside of the mainstream maternity system with no health professional present (\u003cspan additionalcitationids=\"CR8 CR9 CR10\" citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Another multicountry study revealed that 1 in 5 women who attended maternity health facilities had at least one episode of abuse in six European countries\u0026mdash;Sweden, Norway, Belgium, Estonia, Iceland and Denmark (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eQualitative studies have reported women\u0026rsquo;s subjective negative experiences during childbirth in some countries (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Nonconfrontational measures such as returning home and bypassing certain health facilities and/or healthcare providers or accepting mistreatment were reported by women in response to the abuse (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Overwhelmingly, women in Middle Eastern Asian countries experience birth as dehumanizing and disrespectful (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In Guinea, four scenarios in health facilities\u0026mdash;verbal abuse, slapping, physical restraint and refusing to help\u0026mdash;were used to understand the acceptability of mistreatment among service providers and women (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Health care providers are abusive when they feel that women are uncooperative or disobedient or that the lives of their unborn children are at risk during childbirth (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Africa, several studies have revealed considerable reports of negative experiences, with approximately 23.7\u0026ndash;98% of women reporting at least one form of maternal abuse (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). For instance, in Zambia, previous studies among women during labour reported women experiencing verbal abuse and being abandoned during the labour process, thereby deterring some from delivering in health facilities during subsequent pregnancies (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). A qualitative study in Tanzania reported abusive events such as verbal abuse, discriminatory treatment, and being ignored (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Several studies across Africa have reported other forms of maternal abuse, such as physical abuse (such as being slapped by health-care providers), abandonment of delivering a child alone, and being detained for a long time in a health facility (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Nigeria, few qualitative studies have explored women\u0026rsquo;s experiences with intrapartum care. A qualitative study conducted in Benue, Nigeria, by Orpin et al. (2018) revealed that the participants perceived incidents such as being shouted at and the use of abusive language as common practices. A study by Amole et al. (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e) in Kano on the prevalence, pattern and determinants of disrespect and abuse during childbirth among recently parturient women revealed that more than half (55.9%) had experienced at least one form of disrespect and abuse during childbirth. The most common forms of abuse were abandonment and nonconfidential care (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThere is a paucity of empirical data concerning women\u0026rsquo;s experience with intrapartum care in Nigeria, with a noticeable gap in studies in northern Nigeria. Therefore, the aim of this study was to explore the nuanced maternal experience with intrapartum care in Kano, Nigeria, using qualitative research approaches.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis study utilized a qualitative narrative inquiry research design. The CORSEQ guidelines were used for reporting the studies. This study was conducted at Murtala Muhammad Specialist Hospital (MMSH), Kano. The target population for the study was women who delivered at MMSH by spontaneous vaginal delivery successfully and who were in their immediate postpartum period (1\u0026ndash;7 days).\u003c/p\u003e \u003cp\u003eAn interview guide consisting of open-ended questions about maternal experience of intrapartum care was used to conduct an in-depth interview. The interview guide was adapted from a previous study (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The guide was pretested at the study site before data collection. The interview guide included questions and probes aimed at eliciting responses centred on maternal experience of intrapartum care in relation to interpersonal care, obstetric analgesia, childbirth positioning and the physical birth environment.\u003c/p\u003e \u003cp\u003eTwo female research assistants (RN, RM, BNSc) who have experience in qualitative research, along with the female researcher (AR) (RN, RM, MSc. in Nursing) collected the data. They assumed that improved intrapartum care practices can significantly improve maternal health outcomes. Their primary reason for conducting this research was to explore and enhance the quality of maternal care in low-resource settings. Their interest lies in identifying practical, evidence-based strategies that can be widely adopted to improve women's childbirth experiences and outcomes.\u003c/p\u003e \u003cp\u003e Prior to beginning the data collection, the purpose of the interviews was explained to the participants. Confidentiality was assured, and informed consent was obtained. The consent form was read in the local language. In depth, one-on-one interviews lasting between 30 and 60 minutes were conducted at a mutually agreed-upon safe place within the hospital and at a convenient time for the participants. A voice recorder was used to capture the data during the sessions. The audio-taped interviews were transcribed within 24 hours of the interviews, but the information was still fresh.