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The lived experiences of autonomous Angolan midwives working in midwifery-led maternity units
Halmstad University, School of Social and Health Sciences (HOS).
Halmstad University, School of Social and Health Sciences (HOS).
Karolinska Institute, Stockholm.
2001 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 17, no 2, p. 102-114Article in journal (Refereed) Published
Abstract [en]

Objective: to describe the lived experiences of autonomous midwives working in Angolan midwifery-led maternity units.

Design: a qualitative approach using semi-structured, audiotaped interviews, in Portugese. Data were analysed in a six-step process.

Setting: three midwifery-led maternity units in the most densely populated suburbs in the capital of Angola, Luanda. The average number of deliveries per unit was 2500 per year.

Participants: II midwives from the three maternity units.

Findings: four main areas emerged: society/culture, significant others, personal self and professional self. Sub-areas, concepts and supporting statements were defined in each area.

Key conclusions: the midwives served within a population living in rough circumstances but which maintained strong traditional roots. The midwives did not support homebirths, but did assist when needed,The midwives described their professional role as a 'calling: which was very independent, Cure, was considered more important than care, and strong emotions were expressed when discussing cases of failure,The partograph was viewed as an important instrument and continuous learning as crucial in their role as autonomous midwives.

Implications for practice: the model of a midwifery-led delivery unit described in this study may be used in other countries facing the same problems as Angola, Difficulties concerning transfer should be seriously considered as well as adequate education for the midwives. A pre-requisite in order for peripheral maternity units to have any impact on maternal morbidity and mortality, is a well-organised first-referral level.

Place, publisher, year, edition, pages
Edinburgh: Churchill Livingstone , 2001. Vol. 17, no 2, p. 102-114
Keywords [en]
Adaptation, Psychological, Adult, Angola, Attitude of Health Personnel, Attitude to Health, Delivery Rooms, Female, Home Childbirth, Job Satisfaction, Nurse Midwives, Nursing Methodology Research, Nursing Staff, Hospital, Poverty, Professional Autonomy, Professional Competence, Questionnaires, Self Concept
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:hh:diva-3488DOI: 10.1054/midw.2000.0250ISI: 000169609400004PubMedID: 11399131Scopus ID: 2-s2.0-0035379808OAI: oai:DiVA.org:hh-3488DiVA, id: diva2:291581
Available from: 2010-02-02 Created: 2009-12-01 Last updated: 2018-03-23Bibliographically approved
In thesis
1. Challenges and constraints encountered by women and midwives during childbirth in low-income countries: experiences from Angola and Mozambique
Open this publication in new window or tab >>Challenges and constraints encountered by women and midwives during childbirth in low-income countries: experiences from Angola and Mozambique
2004 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aimed to study the actual and perceived quality of midwifery practices during childbirth at peripheral and central health care levels in two low-income countries, Angola (I-III) and Mozambique (IV-V). Theoretical models interpreting women's and midwives' views have been developed.

Objectives: Study I evaluates midwives' use of an adapted model of the World Health Organization's partograph, a tool used to monitor the progress of labour. Study II describes midwives experiences of working without immediate medical assistance. Study III explores women's perceptions of care-seeking behaviour during childbirth. Study IV observes perinatal midwifery care routines and examine partograph documentation. Study V explores and develops a theoretical understanding of factors perceived to obstruct or facilitate midwives ability to provide quality of perinatal care.

Methods: Study I: A one-group pre-and post-test interventional evaluation of 100 partographs from one peripheral delivery unit. Study II: Semi structured interviews with eleven midwives, analysed in a qualitative process comprising six steps. Study III. Ten focus group discussions with pregnant and non-pregnant women, analysed using the grounded theory technique. Study IV. Pre-and post intervention observation of midwifery care of 702 vs. 616 women during delivery and examination of the partographs. Study V: In-depth interviews with 16 midwives, analysed using grounded theory technique. Educational interventions were designed and applied in study II and IV.

Results: Study I. Significant improvement of documenting was found in seven of the ten variables and more partographs were correctly documented in sample II compared to sample I. Missed transfers increased, however, in sample II. Study II: The midwives experiences were sorted under four main areas: (1) Society/culture (2) Significant Others (3) Personal Self (4) Professional Self. Confidence was felt in the role as autonomous midwives but dependency on various factors such as the partograph, a functional referral system, peer support, community trust and continuous supervision was emphasised. Socio-economic hardships were identified as major stress factors for themselves and the women. Study III: Women seemed compelled to "mould" their care seeking behaviour and four patterns, two 'avoiding' and two 'approaching' institutional care were identified. The salient features of each pattern were found to be "personal courage", [B1]"disempowerment", "discarding traditional practices" and "awareness and emancipation". Study IV. No improvements were found in quality of care following the intervention. Common problems proved to be hypothermia and rare initiation of the graphic part of the partograph, which monitors progress of labour. Study V. A process labelled "changing perinatal care management" emerged, which comprised four dimensions addressing aspects related to i) existing environment ii) midwives' interaction with women in labour, iii) midwifery profession and iv) caring technology in order to improve quality of care. Communication and collaboration were identified as change agents.

Conclusions: The findings in this thesis indicate that midwives' ability to provide quality of maternal and perinatal care in lowincome and post-war affected countries is restricted by organizational, structural, educational as well as attitudinal aspects. Women in need of assistance during childbirth are negatively affected as a consequence of midwives reaction to the various constraints, which at times (Luanda) seems to oblige adverse care seeking behaviour. Midwives recognises the need for change, but change is found to be a slow and complex process, which requires engagement by all levels of the care chain. A model suggesting how to achieve quality of maternal and perinatal care in Safe Motherhood context is presented.

Place, publisher, year, edition, pages
Stockholm: Karolinska University Press, 2004. p. 59
Keywords
Women, Midwives, Maternal and perinatal care, Care-seeking behaviour, Moulding and dimensions of change
Identifiers
urn:nbn:se:hh:diva-466 (URN)2082/804 (Local ID)91-7349-822-X (ISBN)2082/804 (Archive number)2082/804 (OAI)
Public defence
2004-03-26, Skandiasalen, Astrid Lindgrens Barnsjukhus. Karolinska Sjukhuset, Stockholm, 00:00 (English)
Available from: 2007-02-05 Created: 2007-02-05 Last updated: 2018-03-23Bibliographically approved

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