Aim: Encouraging women to deliver in facility settings is one strategy to improve maternal and
neonatal outcomes in the developing world. However, in much of sub-Saharan Africa, fewer than
half of pregnant women deliver in health facilities. Fear of maltreatment during labor and delivery
has been shown to be one barrier to facility delivery, yet previous studies have focused solely on
reports from women, rarely seeking insights from practicing midwives. Method: All seven practicing
midwives from a rural hospital in Ghana and ten pregnant women seeking antenatal care
from the same hospital were recruited to participate in in-depth interviews regarding their perceptions
of care during labor and delivery. A semi-structured interview tool and qualitative field
interviewing approach were utilized. All interviews were audio taped, transcribed, and analyzed
using NVivo 9.0. Results: Respondents described situations that precipitate abuse during facility
deliveries, yet not all abuse was seen as acceptable. Two overarching themes emerged: 1) The interaction
between midwives and their patients is analogous to a mother/daughter relationship,
including both a knowledge imbalance and the need for disciplinary action when necessary; and 2)
Midwives feel a strong sense of responsibility for the delivery outcomes and as a result, they will
do whatever it takes to deliver a live baby to a healthy mother. Hitting, yelling, and neglecting
women were reported as common occurrences in the labor and delivery ward. However, each was
undertaken to encourage women to do what was needed to deliver safely. Conclusion: These findings
suggest that the issue of patient maltreatment in low-resource labor and delivery settings is
complex and may be undertaken in what is perceived to be the laboring woman’s best interest. The exploration of alternative strategies to facilitate labor and delivery is warranted, as well as
the provision of adequate support and resources for practicing midwives in rural settings.