\u003c/p\u003e \u003cp\u003eParticipants with Birth Satisfaction Scale-Revised (BSS-RI) scores of 9\u0026ndash;12 (high satisfaction) or 0\u0026ndash;4 (low satisfaction) and those with unique or atypical obstetric histories were selected for the interviews. This method was chosen to ensure a wide range of perspectives, enhancing the richness and depth of the data. Participants were recruited based on their responses in a prior quantitative study, as this study is part of a dissertation that employed a mixed methods approach. This allowed the inclusion of women with varied obstetric experience, further ensuring the comprehensiveness and reliability of the findings. The sample size was determined based on the principle of data saturation, ensuring the comprehensive capture of diverse experiences without redundant data collection. Data saturation was confirmed when no new information emerged, which became apparent after the ninth interview. To validate this saturation point, two additional interviews were conducted, confirming that no new insights would be gained. This approach ensures robustness in the data. The respondents were selected purposively using deviant sampling.\u003c/p\u003e \u003cp\u003eThe criteria for ensuring the trustworthiness of qualitative studies according to Lincoln and Guba (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) were used in this study. Participants were encouraged to be as objective as possible and to support their statements with relevant examples. Credibility was ensured by presenting the interview transcripts to the participants to confirm the accuracy of the descriptions given during the interview and to ascertain that the transcripts accurately portrayed the participants\u0026rsquo; viewpoints.\u003c/p\u003e \u003cp\u003eThe researcher ensured the quality of the data by conducting regular reflective discussions with the research assistants. These discussions were held after the interviews to discuss key findings and identify themes. Throughout the data collection, the study participants were asked to elaborate on or clarify what they said during the interviews to confirm the accuracy of the information captured and the meanings that the participants intended to ascribe. No prior relationship was established between the researchers and the participants before the study commenced. The participants were informed about the researcher's professional background, academic qualifications, and primary aim of the study, but no personal goals or reasons for doing the research were disclosed.\u003c/p\u003e \u003cp\u003e The researchers were mindful of adopting a neutral body posture and tone of voice to avoid influencing participant responses. They also ensured qualitative reduction by writing field notes, recording their philosophy and thoughts about intrapartum care prior to commencement of data collection, maintaining a research journal to reduce any preexisting thoughts and to facilitate reflection after interviewing, and having regular meetings with the other members of the research team.\u003c/p\u003e \u003cp\u003eThe audio recordings were transcribed verbatim and translated from Hausa to English by experts from the Hausa Department of Bayero University, Kano, prior to analysis. The standard \u0026ldquo;forward-backwards\u0026rdquo; translation procedure was used to translate the transcriptions from Hausa to English. The forward translations were then back-translated by a bilingual expert who had no knowledge of the wording of the original Hausa version. The initial analysis of the transcripts was performed by the researcher (AR), who engaged in reflection and highlighted key data from the interviews. Notes on body language and nonverbal communication as well as field notes were also analysed along with the data from interviews to better explain the findings.\u003c/p\u003e \u003cp\u003eThematic analysis was adopted to identify patterned meaning across the interviews. Thematic analysis was chosen to remain as close to the meanings in the grounded data as possible. The interviews aimed to capture the real experiences of women regarding intrapartum care and how these experiences influenced and impacted the decisions of the participants.\u003c/p\u003e \u003cp\u003eFollowing the steps of Braun and Clarke for thematic analysis, the researcher (AR) familiarized herself with the data, reading and rereading the transcripts and writing initial thoughts (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). The researcher then created initial coding manually using Microsoft Word. Interpretative analysis was carried out by using the collated codes, and the data extracts were categorized according to the overarching themes. Subsequently, the identified themes were reviewed and analysed.\u003c/p\u003e \u003cp\u003eData analysis involved line-by-line, open, and axial stages of coding in a constant comparative, iterative manner to capture emergent themes. The researcher constantly reviewed the data to cross-check the validity of the analysis. The identified codes were input into Nvivo, version 14, which grouped the codes and aided in identifying the themes and subthemes from the collected data. Nvivo also helped to ensure the management and grouping of the large amounts of data. Different concepts and data categories were then generated based on the objectives of the study and on the information that was gained through interviews. Different quotes were used to match different themes that emerged from the data. These were grouped into categories. Representative quotes that best captured the idea are presented for illustration. The findings of the study were then returned to the participants to provide feedback related to the accuracy of the data they provided.