Current practice of midwives and their perception of care offered during labour and delivery at Mulago National Hospital Uganda

Abstract

Background: Maternal and neonatal morbidity and mortality are a concern in reproductive health. A number of studies have shown that most maternal deaths occur during labor, delivery and within the first four hours yet these can be reduced by the care that midwives provide. Little is documented on midwives’ current practice and their perception of care offered during labor and delivery at Mulago Hospital. There are still a good number of maternal and neonatal deaths due to preventable causes such as postpartum hemorrhage, obstructed labor, ruptured uterus and sepsis.

Objectives: The aim of this study was to document the current practice of midwives and to explore their perception towards the care they provide. The study also looked at the factors that influence the provision of this care during labor and delivery at Mulago hospital Uganda.

Methods: This was a cross sectional study which employed both quantitative and qualitative approaches. The study participants were midwives, nurse managers, consultant obstetricians and gynecologists. Self administered questionnaires, Skills observation checklist and key informant interviews were used. EPI data software was used for data entry and analysis done using STATA soft ware version 11 with the help of the statistician.

Results: Most of the study participants were registered midwives 48 (76.2%); 37(59%) were 31-40 years of age; 32 (51%) had served for 6-15years and only 3 (4.8%) had done BSN. Thirty two (51%) of the participants had never had in-service training in the previous 1-2 years. Generally, midwifery practice varied in the three areas (Private 6D/E, general labour wards 14 and 5C). Reported use of partograph was higher on 6D/E and wards 14 (69% and 60%) respectively compared to 13%.on 5C labour ward. A bigger proportion of midwives on private ward 6D/E 14(82%) knew that pitocin or misoprostol are the recommended for AMTSL to prevent PPH. Infection prevention practices especially hand washing were generally low in all the three labour wards. Only thirty four (54%) of the midwives knew how to mix magnesium sulphate for management of severe PET/Eclampsia. The qualitative data revealed that the midwifery care offered was sub-optimal in a number of areas. The key informant interviews revealed that some midwives have positive attitudes to work while others have negative one.

Conclusion: The study showed that the overall midwifery practice is suboptimal in most of the key areas (infection prevention, use of partograph, management of PET/Eclampsia with most gaps identified in ward 5C. Factors identified to influence practice include poor attitude, lack of regular up-dates, lack of team-work, shortages (staffing, equipment and supplies) and being under looked by doctors.

Recommendations: Hospital administrators, heads of department and Policy makers should support mandatory regular continuous professional development (CMEs in key areas of midwifery) and provide protocols. Hospital administration should recruit more midwives and ensure availability of equipment and supplies. Dialogue meetings between obstetricians and midwives to improve attitude and strengthen teamwork