Type of Respectful maternity care

Response Y/N/X

Dignity of care

Mother is welcomed in a kind and gentle manner during admission

There is no use of non-dignified language during admission

There is no shouting or use of harsh words/language during history taking

The mother is given a clean bed in antenatal/postnatal ward

Consented care

Consent given for first examination

Consent given for vaginal examination in antenatal ward

Consent given for episiotomy if done during delivery

Confidential care

History of mother taken and/or shared away from others in privacy

Mother’s file handled and kept by authorized persons only

Privacy of Care

There are partitions separating beds in antenatal ward

Each mother has a bed to herself in antenatal/postnatal ward (mothers not sharing beds)

Mother is covered during examination in antenatal ward

Mother is covered while being moved from antenatal ward to the delivery room

Mother is covered appropriately during delivery

Partitions are closed during delivery

Mother is well covered after 3rd stage of labour

There are partitions between beds in postnatal ward

There are partitions/curtains during examination in postnatal ward (if done)

Abuse in care

Patient not shouted at during labour and delivery

Patient not pinched/slapped/pushed/beaten during labour and deliver

Episiotomy(if done) given with anaesthesia