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e with reference number NHREC/17/03/2018/SHREC/2022/3255 was obtained from the Health Research Ethics Committee (HREC), Ministry of Health, Kano State. Informed consent was obtained from the respondents to obtain voluntary participation. Confidentiality was guaranteed by storing the data in a safe place, and only the researcher had access to the data. The objectives, methodology, purpose of the study, and the benefits and risks of the study were explained to all study participants before the interviews. Individual personal identifiers, e.g., names, were not collected to ensure the anonymity of the data.\u003c/p\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic Characteristics of the Participants (N\u0026thinsp;=\u0026thinsp;11) (To be placed under results)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParticipant Code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eParity\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eHighest\u003c/p\u003e \u003cp\u003eEducational Qual.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTrade\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTailor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAgriculture (Poultry)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTailor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eTailor\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eIslamic Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAverage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the participants were between the ages of 18 and 43 years, with a mean age of 27.1 years. Approximately half (n\u0026thinsp;=\u0026thinsp;5) of the participants had completed secondary school. The parity of the participants ranged from one to eleven, and the average was 4.2. One-third (n\u0026thinsp;=\u0026thinsp;4) of the participants were unemployed, and another one-third (n\u0026thinsp;=\u0026thinsp;4) were involved in entrepreneurship. Almost all the participants (n\u0026thinsp;=\u0026thinsp;10) were of the Hausa tribe.\u003c/p\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eThemes Identified from the Study\u003c/h2\u003e \u003cp\u003eThe study consisted of in-depth interviews with 11 postpartum women aged between 18 and 43 years. Analysis of the interview transcripts depicting the women\u0026rsquo;s experience with care rendered to them during labor and delivery and their concept of care revealed three (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) main themes: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) Dignified care during birth, (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) Intense pain and search for relief, and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) Inadequate Care and Neglect.\u003c/p\u003e \u003cp\u003e \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cb\u003eshould be placed on page 12 immediately after the heading Themes Identified from the Study)\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDevelopment of Themes\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSubthemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCodes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDignified care during birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAn overall positive birth\u003c/p\u003e \u003cp\u003eExperience\u003c/p\u003e \u003cp\u003eWomen being grateful\u003c/p\u003e \u003cp\u003eWomen being satisfied\u003c/p\u003e \u003cp\u003eReception on arrival\u003c/p\u003e \u003cp\u003eShe stayed with me the whole time Encouragement to \u0026ldquo;push\u0026rdquo;\u003c/p\u003e \u003cp\u003eEmotional and physical support\u003c/p\u003e \u003cp\u003eThe midwife being central to\u003c/p\u003e \u003cp\u003ethe woman\u0026rsquo;s birth experience\u003c/p\u003e \u003cp\u003eThe caring midwife\u003c/p\u003e \u003cp\u003ePresence of health personnel during delivery\u003c/p\u003e \u003cp\u003eCordial relationship\u003c/p\u003e \u003cp\u003eGood rapport\u003c/p\u003e \u003cp\u003eDid not get tired\u003c/p\u003e \u003cp\u003eMay Allah bless them\u003c/p\u003e \u003cp\u003eCleaned me\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNice, Kind, Calm Lovely, Caring, Compassionate\u003c/p\u003e \u003cp\u003eFunny, Personal Respect, Warm, Attentive, Happy, Honest, Warm reception, Pampered, Patience, Encouraged, consoling, skilled, impressed, appreciate, bless, welcoming, safe, comfortable, helped, playful, joyful, smiling, laugh, reassuring, calm, entertaining, attention, bless, Good care\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntense pain and search for relief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eIt was painful\u003c/p\u003e \u003cp\u003eDiscomforting experience\u003c/p\u003e \u003cp\u003eDon\u0026rsquo;t have words to describe\u003c/p\u003e \u003cp\u003eMost painful experience of my life\u003c/p\u003e \u003cp\u003ePraying to God\u003c/p\u003e \u003cp\u003eThe pain was unbearable\u003c/p\u003e \u003cp\u003eLabour pain likened to death\u003c/p\u003e \u003cp\u003eNo remedy\u003c/p\u003e \u003cp\u003eAllah\u0026rsquo;s name for pain reduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCrying, Screaming, Shouting, Painful, terrible, traumatized, Complaining, distressing, displeasing, Stressed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInadequate Care and Neglect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eShe left me alone\u003c/p\u003e \u003cp\u003eWaiting for a long time before consultation\u003c/p\u003e \u003cp\u003eAbsent midwife\u003c/p\u003e \u003cp\u003eNegative birth experience\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAlone, ignored, badly treated, no help, harassed, shamed, unkind, not attended to, intimidating, shouting, insulted, bullied, wicked, unkind, annoyed, angry, calling,\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eTheme One: Dignified Care During Birth\u003c/h2\u003e \u003cp\u003eThis theme reflects the positive experiences and feelings of gratitude and satisfaction expressed by women during their birthing process. It emphasizes the essential role of the midwife and healthcare personnel in providing comprehensive support, both emotionally and physically, throughout the journey of childbirth. This theme also captures participant contributions that emphasize the astonishing attitudes of health care providers. The majority of the participants expressed that the health care providers, especially the midwives, were kind, caring and very supportive. The majority of the participants also expressed their appreciation for the midwives\u0026rsquo; reassurance and encouragement during labour and delivery. Additionally, \u003cb\u003ethe\u003c/b\u003e majority of the participants opined that a midwife was present with them during the whole delivery period. Some even expressed that they had more than one midwife attend to them during delivery.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eTheme Two: Intense Pain and Search for Relief\u003c/h2\u003e \u003cp\u003eThis theme relates to women\u0026rsquo;s divergent experience of labour and delivery. Most women felt that their experience could not be put into words. The majority opined that the experience was very painful and distressing and unlike anything they had ever experienced in their lives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eTheme Three: Inadequate Care and Neglect\u003c/h2\u003e \u003cp\u003eThis theme reflects the common thread among the subthemes, highlighting the negative experiences and challenges faced by individuals in the context of healthcare. It conveys a sense of dissatisfaction and the perception of insufficient attention or support received from healthcare providers. A few of the participants reflected on the negative experience they had on arrival at the hospital. One of the participants reported experiencing verbal abuse, bullying and intimidation from health care providers. Similarly, another participant reflected that she did not have anyone with her during delivery, which affected her experience.\u003c/p\u003e \u003cp\u003e \u003cb\u003e(\u003c/b\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e \u003cb\u003eshould be placed on page 14 after the heading Theme Three: Inadequate Care and Neglect, just before discussion).\u003c/b\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eQuotations of Participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTheme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eQuotations\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003e\u003cb\u003eTheme One: Dignified care during birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The reception was beyond my imagination, I was pampered and they showed me respect. They encouraged me. The midwife kept consoling me, telling me sorry, that it will soon be over. The staff are very skilled, I am so impressed. That made me very happy.\u0026rdquo;\u003c/em\u003e (Participant 6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I had a very good reception on arrival, I was not harassed or shamed by anyone.\u003c/em\u003e (Participant 5)\u0026rdquo;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I was well received on arrival, the midwife immediately asked me to come in and gave me a bed to lie on. She checked me and told me that the baby is on his way. I really appreciated that, I felt respected\u0026rdquo;\u003c/em\u003e (Participant 9)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;When I came to the hospital, the staff attended to me very well, although, there has been rumors spreading around about how unkind and harsh the staff are, but honestly, I did not experience this at all. I was well received, they were very caring and nice. And I am so grateful. May Allah bless them abundantly\u003c/em\u003e.\u0026rdquo; (Participant 11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;What impressed me the most was that they did not get tired, whenever I called, they will come, when I call again, they will still come. I have even gotten so close to some of them.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Honestly, they are very kind. All the staff I met were very kind. Although, I have not known them for a long time, I can say that they are very kind. I didn\u0026rsquo;t meet one person that shouted at me or that was unkind or disrespectful. They were very encouraging and it was that encouragement that gave me the courage and strength to push when they asked me to\u0026hellip;\u0026rdquo;(\u003c/em\u003eParticipant 10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Yes, they (midwives) really tried, when I was admitted, whenever they came around, they will ask me to stand up and move around, that it will help me deliver faster, and when am tired they ask me to go back to my bed and rest. So, I really appreciated that concern that they showed and that made me feel supported as if I was not all alone. The midwife helped me a lot, I don\u0026rsquo;t think I would have been able to give birth myself if not for her.