Exploring midwifes' experiences regarding quality intrapartum care

Abstract

Nationally literature reveals that South Africa (SA) is also one of the developing countries with a high maternal mortality ratio estimated at 3814 in 2014-2016, which demonstrates poor quality intrapartum care (SA, 2018:85). North West Province (NWP) and Ngaka Modiri Molema (NMM) district as part of SA also experience high rate of maternal deaths (SA, 2018). These large numbers of maternal deaths are worrying largely because (CARMMA: 2012) mandate is that no woman should die while giving life. The majority of maternal deaths are preventable and have many common preventable factors (SA, 2018:85). Literature continues to highlight the challenges faced by midwives during intrapartum care that may influence quality. The challenges faced by midwives during intrapartum care that may influence quality in other countries, seems to be the shared sentiments with SA. The challenges faced by midwives inadvertently affect their service delivery with respect to providing quality intrapartum care. This research was conducted in an effort to make a meaningful contribution to the body of knowledge, specifically knowledge related to the experiences of midwives regarding the quality of intrapartum care in a public hospital in the North West Province, and to propose guidelines to enhance the quality of intrapartum care. A qualitative study design was used and data was collected through the use of semi-structured in-depth interviews. Purposive sampling was used to select participants who represent the target population. The sample used for the study included the midwives with 6 months and above experience in intrapartum care unit. A trial run was conducted and the interview schedule was finalised. Twelve semi-structured in-depth interviews were done until data saturation had been reached. Trustworthiness was ensured according to the principles of credibility, dependability, conformability and transferability. A tape recorder was used to capture data and the data were transcribed verbatim. Field notes were written down for each interview. Data analysis was done by means of content analysis by the researcher and an independent co-coder. Themes, categories and sub-categories were identified. The findings indicated that most of the midwives experienced challenges, which might affect quality of intrapartum care. The identified challenges experienced by midwives were both managerial and clinical in nature. Identified areas of concern are lack of resources and challenges in providing quality care. Conclusions drawn from the findings and integrated literature that was conducted stressed that midwives' experiences regarding quality intrapartum care were that quality is not of the highest standard, and is often compromised. Therefore, since midwifery care has an essential contribution to enhancing high- quality maternal and new-born services, it indicates that midwives are the backbones of midwifery services as they are capable of bringing about change that will enhance quality of intrapartum care and reduce Maternal Mortality Rate (MMR). Guidelines were proposed for nursing practice, nursing education and nursing research, for enhancing the quality of intrapartum care in public hospital.