Assessing Strategies of Obstetric Fistula Management by Nurses/Midwives of Yaoundé Central Hospital and University Teaching Hospital

Every minute, a woman dies in pregnancy, and for every woman who dies 20 - 30 others will survive with morbidity, one of which is obstetrical fistula. Women who suffer from obstetric fistula experience continuous incontinence of urine and/or stool, stigma, social isolation and associated health problems. The World Health Organization estimates that there are currently more than 2 million women living with untreated obstetric fistula mostly in sub-Saharan Africa and South-East Asia, as well as in various other parts of the world. Caring for fistula patients and nursing them back to full physical and mental health can be one of the most challenging and also rewarding tasks undertaken by nurses. The surgery cannot succeed without proper pre-, peri- and post-operative care. The patients undoubtedly recover better with high-quality care—meaning the truly holistic, generous, and selfless care of a nurse who has the skills, understanding and determination to help these very vulnerable patients. Objective: This research seeks to assess the strategies of obstetric fistula management by nurses/midwives of Yaoundé central hospital and CHU by exploring the care they offer to clients pre-operatively, post-operatively, and when they are discharged from the hospital. Achieving Millennium Development Goal (MDG) 3 still remains a challenge to the developing countries although maternal mortality reduction is a priority agenda of each country. Methodology: This retrospective cross-sectional descriptive study design employed a sample of 100 nurses/midwives on active service, and who have at least managed a case of obstetric fistula. A quantitative questionnaire was used to collect data, which was analyzed using SPSS version 23. Results: The study proved a highly significant difference between management and qualification, with a p-value of 0.002. Also, it showed that there was a statistically significant difference between longevity of service and management with a p-value of 0.001. A majority of respondents were nurse assistants (52%), and up to 43% of respondents had 11 - 20 years of work experience. Up to 53% did not offer standard care with respect to their qualification, and up to 52% did not offer standard care with respect to their longevity in service. Conclusion: VVF is the most common type of obstetric fistula with a frequency of 6 to 10 cases, there is an overall poor management of obstetric fistula by nurses and midwives in YCH and CHU. There is an urgent need to train and retrain these health workers on the management strategies of obstetric fistula and to remind them of their personal commitment as care givers.

Essential competencies for three grades of midwives in China

Objective:To identify the essential competencies for different grades of midwives in China.Methods:A nationwide modified Delphi process was implemented to amend and screen the indicators.Thirty expert panellists including practitioners (nurse-midwives),clinical managers,academic educators and obstetricians completed a two-round Delphi study through an electronic survey that was supplemented by an expert panel meeting for discussion of comments and suggestions.Results:All panellists completed two rounds of Delphi study and at least 75% of them achieved a consensus on 224 items (W1 =0.150,W2 =0.173).Seven domains were established,namely,'Professional quality','Antenatal care','Intrapartum care','Postnatal care','Neonatal care','Gynaecological care','Public health care & Integrative competency'.Generalised maternal and neonatal knowledge and perinatal care skills were set for'junior'midwives,pathological care for'senior'ones and supervisory abilities and promotion of discipline for'expert'ones.Conclusions:This research developed three grades of essential competencies for midwives in China.The next step will be assessment in clinical settings for further response.The set was in line with the concepts of International Confederation of Midwives under the domestic context.This set could be adopted as a reference in developing normalised midwifery practice,education and certification.

Understanding Midwives’ Perspective on Care of Post Cesarean Section Women at the University Teaching Hospital—Women and Newborn, Lusaka

Background: A cesarean section is a major obstetric surgical procedure performed for the purpose of delivering a live baby when vaginal delivery would put the mother and the baby at risk due to complications of pregnancy, labour and delivery. Although caesarean section is a life saving procedure, it is associated with a number of risks or problems in the postoperative period. The aim of the study was to understand the Midwives’ perspective on the care of postpartum mothers who had cesarean section at the University Teaching Hospital—Women and Newborn in Lusaka District. Methods: A descriptive cross sectional survey was conducted at the University Teaching Hospital—Women and Newborn in Lusaka. 51 Midwives working in postnatal wards were consecutively selected to participate in the study. Data was collected using a self administered questionnaire with a 4 point Likert scale and also some closed and open ended questions. SPSS version 20 statistical package was used to analyse data, expressed as descriptive summary measures. Results: All the 51 Midwives were female and they scored themselves highly on a 4 point Likert scale as always performing all the immediate post-operative care on the postpartum mothers who had a caesarean section while the score was much lower during the subsequent post-operative period. Staffing levels and medical-surgical materials were found to be low and affect care of Postpartum mothers (P-0.050). The majority (94.2%) of the Midwives also indicated that C-section mothers were not given any form of written materials or standardized instructions to take home as reference material during the Information, Education Communication sessions on discharge (P-0.001) and home/domiciliary visits to postpartum mothers who had C-sections on postpartum were not being undertaken. Conclusion: There was need to improve the care rendered to the postpartum women who had complicated labour and delivery including caesarean sections in order to promote good health and to prevent postpartum complications.