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Honestly, they really tried. What I appreciated the most was that the midwife stayed with me throughout my labour and even during my delivery. And after delivery, they cleaned me up, cleaned the baby and they advised me to rest.\u0026rdquo;\u003c/em\u003e (Participant 5)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;They were very playful and joyful. The midwife was always smiling and trying to make me laugh. After I delivered, whenever anyone of them passes they will look at me and smile. And I really appreciated that.\u003c/em\u003e\u0026rdquo; (Participant 6)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I had about 2 or 3 midwives with me when I delivered. Even during the labour, they kept checking on me, they will go to their station and then come back and check on me.\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003e\u003cb\u003eTheme Two: Intense Pain and Search for Relief\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;A Midwife!!! (Expresses shock) I had 3 midwives attend to my delivery. They paid so much attention to me, one was trying to deliver the baby, one was reassuring and encouraging me and the other one was supporting my abdomen and back\u0026rdquo;\u003c/em\u003e (Participant 8)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It was a very distressing experience. I felt as if my head was being unscrewed from my body. I felt as if my body was not in my body. But with Allah\u0026rsquo;s intervention, the baby was delivered in a short while, but she was delivered dead. (Starts crying)\u003c/em\u003e \u0026ldquo;(Participant 1).\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It was a very displeasing experience (Laughs gently). The pains started slowly, after a while we came to the hospital, I spent over 48 hours in labour before delivery. After a while they informed me that I was going to have a surgery to deliver my baby. But later they gave me a pill, and put it under my tongue, then strong contractions started. It did not take long after that, and I delivered my baby\u0026rdquo;\u003c/em\u003e (Participant 4)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;It was painful but not as painful as I thought it will be. The labour itself was not very painful, but the delivery, Hmnn\u0026hellip;. (Sighs) I don\u0026rsquo;t even have words. It was the most painful experience of my life. I was lucky, I didn\u0026rsquo;t have a long labour, and it was very fast.\u0026rdquo;\u003c/em\u003e (Participant 7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;Hmnn\u0026hellip; I don\u0026rsquo;t even have words to describe what I felt. I was so stressed and in so much pain. There are no words to describe what happened to me\u003c/em\u003e.\u0026rdquo; (Participant 10)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I spent 2 days sleeping on the cold hard ground before I was able to see the doctor. Despite sleeping at the hospital the first day, the line was still too long and so I was not able to see the doctor, it was after the 2nd day that I was lucky enough to be on the line.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The way I was received was bad, I waited for a long time before seeing the doctor, I came to the hospital around Zuhr prayer (1 pm), but I was not attended to until around 12 midnight.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;what annoyed me the most and made me very unhappy was that, when I finally got to see the doctor, he just started shouting at me, he was so angry, that why was I coming to the hospital now, when I am almost due for delivery. Why didn\u0026rsquo;t I come early, He was not a Hausa man, he was shouting, raising his voice in English and the other doctor there was translating it to me in Hausa. I was trying to explain that I did not do my Antenatal here, that I was referred because of a problem, but He did not listen to me at all. I did not understand why he was angry, or is it a crime to do antenatal in any other hospital other than Murtala?\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTheme Three: Inadequate Care and Neglect\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The midwife was not with me when I gave birth, I was all alone and they did not allow my relatives to stay with me. I felt the baby coming out and I kept shouting and calling on the staff, before they came, my baby was already out. I kept calling and calling before they came. To add to that, there was no power at that time, so everywhere was dark. I held on to the bed rails and just kept shouting\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;The way I was received was bad, I waited for a long time before seeing the doctor, I came to the hospital around Zuhr prayer (1 pm), but I was not attended to until around 12 midnight.\u0026rdquo;\u003c/em\u003e (Participant 1)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;I spent 2 days sleeping on the cold hard ground before I was able to see the doctor. Despite sleeping at the hospital the first day, the line was still too long and so I was not able to see the doctor, it was after the 2nd day that I was lucky enough to be on the line.