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The Challenge of Improving Perinatal Care in settings with Limited Resources: Observations of Midwifery Practices in Mozambique
Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
Department of Woman and Child Health, Division of Reproductive and Perinatal Health Care, Karolinska Institutet, Stockholm, Sweden.
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2006 (English)In: African Journal of Reproductive Health, ISSN 1118-4841, Vol. 10, no 1, p. 47-61Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to observe and analyze midwifery care routine related to asphyxia and hypothermia during the perinatal period and to investigate the effect of an in-service education program. A direct non-participant pre-and post intervention observation study of midwifery a performance during childbirth was conducted at a labour ward in Maputo. The observed groups consisted of 702 and 616 midwifery –attended deliveries. Examination was also conducted of the partographs (702 vs. 616). The quality of midwifery care related to prevention and early detection of asphyxia and hypothermia was found to be inadequate and the intervention had no significant effect upon the midwives' performances. This could be attributed to the quality of the intervention itself or to failure of implementing managerial decisions such as transfer to partograph documentation from obstetricians to midwives. Change in professional performance does not automatically follow awareness of evidence-based midwifery practices, but requires behavioural change, which may be more difficult to achieve.

Place, publisher, year, edition, pages
Benin City, Edo State, Nigeria: Women's Health and Action Research Centre , 2006. Vol. 10, no 1, p. 47-61
Keywords [en]
Infant, Newborn, Midwifery, Mozambique, Perinatal Care, Pregnancy, Pregnancy Outcome, Risk Factors
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:hh:diva-3794PubMedID: 16999194Scopus ID: 2-s2.0-33750092569OAI: oai:DiVA.org:hh-3794DiVA, id: diva2:291745
Available from: 2010-02-03 Created: 2010-02-03 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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Odberg Pettersson, Karen

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