Effects of Individual Explanations by Midwives about the Process of Delivery, Using 3D Animation Software, on Parturient Females’ Understanding of and Satisfaction with Delivery

Objectives: To clarify the effects on the delivery experience of midwives giving parturient females individual explanations about how the course of delivery, using 3D animation software (Delivery Animation). Method: 1) Subjects: Women admitted to Institution A for delivery;70 in the intervention group (34 primipara, 36 multipara), and 79 (41 primipara, 38 multipara) in the control group. 2) Data collection method: Intervention group;3) During phases 1 and 2 of delivery, after internal examinations, collaborative-researcher midwives gave parturient women explanations about the course of delivery, using tablets with the Delivery Animation software installed. This software was independently developed by the researchers. On postpartum day 1, the collaborative-researcher midwives distributed anonymous, self-administered questionnaires to the postpartum women. 4) During phases 1 and 2 of delivery, the course of delivery was explained using existing methods, and anonymous, self-administered questionnaires were distributed on postpartum day 1. 5) The intervention group and control group were compared using descriptive and inferential statistics, organized into primipara and multipara. Results: In the Understanding the Delivery Process category, primipara in the intervention group had significantly higher scores for “understood baby’s rotation” (p < 0.01) and “understood progress through delivery” (p < 0.05). In multipara, the intervention group scored significantly higher for “understood baby’s rotation” (p < 0.01). In the anonymous self-evaluation, primipara in the intervention group scored significantly higher in “midwife I could trust was by my side” (p < 0.01). Opinions on the Delivery Animation were classified into 7 categories. In their evaluations of the Delivery Animation, 89.0% of primipara and 92.0% of multipara said it helped them understand the course of labor, and 85.0% of primipara and 86.0% of multipara said it helped them communicate with the doctor/midwife. Conclusion: The significant differences in understanding of the course of delivery seen between the intervention and control groups, the satisfaction scores on the “Self-evaluation scale for experience of delivery (abridged version)” questionnaire, opinions about and evaluation of the Delivery Animation all show that a personal explanation of the course of childbirth has a positive effect on the understanding and satisfaction of parturient women.

COVID-19 Pandemic through the Lenses of Nurses and Midwives in Zambia: Exploring Depression, Anxiety and Stress

Following the declaration of COVID-19 as an international health emergency, Zambia like many other countries implemented measures to limit human interaction and curb the spread of the disease. In the midst of these measures, nurses and midwives continue to provide care to suspected and confirmed cases of COVID-19, which puts them at risk of contracting the disease and compromising their psychological wellbeing. The aim of this study was to assess the levels of depression, anxiety, and stress experienced by nurses and midwives working in health facilities in two districts of Zambia during the COVID-19 pandemic. This descriptive cross-sectional study involving 187 nurses and midwives was conducted between July and December 2020 in selected health facilities in Lusaka and Chilanga Districts. The Depression Anxiety and Stress Scale (DASS) 21 was used to collect the data which was analysed using univariate analysis. Majority of the respondents were female (84%) and mean age at 30.1 (SD 9.05) years, 58.3 percent were married, and 50.84 percent had children. The mean work experience was 6.63 (SD 4.75) years, and 54 percent had worked for less than five years. Overall, 22.5 percent of nurses and midwives reported depression, 52.4 percent had anxiety and almost half (42.2%) had varying levels of stress. Anxiety and stress correlated significantly with working in COVID Isolation departments (P = 0.001). Strategies such as strict adherence to infection prevention measures, seeking help from family and friends and recognition by hospital management were a significant supportive measure (P < 0.001). Nurses and Midwives working directly with COVID-19 patients reported greater incidence of depression, anxiety and stress, similar to findings from previous research around the world. Therefore, efforts should be focused on developing and providing counselling and other support services to mitigate the effects of COVID-19 and enhance psychological wellbeing for health professions.