\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;what annoyed me the most and made me very unhappy was that, when I finally got to see the doctor, he just started shouting at me, he was so angry, that why was I coming to the hospital now, when I am almost due for delivery. Why didn\u0026rsquo;t I come early, He was not a Hausa man, he was shouting, raising his voice in English and the other doctor there was translating it to me in Hausa. I was trying to explain that I did not do my Antenatal here, that I was referred because of a problem, but He did not listen to me at all. I did not understand why he was angry, or is it a crime to do antenatal in any other hospital other than Murtala?\u0026rdquo;\u003c/em\u003e (Participant 3)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe findings of the study showed that the majority of the participants had good reception upon arrival at the hospital, and they also expressed that the health care providers, especially the midwives, were kind, caring and very supportive. Paradoxically, the majority of participants reported having good and positive experiences with midwives. This study aligns with research from Ghana, where respectful communication played a significant role in fostering a positive birth experience. This emphasizes the importance of going beyond technical competence and creating a supportive environment (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile our findings showcase positive interactions, they also exist in a larger context where studies reveal widespread disrespect and abuse in childbirth care across sub-Saharan Africa. This paradox underscores the critical need for continued efforts to ensure that respectful maternity practices become the norm, not the exception. Contrary to the findings of this study, a qualitative review identified sub-Saharan Africa as one of the main areas where disrespectful childbirth care continues (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Likewise, in Ghana, some participants said they were being shouted at by harsh and intolerant nurses/midwives (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). A similar study in Australia also revealed that women cited negative experiences surrounding their maternity care experience, such as feelings of isolation, conflicting advice, feeling ignored, and minimal to no continuity, in contrast to the euphoric feelings of birth, immense support, guidance, and encouragement (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSimilarly, the findings of this study contrast with the qualitative meta-synthesis of the expectations and experiences of women in sub‑Saharan African low- and low- to middle-income countries, which revealed that women still encounter disrespectful care in health facilities in LLMICs, including physical and verbal abuse, discrimination, and lack of privacy (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnother noteworthy finding of this study was that most women felt that their experience could not be put into words. The majority opined that the experience was very painful and distressing and unlike anything they had ever experienced in their lives. This finding was validated by research conducted in Uganda, which showed that women described their experience as prolonged and exhaustive labour pains with moments of confusion, inability to move, backs being felt in pieces and feelings of despair (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). While the majority of participants expressed gratitude for the kindness and support they received from midwives, some harbored preconceived negative notions, highlighting the multifaceted nature of patient-provider interactions in childbirth settings. These findings underscore the importance of dignified care at birth and emphasize the pivotal role of healthcare providers in fostering a supportive environment for women undergoing childbirth. Moreover, the discrepancy between positive experiences reported by participants and the literature on disrespectful maternity care in sub-Saharan Africa prompts further reflection on the cultural and contextual factors influencing intrapartum care experiences in low-resource settings.\u003c/p\u003e \u003cp\u003eMoving forward, it is imperative to leverage these insights to inform targeted interventions aimed at enhancing the quality of intrapartum care delivery in Kano and similar settings. Strategies should prioritize improving patient-provider communication during the antenatal period, addressing gaps in health literacy, and promoting respectful and compassionate care practices. By embracing a holistic approach to maternal healthcare research, we can drive meaningful advancements in intrapartum care and contribute to positive birth experiences for women in Kano and beyond.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides valuable insights into maternal experience with intrapartum care in Kano, Nigeria. The study revealed that most women felt that their experience with childbirth cannot be put into words, and the majority opined that the experience was very painful and distressing and unlike anything they had ever experienced in their lives. While there are positive aspects, there are areas for improvement. This research calls for a holistic approach that prioritizes respectful care, pain management, informed mothers, and well-equipped healthcare providers. By creating a truly supportive environment, we can ensure positive childbirth experiences for all women.