“Caring is Curing”: Views from Women in Improving

Maternal Health Care in Aceh, Indonesia

Suryane Sulistiana Susanti

, Suryane Sucaesaria Supradaniati

, and Farah Diba

Department of Family Health Nursing, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Department of Midwifery, Muhammadiyah Tangerang University, Tangerang, Indonesia

Department of Community Health Nursing, Faculty of Nursing, Syiah Kuala University, Banda Aceh, Indonesia

Keywords: Maternal Health, Maternity Care, Mothers, Women Involvement, Qualitative, Phenomenology

Abstract: In the current policies and provision of maternal health, a clear need has emerged on the importance to

attach both women’s views and their involvement in maternity care. Increasingly, women seek knowledge,

satisfaction and involvement about their received maternity care. In Aceh Province, Indonesia, maternal

mortality still becomes concern in maternal health care. Therefore, the need to increase the women’s

knowledge and their involvement in maternal health become the importance aspect in improving maternity

care. The aim of this study was to examine the perception of women concerning their knowledge,

satisfaction and involvement in improving maternal health care. Qualitative study design with

phenomenology approach was utilized. Theoretical sampling strategy has been employed. Data collection

involved in-depth interviews where sample size was determined by data saturation. Interviews were

recorded, transcribed verbatim and thematically analysis. Ethic approval was gained and Interviews were

conducted with 12 mothers. The current emerging themes emerged the importance of information during

pregnancy and childbirth, relationship between women and midwives; support from the health professionals

and involving women’s partner during pregnancy and childbirth. Understanding the need from women in

maternity care can assist the midwives in supporting the women’s right in improving maternity care.

1 INTRODUCTION

The global policy and provision of maternal health

has largely focus on the importance of attaching the

women’s knowledge and their involvement in

maternity care (Koblinsky, 2016; Paudel, et. al.,

2015). The quality of maternity care is defined as the

provision of maternal health services and

appropriate treatment for the individuals and

population based on professional knowledge and

inherent with the reproductive rights (Gamedze-

Mshayisa, et. al., 2018). Perceived quality is the

central element in service utilization and users plays

an important role in determining quality of care

(Srivasta, et. al., 2015). The women’s access to

maternity care influenced by their opinion and

experiences with health systems (Larson, et. al.,

2014). Accessing women’s perception provides the

opportunity to hear their voice and more responsive

to the people’s need and expectation; thus it enable

the health system more effective (Gamedze-

Mshayisa, et. al., 2018).

Currently, there is an increasing attention and

recognition to have respectful maternity care based

on the women’s personal, social and health needs

(Koblinsky, 2016; Bohren, et. al., 2015). It is

important to engage with the women’s experiences,

since they are in the position to provide in-depth

information, based on their experiences to maternity

care. This study uses qualitative methodology in

order to explore the women’s experiences related to

their pregnancy and childbirth, inherent with the

maternity care that they received. This enables to

understand their views on what they perceived as

quality of maternal health care.

The study aims to explore the perception of

women concerning their knowledge, satisfaction and

involvement in improving maternal health care; with

the objectives to explore the views of women in

improving maternity service and to examine factors

which promote the quality of maternity service.

Susanti, S., Supradaniati, S. and Diba, F.

“Caring is Curing”: Views from Women in Improving Maternal Health Care in Aceh, Indonesia.

DOI: 10.5220/0008396602110216

In Proceedings of the Aceh International Nursing Conference (AINC 2018), pages 211-216

ISBN: 978-989-758-413-8

211

2 METHODS

This study used qualitative phenomenology design

with semi-structured in-depth interviews. This

method enabled to explore the women’s knowledge

and their views regarding improving maternal health

services; including their interaction with the health

care providers which influenced their pregnancy and

childbirth experiences.

2.1 Study Setting

Indonesia is one of the countries in South East Asia

that has high maternal mortality rate (MMR) with

126 maternal deaths in 100.000 lives (WHO, 2015).

The Aceh Province has relatively higher MMR than

the average Indonesian MMR, with 134 maternal

deaths in 100.000 lives and neonatal mortality rate

24 in 100 lives (Indonesian Ministry of Health

(MoH), 2015). The study focused in Aceh Besar

district (Kabupaten) where it has 23 sub-districts

(Kecamatan) with one public hospital in the

district’s capital city and each sub-district has public

health center called Puskemas. Puskesmas is part of

the public health system in Indonesia which provides

preventive, promotive and curative health care

services to the community. In terms of maternal

health services, each Puskesmas has maternal and

neonatal unit that provide services to the community

particularly the women and children.

