Norwegian midwifery students' perceptions and experiences of respectful and disrespectful maternity care – a qualitative study

Objective As increasing emphasis is placed on providing respectful maternity care (RMC) for a positive pregnancy and birth experience, this study aimed to explore midwifery students' perception and experience of RMC during their clinical placement in Norway. Methods Semi-structured qualitative interviews were conducted online with 8 final year midwifery students from 3 educational institutions in Norway. Reflexive thematic analysis was performed. Results Four main themes were identified: Respecting women's needs and preferences, Woman centred communication, Protocol-driven care reducing women's agency and Student's position and professional adaptations. Students reported that the foundation for RMC was a respectful relationship, built through being with the woman and providing one-to-one care. This together with gaining knowledge about and respect for women's wishes enabled individualized care. Timely and adequate information through a dialogue was deemed essential to RMC. At the same time, students reported observing that guidelines were often prioritized over women's wishes, and interventions were frequently performed without consent. Students also reported dehumanizing practices such as prolonged painful and multiple vaginal examinations while women asked for the procedure to end. The perceived power hierarchy in their practice environment led to conformity and hesitation to discuss perceived disrespectful care. Conclusion Students showed a comprehensive understanding of respectful and disrespectful care, in line with the published evidence on this topic. Despite limited experience in practice, they all had observed disrespectful practice. Our findings highlight areas where increased awareness and reflection could further strengthen RMC. More research on interventions to ensure RMC by all caregivers is needed.