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSuggestions for Further Research\u003c/h2\u003e \u003cp\u003eFurther research in the field of intrapartum care should focus on longitudinal studies to investigate the enduring effects of childbirth experiences on maternal and neonatal health outcomes over time. Additionally, there is a need for comparative research to explore disparities in intrapartum care experiences across different healthcare settings and demographics, shedding light on factors influencing the quality of care provided. Intervention studies, including training programs for healthcare providers and community engagement initiatives, are also warranted to evaluate the effectiveness of targeted interventions aimed at improving intrapartum care quality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and Limitations\u003c/h2\u003e \u003cp\u003eThe strengths of this study include the utilization of a qualitative narrative inquiry design, allowing for an in-depth exploration of women's nuanced childbirth experiences. Additionally, the rigorous analysis process, including member checking and triangulation of data sources, enhances the credibility and trustworthiness of the findings.\u003c/p\u003e \u003cp\u003eThis study has several limitations, including potential courteousness bias, as the data were collected from women still admitted to the hospital, which may have led to socially desirable responses. Additionally, the study included only mothers who gave birth through spontaneous vaginal delivery, limiting the generalizability of the findings to all postpartum women. The major limitation is sampling bias, as deviant sampling was used, which may not represent the broader population of postpartum women in Kano, Nigeria.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare no conflict of interest regarding the submitted manuscript. There are no financial, personal, or professional associations that might pose a conflict or bias in the content of the research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors gratefully acknowledge the staff of Department of Nursing Science, Bayero University, Kano for their unwavering support towards this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Support:\u003c/strong\u003e There was no external funding for this research.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eASR conceived the study and drafted the protocol, initial design, led the collection and analysis of the data and writing of the draft of the manuscript. IA, UY, MAL and CJM reviewed the protocol and ethics submissions, contributed to the survey design, pilot testing and to the data analysis, interpretation and supervision. All authors contributed to the review and editing of the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eGetenet AB, Teji Roba K, Seyoum Endale B, Mersha Mamo A, Darghawth R. Womens\u0026rsquo; satisfaction with intrapartum care and its predictors at Harar hospitals, Eastern Ethiopia: a cross-sectional study. Nurs Res Rev. 2018;Volume 9:1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eWorld Health Organization. Intrapartum care for a positive childbirth experience [Internet]. Geneva, Switzerland; 2018. 212 p. Available from: http://apps.who.int/iris/bitstream/10665/260178/1/9789241550215-eng.pdf?ua=1%0Ahttp://www.who.int/reproductivehealth/publications/intrapartum-care-guidelines/en/\u003c/li\u003e\n\u003cli\u003eGhanbari-Homaie S, Meedya S, Mohammad-Alizadeh-Charandabi S, Jafarabadi MA, Mohammadi E, Mirghafourvand M. Recommendations for improving primiparous women\u0026rsquo;s childbirth experience: results from a multiphase study in Iran. 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Available from: https://doi.org/10.1371/journal.pone.0194906\u003c/li\u003e\n\u003cli\u003eKabue MM, Grenier L, Suhowatsky S, Oyetunji J, Ugwa E, Onguti B, et al. Group versus individual antenatal and first year postpartum care: Study protocol for a multi-country cluster randomized controlled trial in Kenya and Nigeria. Gates Open Res. 2018;2:1\u0026ndash;21. \u003c/li\u003e\n\u003cli\u003eLukasse M, Schroll AM, Karro H, Schei B, Steingrimsdottir T, Van Parys AS, et al. Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries. Acta Obstet Gynecol Scand [Internet]. 2015 May;94(5):508\u0026ndash;17. Available from: https://onlinelibrary.wiley.com/doi/10.1111/aogs.12593\u003c/li\u003e\n\u003cli\u003eOrpin J, Puthussery S, Davidson R, Burden B. Women\u0026rsquo;s experiences of disrespect and abuse in maternity care facilities in BenueState, Nigeria. BMC Pregnancy Childbirth. 2018;18(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eBalde MD, Bangoura A, Diallo BA, Sall O, Balde H, Niakate AS, et al. A qualitative study of women\u0026rsquo;s and health providers\u0026rsquo; attitudes and acceptability of mistreatment during childbirth in health facilities in Guinea. Reprod Health. 2017 Jan;14(1):4. \u003c/li\u003e\n\u003cli\u003eHussein SAAA, Dahlen HG, Ogunsiji O, Schmied V. Women\u0026rsquo;s experiences of childbirth in Middle Eastern countries: A narrative review. Midwifery. 2018 Apr;59:100\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eHussein SAAA, Dahlen HG, Ogunsiji O, Schmied V. Jordanian women\u0026rsquo;s experiences and constructions of labour and birth in different settings, over time and across generations: a qualitative study. BMC Pregnancy Childbirth [Internet]. 2020 Dec 10;20(1):357. Available from: https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-020-03034-3\u003c/li\u003e\n\u003cli\u003eSmith J, Banay R, Zimmerman E, Caetano V, Musheke M, Kamanga A. Barriers to provision of respectful maternity care in Zambia: results from a qualitative study through the lens of behavioral science. BMC Pregnancy Childbirth [Internet]. 