Respectful Care at Birth

Dr. Mohammad Baharuddin, SpOG, MARS

Definition
Is a unique approach which has been implemented whose
target is to make childbirth a positive and satisfying experience for both women and their famiy as a whole

Considering womens values, beliefs, feelings, and

respecting their dignity and autonomy during birthing process

Reducing over medicalized childbirth, empowering women

and the use of evidence based maternity practice are strategies that promote humanized birth

References : Behruzi et all BMC Pregnancy and Childbirth 2010 10:25

Budi Kemuliaan Association

Is a Non-profit civil society organization established in 1912

by
Indonesians & Dutch Pioneers Inspired by Princes Kartinis Book (Indonesian Hero & Philosopher) BRIGHTNESS AFTER DARK

 Religion

Kartinis Letter #1

Letter to Eddie A August 15, 1902. How happy I am looking for the best in and of every aspect. The Light of God is in every person, in every thing, even in worst thing. Truthfulness must get soaked in the inner spirit of people, making it transparent for all to see it as an obligation. This very transparence, makes life so beautiful, both for others and for ourselves

Idealism
in our imagination which is so clear and bright ; We shall work hard for the sake of our people, educate and enhance their characters, so as to make it possible for them be a better nation

Kartinis Letter #2
Women ,
Letter to Mrs. Abendanon, January 1901 embodiment of my imagination about women, which is preferably a blend of noble conduct and manner as well as highly intellectual character accompanied by eternal womanhood nature

Because I am very sure, that women may give big influence to the society. The apple of my eye is no more than becoming a teacher. I want very much to educate children and to build their characters, to make their young mind smart, to develop them into future women

Kartinis Letter #3
Education ,
A letter to Nellie V. Kol August 1901 For me, educating is developing characters and intellectual. The teachers task does not cease in developing senses only, but also in compulsorily maintaining character development. Teachers shall have moral obligation though no legal obligation obliges. It is decency to bear in mind that intellectual development alone shall not a guarantee of its ethics.

Budi Kemuliaan Maternity and Children Hospital

Established in 1917 In an area of 10.809 square meter

Budi Kemuliaan Health Institution

provides

Reproductive Health Services (Budi Kemuliaan

Maternity and Children Hospital)

Education (Midwifery Academy ) Training and Research

Budi Kemuliaan Association

The members of Budi kemuliaan Association are not
entitled for receiving the profit (dividend).

The said profit shall be returned in the form of Health

Institution improvement and employees welfare to be A Model

As a result, Budi Kemuliaan Health Institution is the

public asset, which is implemented by the public and benefited by the public.

Mission
to ensure growth and development of better future generation through the best and affordable health services as well as continuing community based implementation in health services, education,training and research

Vision
to become a credible health institution which provide the best and affordable health services for all strata of the society, to build a better generation .

Budi Kemuliaan Objective of Business 2008-2013

Health institution with an organization structure and
management system which capable to respond to an integral service-education-training-research.

Health institution which has already implemented an

optimal essential Health Reproduction service.

Health institution which capable to identify and

establish strategies and produce valuable researches in the society as well as to initiate research cooperation.

Health institution which capable to educate and train

human resources to become agent of change

Political Charge Technical Charge Sustainable --- cultural change Outlook Change Competitor/Custome r
Company

Segmentation Targeting

Positioning
Differentiation

SME

Marketing

Architecture

Strategy Tactic Value

Marketing Mix Selling

Enterpriseinspiration

Scorecar d

Customer Value People Value Shareholder Value

Brand Service Process

Culture Institution

The Six Pillars of Character

Delivery Room

As Model for Care

Budi Kemuliaan Hospital:

Provide with assumption that the service be given to

everyone who have respect and dignity

Deposit-free on admission
Selected cases for free treatment

Choices of services according to the level of providers

Implementation of standard care

Results
Maternal death
Near-miss case audit Medical Audit CPD /Training

Number of Delivery
6,216 6,561 7,626
7,335

6,672

6,100

6,633

7,977

7,773

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

6,544

6,151

7,948

CFR 2011
DEATH CASE FATALITY RATE OF PE/E CASE FATALITY RATE OF PPH CASE RATE %

467

0.01

1.07

26

0.04

3.85

Budi Kemuliaan Characteristics of the setting regarding to childbirth practice

NO 1. CHARACTERISTIC Average childbirth per year Referral Cases to hospital 2. Medical Interventions : C-section rate 27% 7.948 51%

Epidural analgesia Episiotomy with indication for first pregnancy Continues Electronic Fetal Monitoring Routine IV line in normal pregnancy 3. Physical environment : Joining room for family Private post partum room
Shared postpartum room Individual room for all labour

7% + -

+ +
+ +

Budi Kemuliaan Characteristics of the setting regarding to childbirth practice

NO 4. CHARACTERISTIC Main care providers : Nurse-Midwife Obstetricians & Gynaecologists General Practitioners 5. Continuity of care : Care is provided by the same care provider during prenatal 6. Natural methods of relieving pain : Emotional support by companion Emotional support by midwife companion Changing position Breathing techniques + + + + occationally + + +

Budi Kemuliaan Characteristics of the setting regarding to childbirth practice

NO 7. CHARACTERISTIC Rules/Regulation : Eating during labour Conditional companion during labour and delivery Companion C-section Having kids companion Companion in post partum period + + Rare Rare +

Staying baby in mothers room in first 24 h after delivery

Breast feeding within first hours of life Rooming-in Average duration of hospitalization after C-section Average of hospitalization after normal vaginal delivery

+
+ + 2-3 days 2 days

BK Exit questionaire 2011

86.6% 86.8% 86.4% 85.5% 84.3% 81.1% 82.0% 80.8% 80.1% 78.3% 83.6% 84.4%

Friendly

Good attitude

Humanic Clues Can Convey Respect or Disrespect

Respectful treatment of the customer is fundamental to delivering a quality services ; no customer wants to feel disrespected
Disrespectful service is inherently

Poor service