Design of curriculum for specialised midwive training based on investigation of needs of midwives in Beijing

Objective:This study aims to provide a basis for the curriculum provision,training form and training time of midwifery managers in Beijing and understand the needs of the midwives' participation in specialist certification training.Methods:Ten midwifery managers and midwives in Beijing were selected for a group interview.Based on the interview results,the researchers designed a questionnaire.As the midwives were from different hospital levels in Beijing,stratified random sampling method was adopted.A total of 137 people were surveyed through a web questionnaire.Results:In total,99.25% of the respondents believe that midwifery specialist training needs to be carried out in Beijing.Moreover,55% of them believe that half-time training is reasonable.The respondents believe that the proportion of theoretical and practice training should be 1∶2.In total,91.79% and 85.07% of the respondents believe that contents of midwifery research and midwifery management need to be increased,respectively.Conclusion:Midwives in Beijing need midwifery specialist training.Half-time certification training complies with the clinical needs.Midwifery specialist certification enhances the professional identity of midwives.

Midwives’views and experiences of providing healthy eating advice to pregnant women:a qualitative content analysis of semi-structured interviews

Objective:To explore midwives’views on how they provide healthy eating education to pregnant women after attending a healthy eating education workshop/webinar.Methods:A qualitative descriptive approach was utilized.Semi-structured interviews were conducted to explore the views and experiences of midwives on providing healthy eating education for pregnant women.A purposive sample of six midwives was interviewed face-to-face,and one was conducted by telephone interview.Data were analyzed through qualitative conventional content analysis.Results:Midwives described their views and experiences of factors that impacted their role in providing healthy eating educa-tion.They identified three categories:perceived role of midwi ves,health literacy,and model of care.Conclusions:Knowledge and confidence of midwives improved after attending the workshop/webinar on healthy eating education.Findings suggested that midwives perceived their role as important in providing nutrition education.However,time and resources were highlighted as challenges when providing healthy eating education for pregnant women.The availability of health literacy and model of care were significant factors in enabling midwives to adequately provide this education.Midwives acknowledged a need for further education in areas of vegan diet,cultural food preferences for ethnic minority groups,and regular updates on national healthy eating guidelines.

A review of the definition and scope of practice of midwives in five representative countries

Objective： To review the definition and scope of the practice of midwives in Sweden, Finland, the United Kingdom, the United States, and Australia to find models and make suggestions for reforms in the midwifery policies of China. Methods： This article reviewed the midwifery policies published by authorities, organizations, and governments of these countries and relevant literature in the databases of PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature （CINAHL）, China National Knowledge Infrastructure （CNKI）, and Wanfang database. Results： The definition and scope of practice of midwives in five representative countries and China were reviewed. The similarities and differences in midwifery policies among them show that most countries set standards based on the definition and scope of practice of midwives recommended by International Confederation of Midwives. Conclusions： The definition of midwives should include registration, midwifery education, and acceptance standards. The scope of practice of midwives should specify an autonomous environment, the objective of care, the period of care involved, prescribing rights, emergency treatment, and health counseling.

Physical assessment ability of nurses and midwives on maternal care in Mongolia

This study examined the physical assessment ability of Mongolian nurses and midwives engaged in maternal care and the factors that could influence this ability. We found that nurses and midwives from prefectural hospitals had higher scores than those from national and district (soum) hospitals. The latter group could not perform more than half of the 28 tested procedures on their own, even though most had over 10 years’ experience. Therefore, to decrease the Mongolian maternal mortality ratio, we argue that in-service training for nurses and midwives in both the capital city and peripheral areas is needed.

Midwives’ Professional Satisfaction and the Quality of Obstetric Care in Developing Country

Introduction: In Africa, poor working conditions affect the motivation of health care providers. The objective is to study midwives’ professional satisfaction on the technical quality of emergency obstetric care in Senegal. Material and Methods: This was a prospective study of 16 hospitals in Senegal. The job satisfaction of midwives was measured during a personal interview. The instrument used was validated in Senegal and Mali. Other data collected relate to professional and institutional characteristics. A treatment observation grid was used to measure the quality of obstetric care in labour wards. Mixed-model linear regression was used to estimate the effect of satisfaction on the quality of obstetric care. Results: A total of 65 midwives were interviewed and 325 patients observed. The average quality score was 8.7 ± 1.7. The satisfaction scores ranged from 42.2 ± 17.4 (salary) to 76.7 ± 12.1 (morale satisfaction). A positive and significant correlation was found between quality of care and management (cc = 0.56), remuneration (cc = 0.40), task (cc = 0.32), workload (cc = 0.24) and training (cc = 0.29). The linear mixed model shows that salary (β = 0.40), continuing education (β = 0.17) and management style (β = 0.42) improved the quality of care. Association between moral satisfaction and quality care was negative (β = ﹣0.53). Conclusion: The satisfaction of health professionals is a major determinant of the quality of obstetric care. Its inclusion in the fight against mortality has become imperative in developing.