2020;20(1):26. Available from: https://doi.org/10.1186/s12884-019-2579-x\u003c/li\u003e\n\u003cli\u003eMukanga B, Nyirenda HT, Choka N, Mulenga D, Daka V. Experiences and drivers of verbal abuse among women during labour and delivery in Ndola and Kitwe districts of Zambia. Cogent Med [Internet]. 2021;8(1). Available from: https://doi.org/10.1080/2331205X.2021.1924432\u003c/li\u003e\n\u003cli\u003eKujawski S, Mbaruku G, Freedman LP, Ramsey K, Moyo W, Kruk ME. Association Between Disrespect and Abuse During Childbirth and Women\u0026rsquo;s Confidence in Health Facilities in Tanzania. Matern Child Health J. 2015 Oct;19(10):2243\u0026ndash;50. \u003c/li\u003e\n\u003cli\u003eAmole T, Tukur M, Farouk S, Ashimi A. Disrespect and abuse during facility based childbirth: The experience of mothers in Kano, Northern Nigeria. Trop J Obstet Gynaecol [Internet]. 2019;36(1):21. Available from: http://www.tjogonline.com/text.asp?2019/36/1/21/256483\u003c/li\u003e\n\u003cli\u003eMilton R, Alkali FI, Modibbo F, Sanders J, Mukaddas AS, Kassim A, et al. A qualitative focus group study concerning perceptions and experiences of Nigerian mothers on stillbirths. BMC Pregnancy Childbirth. 2021;21(1):1\u0026ndash;13. \u003c/li\u003e\n\u003cli\u003eLincoln YS, Guba EG. Naturalistic inquiry. Sage [Internet]. 1985; Available from: oi. org/10.1016/0147-1767(85)90062-8\u003c/li\u003e\n\u003cli\u003eDanzima NY, Dehghan Nayeri N, Arpi M, Buunaaim ADB, Tijani A. The Lived Experiences of Postpartum Women in Ghana Regarding Nursing Care During Childbirth and Their Concept of Care-A Phenomenological Study. Res Sq [Internet]. 2021;1\u0026ndash;16. Available from: https://doi.org/10.21203/rs.3.rs-257786/v1\u003c/li\u003e\n\u003cli\u003eLavender T, Bedwell C, Kasengele CT, Kimaro D, Kuzenza F, Lyangenda K, et al. Respectful care an added extra: a grounded theory study exploring intrapartum experiences in Zambia and Tanzania Handling editor Seye Abimbola. BMJ Glob Heal [Internet]. 2021;6:4725. Available from: http://gh.bmj.com/\u003c/li\u003e\n\u003cli\u003eAfaya A, Dzomeku VM, Baku EA, Afaya RA, Ofori M, Agyeibi S, et al. Women\u0026rsquo;s experiences of midwifery care immediately before and after caesarean section deliveries at a public Hospital in the Western Region of Ghana. BMC Pregnancy Childbirth. 2020;20(1):1\u0026ndash;9. \u003c/li\u003e\n\u003cli\u003eHargreaves S, Young S, Prior SJ, Ayton J. Exploring Women\u0026rsquo;s Experiences of Maternity Service Delivery in Regional Tasmania: A Descriptive Qualitative Study. Healthc. 2022;10(10):1\u0026ndash;11. \u003c/li\u003e\n\u003cli\u003eAhmed SAE, Mahimbo A, Dawson A. Quality intrapartum care expectations and experiences of women in sub-Saharan African Low and Low Middle-Income Countries: a qualitative meta-synthesis. BMC Pregnancy Childbirth [Internet]. 2023;23(1):1\u0026ndash;19. Available from: https://doi.org/10.1186/s12884-022-05319-1\u003c/li\u003e\n\u003cli\u003eNamujju J, Muhindo R, Mselle LT, Waiswa P, Nankumbi J, Muwanguzi P. Childbirth experiences and their derived meaning: a qualitative study among postnatal mothers in Mbale regional referral hospital, Uganda. Reprod Health [Internet]. 2018;15(1):183. Available from: https://doi.org/10.1186/s12978-018-0628-y\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Childbirth, Maternal, Experience, Intrapartum, Qualitative","lastPublishedDoi":"10.21203/rs.3.rs-4796211/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4796211/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eChildbirth experience significantly impacts maternal and neonatal outcomes, with negative experiences leading to consequences such as postpartum depression, self-care neglect, sleeping problems, posttraumatic stress disorder and the reluctance to use health facilities and recommend hospital delivery to other women.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim:\u003c/strong\u003eThis study aimed to explore maternal experience with intrapartum care in Kano, Nigeria.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eA qualitative narrative inquiry approach involving in-depth interviews with 11 postpartum women was utilized. The interviews were transcribed, translated, and thematically analysed to identify patterns and themes related to maternal experiences of intrapartum care.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003eThree main themes emerged: (1) Dignified care during birth, emphasizing positive experiences with midwives and healthcare personnel; (2) Intense pain and search for relief, highlighting the challenging nature of labor; and (3) Inadequate care and neglect, capturing negative experiences with wait times, lack of support, and even verbal abuse.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003eThis study highlights the diverse range of maternal experiences during childbirth in Kano, Nigeria, encompassing both positive and negative aspects of intrapartum care.\u003c/p\u003e","manuscriptTitle":"“Heard or Unheard?” a Qualitative Inquiry Into the Nuanced Experiences of Mothers with Intrapartum Care in Kano, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-23 11:40:24","doi":"10.21203/rs.3.rs-4796211/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"03899b65-a4ba-42dd-98b6-f815f6ef99ff","owner":[],"postedDate":"August 23rd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-20T14:09:54+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-23 11:40:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4796211","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4796211","identity":"rs-4796211","version":["v1"]},"buildId":"zQwnuV7TCBrMSSSToR1PI","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}