2.2 Data Collection

All in-depth interviews took place in one of sub-

districts in Aceh Besar. The participants were

selected by the virtue of providing information and

knowledge inherent with the study aims and

objectives. The selection criteria for the participants

includes: giving birth within the last 12 months,

gave birth with the health professionals’ assistance

(midwives), resides in the study setting, willingness

to participate in the study and have the ability to

provide the consent of the study. The snowball

sampling was also conducted in order to obtain rich

information from the participants.

Prior conducting the interview, all participants

were asked to sign written informed consent which

was reviewed verbally by the interviewer. In order to

protect and minimise potential harm to the

participants, pseudonym were utilized and all the

information regarding place, health facilities and

other identified persons had been anonymously

placed during the study analysis and reporting the

study findings.

The interview guidelines were prepared and pilot

tested with 3 participants whom have similar criteria

in the neighboring sub-district; in order to adjust and

clarify the questions’ flow. The interviews were

conducted in Bahasa Indonesia and some of them

were in local Acehnese language. The duration of

the interviews lasted within 1 – 1.5 hours in the

participants’ home. All the interviews were

conducted by the first author and field notes were

also taken during the interviews in order to record all

the interviews’ comments and the situation in detail.

2.3 Data Analysis

All the interviews were audio recorded, transcribed

verbatim and analyzed by the first author. The

transcripts were analyzed using thematic analysis by

identifying all sections which relevant to the

research questions. The next step was to assign the

content which frequently occurred, coded and then

classified in the form of emerging themes. The study

result were summarized and discussed by all the

authors in order to reach the agreement. All the

emerging themes and participants’ quotes were then

translated into English.

3 FINDINGS

There were 12 postpartum mothers aged 20 – 40

years participated in this study. Most of them are

multigravida mothers with the newborn as young as

5 days old. Most mothers have the senior high

school education and stay at home mothers. Table 1

shows the characteristics of the participants whom

involved in the study.

Table 1: The Characteristics of the Mothers Interviewed.

Characteristics

Categories

Frequency

(N=12)

Parity

First

Second

Third or more

Type of birth

Normal

Caesarean

There were four themes emerged from the study

which explained the women’s views regarding

improving maternal health care.

3.1 The Importance of Information

during Pregnancy and Childbirth

This theme emphasized on the importance of

information for the mothers during pregnancy and

childbirth. The mothers considered the information

as source of knowledge in order to prepare for the

parenthood, kept informed about their pregnancy

and childbearing progress also as a source of

reassurance. Moreover, the information also enables

the mothers to feel included in maternity services by

enabling them to make choice for their maternity

care.

3.1.1 Preparing for Parenthood

Although most participants were multigravida

mothers, they still required information especially

from the health professionals to assist them in

carrying out their roles during the childbearing

process. Moreover, some young mothers desperately

need all the information during their pregnancy and

childbirth.

As a new mother sometimes I get confused

and don’t know what to do, especially I don’t

have my family around...so the midwife is the

only person I ask for help. (Andien, 23 years)

This is my second pregnancies...but still if

they (midwives) delivered the information

regarding my pregnancy and how to keep my

first born healthy while I’m pregnant...it

would be very helpful...it will relieve my

stress little bit...because each pregnancy are

different... (Dara, 26 years)

3.1.2 Informing the Progress of Pregnancy

and Childbearing

Most mothers considered the maternity information

from the health professionals as obtaining

information about the progress of their pregnancy

and childbirth. They required this information to

ensure both the mothers and their babies in healthy

condition.

It is better if they (the midwives) inform us

about the process that we’re going

through...from pregnancy to after birth.

(Fatma, 34 years)

Everytime I go to my midwife (to get

pregnancy check), she always ensure whether

I had enough sleep, do I still feel the baby

movement...eating healthy food...and she

even made a phone call to make sure I am

alright...it is nice and I get knowledge as

well...also I feel comfortable by her care.