Midwives’ utilization of nonpharmacological pain relief measures for labor pain management: A descriptive cross-sectional study

Objectives:This study sought to examine midwives’utilization of nonpharmacological pain relief measures in labor pain management and to test the relationship between midwives’knowledge and utilization of nonpharmacological pain relief measures for labor pain management in secondary health facility in Calabar,Cross River State,Nigeria.Materials and Methods:A descriptive cross-sectional design was used for the study.The study was rooted in Katherine Kolcaba’s Comfort theory.Totally,67 participants were recruited for the study using the purposive sampling technique.A self-made structured questionnaire was used to obtain participants’information on knowledge,utilization,and predictors of nonpharmacological pain relief measures.Results:Although 41(61.2%)of the participants had knowledge about nonpharmacological pain relief measures,few did not know some of the cognitive-behavioral and environmental measures in labor pain management.There was 35.8%(24/67)for utilization of cognitive-behavioral measures and 55.2%(37/67)for psychological/emotional measures for labor pain management by respondents,respectively.Fifty(74.6%)of respondents agreed that predictors such as lack of knowledge,lack of updates and training,work experience,best practice guidelines,and equipment were hindrances to utilization.There was statistically significance in relationship between the level of knowledge and utilization of nonpharmacological pain relief measures(r=0.6,P<0.05).Conclusion:The utilization of nonpharmacological measures for labor pain management is low,thus it is recommended that frequent education,training updates on effective labor pain management,provision of clinical guidelines on labor pain management,and enrichment of midwifery training curriculum are imperative to ensure quality labor pain management and positive health outcome.

Midwifery and Midwives Service Scheme: A Panacea for Improvement of Some Maternal and Neonatal Indices in Nigeria—A Brief Review

Introduction: Midwifery is the art of caring for women during childbearing. It is practiced throughout the world according to the norms, traditions and cultural practices found in each country. Maternal mortality in Nigeria is high but there are wide variations between the geopolitical zones of the country. Government has established the midwives service scheme (MSS) as part of efforts towards reversing the country’s unacceptably high maternal mortality trends. To improve these indices, the MSS in Nigeria engaged newly graduated unemployed and retired midwives to work temporarily in rural areas. The midwives are posted for twelve months to selected primary care facilities linked through a cluster model in which four such facilities with the capacity to provide basic essential obstetric care are clustered around a secondary care facility with the capacity to provide comprehensive emergency obstetric care. This brief review is an attempt at exploring the impact of the midwives service scheme on maternal and neonatal indices in Nigeria. Main content: The outcome of the MSS four years has been an improvement though unevenly and marginally, in these indices in the various geopolitical zones of Nigeria. Improvements have been noticed in maternal indices such as antenatal care attendance, women receiving two doses of tetanus toxoid and number of deliveries by skilled personnel. Also reduction in maternal and neonatal mortality has been observed over the years following introduction of the scheme. Major challenges however, include lack of essential drugs, poor accommodation facilities for MSS staff, irregular payment of their remuneration and lack of water/power supply to some designated facilities for the scheme. Recommendations and conclusions: It is therefore recommended that 24 hours availability of essential drugs at primary healthcare centers be maintained. This should happen in conjunction with regular payment of full entitlements and benefits and provision of secured, habitable and good accommodation for MSS staff. Finally, aggressive community mobilization should continue in order to engender community involvement and participation for sustainable program development.

Morpho-Physical and Psycho-Social Determinants of Low Back Pain in Midwives Population in Benin

Background: Low back pain is a real public health problem. Lots of studies have been done about it, but not in midwives group. The latter seem to be exposed to low back pain due to morphological, physical and psycho-social factors. We therefore study the place of these factors in the occurrence of low back pain in midwives. Method: Prospective, cross-sectional and analytical study, it is done with 102 midwives of university hospitals in Benin. They were interviewed and examined. An eventual link with their history of low back pain, for at least 3 months during the last 12 months before the study, was checked to their morphological aspects (spinal curvatures, BMI), physical examinations data (strength and muscular flexibility) and psycho-social factors (relationship with colleagues and either, stress, ...). The effect of these factors was assessed using relative risk (RR) with a 95% confidence interval. Results: Different morpho-physical and psychosocial disturbances were observed in midwives. 81% had a history of low back pain. The latter have a statistically significant relationship with the different factors studied. These were mostly exposure factors, but poor midwife relationship with their hierarchical superiors was a protective factor (RR = 0.69 and p = 0.0106). Discussion-Conclusion: In Benin, health workers and especially midwives are very exposed to low back pain. The latter are often associated with different morphological, physical and psycho-social disturbances. The knowledge of those parameters is interesting to reduce this high prevalence of low back pain in midwives.

