Choice versus safety: a qualitative exploration of the complexities of respectful maternity care in Singapore

Respectful Maternity Care (RMC) emphasises dignity, autonomy, and compassion as universal rights, yet its practical enactment within highly medicalised, standardised, and multicultural systems remains complex. This study aimed to explore how RMC is enacted by women and obstetricians, nurses, and midwives in hospital-based maternity care in Singapore. A qualitative exploratory study involving in-depth semi-structured interviews with mothers and healthcare providers was conducted. Mothers with maternity experience within the last 48 months were included regardless of parity (number of previous pregnancies). Healthcare providers were included if they had worked within the maternity setting within the last 4 years. Braun and Clarke's reflexive thematic analysis approach was used to develop themes and subthemes. We found that concepts of RMC, particularly autonomy, were interpreted differently by mothers and providers. Though nurse-midwives were intermediaries for respectful care, providers were operating within the constraints of protocol-driven efficiency within a technocratic society with norms of deference to authority. Mothers demonstrated situated agency by drawing on informal networks and using payment tiers to secure more relational care. However, this market-based differentiation risks commodifying dignity and deepening inequities in RMC based on the ability to pay. Systems need to integrate relational autonomy and informed choice to improve respectful maternity care practices.