(Geubrina, 32 years)

3.1.3 Source of Reassurance

During the interviews, most mothers discussed the

information provided by the health staff as a source

of reassurance. The average women living in rural

area considered having less access to health

education especially in maternity care. Therefore,

during the maternal health services, most women

rely the information from the health professionals

and intend to be passive during the interaction with

their midwives. The health information provided by

the health staff would be the source of assurance

even in the situation where they do not have any

knowledge regarding their needs in maternity care.

Sometimes I don’t know what to

ask...because, this is my first pregnancy, also

I am too shy to ask since there are many

people around (in puskesmas)...so if the

midwife could just provide all the

information, it is so much appreciated.

(Inong, 20 years)

The midwife often asked…’do you have any

questions?’ I don’t even know what to ask...I

have no experience of being pregnant

before... (Jelita, 22 years)

3.1.4 The Ability to make Informed Choice

The provision of knowledge and information

regarding maternal health, should be aim to involve

women in maternity services that they received.

Most participants in the study considered the health

“Caring is Curing”: Views from Women in Improving Maternal Health Care in Aceh, Indonesia

213

information delivered from the health professionals,

should be followed by providing the chance to

choose their maternity care. The mothers’

involvement regarding their care during pregnancy

and childbirth would increase their comfort in

obtaining the health services.

Usually the midwife who educate us (the

mothers)…will give us the chance to choose

about the treatment that we will have...it

made me feel involved and cared for...

(Buleuen, 37 years)

When she (the midwife) asked me whether I

would like to deliver in her clinic or

Puskesmas, I felt that she has fewer egos and

she understand me very well. (Hasnah, 29

years)

3.2 Relationship between Women and

Health Care Providers

All the mothers participated in the study addressed

the importance of having good relationship with the

health care providers in terms of improving

maternity services. The harmonious relationship

between the women and their midwives is the key of

having successful maternity care provision. Most

mothers considered good relationship with their

health professionals as being listened and respected

during the care of pregnancy and childbirth.

3.2.1 Being Listened

The idea of being listened is having balanced

relationship by the ability to listen others

perspectives. In terms of maternity care the mothers

considered their needs of being listened about their

concerns and circumstances related to their

pregnancy and childbirth. It enabled the health

professionals providing the right maternal health

services to the women and their newborns.

I prefer the midwife who is willing to hear

my concern, it shows that she care and most

probably she will provide the care that I need.

(Dara, 26 years)

It would be nice to have the midwife who is

friendly and care about us (mothers), because

then we will not be reluctant to come to her

and seek the treatment from her. (Ella, 32

years).

3.2.2 Being Respected

Being respected is considered of having the chance

to provide and received the care in respectful

manner. Most mothers discussed having the feeling

of being cured by only obtaining care in respectful

way and considered their rights in maternity care.

I like her (the midwife) because she doesn’t

make decision for my treatment by herself,

she always ask my opinion...I like the way

she makes me feel included during the

treatment. (Leli, 32 years)

I feel like being cured already when she cares

about me...all my pain and worries are gone

and I have the strength during the childbirth.

(Keumala, 28 years)

3.3 Support from the Health

Professionals

Having support from the health professionals is the

important aspects required from the mothers in

maternal health care. They considered seeking

maternity care to a supporting health professional in

order to have successful childbirth and childbearing

process also to be involved in decision making.

3.3.1 Successful Childbirth

The health professionals should considered having

both clinical and interpersonal skills in order to

deliver successful childbirth. Providing support to

the mothers is the key to obtain their trust and

optimising the care to the women.

Off course I will look for the experienced

midwife…usually she has the skill and good

knowledge...because I want to have a

comfortable...and safe childbirth and healthy

baby. (Cahaya, 25 years)

When you feel supported especially by the

midwife…at least you will feel at ease…and

this really helps during childbirth. (Ella, 32

years).

3.3.2 Support during the Childbearing

Most postpartum mothers considered having less

attention compared to the stage of their pregnancy

and during childbirth. Support from the health

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professionals during the childbearing process also

important in having good quality of maternity care.