Knowledge and Skills Gap of Midwives to Conduct Obstetric Ultrasonography Screening in Primary Health Care Facilities in Kajiado and Kisii Counties, Kenya

Background: Ultrasound remains a tool of much importance in maternity care with midwives regarded as key health professionals when it comes to care of pregnant mothers. There is however limited study on the knowledge and skills gaps of midwives in conducting obstetric ultrasonography screening. The purpose of this study was to assess the specific obstetric ultrasonography knowledge and skills gaps among midwives based in primary health care facilities. Methods: A cross-sectional study employing both qualitative and quantitative method was conducted between July and August 2019 with 274 midwives. A structured questionnaire was used to collect data while Focus group discussion and Key Informants Interview were used to collect qualitative data. Descriptive statistics were used to summarize the data test associations between variables while the qualitative data were used to compliment the questionnaire data in eliciting more information on the gaps. Findings: Almost all (94.5%) the midwives had never been trained on any basic obstetric ultrasound while six of those that had been trained in early stages by the project lacked equipment to practice the acquired skills. More than three quarters of the respondents opined that they wished to provide personalized care services to mothers/clients seeking Antenatal Care Services (ANC) in their community at a fee while only 13.9% had knowledge that obstetric screening should be done before 24 weeks gestation. Four out of ten of the respondents scored themselves a one (1) on the level of confidence they have using an ultrasound machines or technology. Conclusion: There still remains a huge gap as far as training of midwives on basic ultrasound screening is concerned. The lack of basic obstetric ultrasound screening skills is a barrier to rolling out Point of Care Ultrasound (POCUS) screening services. However, midwives are motivated and willing to learn basic ultrasonography skills to further the objectives of Universal Health Coverage (UHC). Concerted efforts should be made to train midwives on basic obstetric ultrasonography skills in addition to availing mobile/hand held ultrasound technology in Primary Health facilities for them to apply the transferred skills. A sustainable business model to enable mothers continuously afford the services is critical as well.

Relationship of High Work Engagement among Staff Midwives with Their Immediate Superiors’ Burnout on Maternity and Labor Wards in Japan

Introduction: Mental conditions for work among workers are related to clinical performance and influenced by colleagues within the same workplace. The aim of study was to examine the work engagement and burnout of staff midwives working on maternity and labor wards and to determine the factors related to high work engagement of staff midwives, including their immediate superiors’ work engagement and burnout. Methods: A cross-sectional questionnaire survey was employed in Japan. Questionnaires were distributed to 452 midwives/nurses working on maternity and labor wards of 20 hospitals and responses from 96 staff midwives and 17 of their immediate superiors were analyzed. Work engagement and burnout (exhaustion, cynicism, and professional efficacy) were assessed by the Utrecht Work Engagement Scale and the Maslach Burnout Inventory-General Survey, respectively. To examine the association of work engagement among staff midwives with their ages, marital status and work engagement and burnout of their superiors, logistic regression analysis was conducted. Results: Immediate superiors showed significantly higher level of work engagement than staff midwives, while there was no difference in the burnout. High work engagement of staff midwives was significantly correlated with the professional efficacy (AOR 1.93, 95% CI 1.12 - 3.33) and cynicism (AOR 2.01, 95% CI, 1.04 - 3.90) of their immediate superiors. There was no correlation of work engagement between them. Conclusions: High work engagement of staff midwives was correlated to high professional efficacy and cynicism of their immediate superiors, suggesting that there might be crossover effects on mental conditions for work between staff midwives and their immediate superiors.