It is better to have the midwife and other

health staff from puskesmas to come

visiting...sometimes we as mother couldn’t

go to Puskesmas very often since we have the

baby... (Andien, 23 years)

It seems that since we have already gave

birth, they (midwife) considered we are doing

OK…in fact there are many things happen

after the childbirth…especially I am a new

mothers…I still confuse…the midwife’s

support is really needed… (Jeulita, 22 years)

3.4 Involving Women’s Partner during

Pregnancy and Childbirth

The role of male partner is considered important

within the woman’s life, especially during

pregnancy and childbirth. Most mothers generally

gained support from their families during pregnancy

and childbirth. However, the support mainly still

derives from their mothers and female relatives. The

women considered their husbands should be

involved more than just physical support but also

social and emotional support.

My husband is very helpful so far…but I

wish he could be involved more than just take

me to the midwife (for pregnancy check)…I

have asked him to be present as well every

time I meet with the midwife, but he said it is

the “woman” business… (Cahaya, 25 years)

Usually when we are pregnant it is the

mother or sister we ask for assistance

(support)…because you know

(uhmm)…being pregnant or gave birth is

related to women…they (husbands) don’t

have experiences on those things…but I

mean…men could also assist women in other

things right…for example taking care of our

other kids while I’m pregnant or at least

emotional support… (Buleuen, 37 years)

4 DISCUSSION

The research findings displayed as core category of

“Caring is curing” emphasizes on the importance of

feeling cared for and supported from the women as a

central focus on the provision of maternity care.

Despite receiving comprehensive care, the women

highlighted the need for more information in order

to support their knowledge in addition for their

wellbeing during pregnancy and childbirth. It is

conceivable that providing the information within

the maternal health services is already considered as

treatment in maternity care. Maternal health

information and education enable the women having

the capability to make decision and assured about

their pregnancy and childbirth (Hou & Ma, 2013).

Furthermore, the women’s relationship with the

midwives as their maternal health care provider also

contributed to the effective provision of maternal

health care. Most women considered their midwives’

preferences not only based on the professional but

also personal relationship. This situation required

more responsibility from the health care provider in

order to have good personal skills in terms of

delivering maternity care. A respectable relationship

between the health care provider and the women is

considered has the ‘healing’ effect to the women and

facilitates the adequate maternal health service.

Adapting good personal skill to professional skills in

delivering maternity services enabling the health

care providers to provide sufficient maternal health

care (Bradfield, et. al., 2018).

The study also underlined the importance of

involving partners by highlighting their role during

pregnancy and childbirth. The evidences show that

male involvement in maternity care reduce maternal

anxiety (Kaye et. al., 2014; Ghosh et.al., 2010) and

increase the women’s uptake to maternity care

(Mirkovich et. al., 2017; Kaye et. al., 2014). Despite

male involvement as a source of financial support

and facilitating to the health facilities; the women

emphasised the role of their male partners to be

involved in emotional support. The need to be

motivational supported also considered in order to

empower the women in receiving adequate maternal

health care.

5 CONCLUSIONS

The study findings provide useful explanation and

in-depth information on the provision of maternity

care based on the caring process. This knowledge

will provide potential intervention related to

improving the quality of maternal health care. For

most women interviewed in this study their

understanding of adequate maternity care is

influenced by their feeling of being cared for also

“Caring is Curing”: Views from Women in Improving Maternal Health Care in Aceh, Indonesia

215

treated with respect. Efforts to implement

intervention targeted to women’s care should be

focus on the women’s need and their wider context

of social and psychological aspects. Therefore, this

study serves an illustration of the women’s live

experiences in terms of their interaction with health

care providers and health facilities, as well as their

surrounding activities and companions regarding the

maternity care. This knowledge will add to the

intervention to improve the quality of maternal

health services.

ETHICS APPROVAL

This study holds ethical approval from Ethics

Committee of Faculty of Nursing, Syiah Kuala

University in Banda Aceh, Indonesia.

DISCLOSURE

The authors state that they have no competing

interests.

AUTHORS’ CONTRIBUTIONS

and SS

involved in conceptualising and

designing the study. SS

conducted the interviews

performing data analysis and prepared for the

article’s first draft. All authors commented on the

first draft and contributed to the revisions of the

manuscript. All authors read and approved the final

manuscript.

ACKNOWLEDGEMENTS

This publication was supported by the Faculty of

Nursing, Syiah Kuala University. The authors would

like to thank all the mothers who have participated

in the study and all the stakeholders in the study

setting for enabling this research to be conducted.

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