Scaling up Nigeria’s Midwives Service Scheme and Reducing Inequality Gaps in Maternal Mortality

The Federal Government of Nigeria in December 2009 launched midwives service scheme to address the shortage of skilled healthcare workforce needed to drive the efforts at improving maternal and infant health, towards the attainment of MDGS 4 and 5. This was in response to the unrelenting increase in maternal mortality in Nigeria. This review explores the implementation of the scheme and the extent to which its set-goals are achieved vis-à-vis many challenges confronting it. The review first explores the ecologic perspective on maternal mortality to identify factors responsible for high mortality among Nigerian women and the inequality gaps in maternal mortality. The review identifies the need to scale up midwives service scheme to areas in dire health needs, identifies the need for health needs assessment, and recognizes community participation as an essential ingredient in ensuring the sustainability of midwives service scheme. Routine evaluation of midwives service scheme is identified as an important tool for assessing the effectiveness of the scheme in achieving its objectives towards improvement in maternal health and reduction in inequality gaps in maternal mortality. The review proposes multi-sectoral interventions in tackling inequality gaps in maternal mortality with strategic focus on addressing inequalities in health and social determinants of health.

Perception of Pharmacovigilance by Nurses and Midwives of the Cocody University Teaching Hospital in Abidjan

Objective: To assess the perception on pharmacovigilance by the nurses and midwives at the University Teaching Hospital (CHU) of Cocody in 2017. Methodology: Descriptive and analytic cross-sectional study conducted in 17 services of the University Teaching Hospital (CHU) of Cocody using an anonymized and standardized questionnaire. Results: The response rate was 39.33% for the 86 nurses and 21 midwives with at least 10 years of professional experience (50.6%). 57.94% of the respondents (n = 62) have already heard about pharmacovigilance during their basic training (40.18%, n = 43). However, only 19.63% (21/107) of the respondents knew about the existence of a pharmacovigilance unit which they wrongly located to the pharmacy (11/21) of the CHU of Cocody. 40.18% of respondents (n = 43) had previously experienced an adverse drug reaction that was reported (76.74%, n = 33) to a hierarchical supervisor (60.60%, n = 20). The causes of non-reporting were either the frequent occurence (4/10) or the benign nature (2/10) of the adverse drug reaction. Specific actions to be taken (37.38%, n = 40) and a feedback (28.97%, n = 31) were the respondents’ main expectations for the stimulation of the reporting system. They also wanted the pharmacovigilance monitors to regularly visit their services (34.57%, n = 37) and to provide them with the reporting forms (30.84%, n = 33). Conclusion: Our study has allowed us to highlight the lack of knowledge of the pharmacovigilance and to identify certain factors that could improve the perception of the pharmacovigilance by the nurses and the midwives in Ivory Coast.

Experiences of Midwives for Caring Unbooked Pregnant Mothers in a Maternity Unit at a District Hospital in the Eastern Cape Province

Background: South Africa struggles to improve maternal health outcomes resulting to its failure to achieve millennium development goal for maternal health. Non-utilisation of antenatal health services by pregnant mothers is the leading cause of unbooked cases that complicate the labour stages. Purpose: The purpose of the study was to explore the experiences of midwives for caring unbooked pregnant women in a maternity unit at a district hospital in the Eastern Cape province of South Africa. Design and Methods: A phenomenological approach was adopted in this study. Specifically, a descriptive phenomenological deign was used to explore midwives’ experiences for caring unbooked pregnant women in maternity ward of a district hospital on six (6) purposively selected midwives. In this study, the researcher utilised individual, semi structured phenomenological interviews to collect data from midwives caring for unbooked pregnant mothers in a maternity unit. Data saturation was reached after carrying out the six interviews. These interviews were audio taped and transcribed verbatim and Interpretative Phenomenological Analysis framework steps method of qualitative data was applied to analyse the collected data. Results: Three thematic categories emerged from data analysis: 1) Experiences of midwives, which interfered with emotional challenges leading to fear and anxiety. Experiences of midwives were also associated with shortage of midwives and leading to maternal incidences. 2) Caring for unbooked pregnant mothers interfered with incompetency and inexperienced midwives and reported a lack of debriefing. 3) Support system which was seen as lacking from managers. Conclusion: The study recommended collaboration with primary health care clinics including community leaders, and employment of highly skilled professionals and in-service trainings of the current midwives to minimise unnecessary incidences.

Midwives’views and experiences of providing midwifery care in the task shifting context:a meta-ethnography approach

Objective:This study aimed to explore the existing knowledge about midwives’views and experiences of providing care for women in the context of task shifting.Methods:We conducted a qualitative systematic review using meta-ethnography to describe the views and experiences of midwives on providing care in the context of task shifting.Comparative textual analysis of published qualitative studies involved translation of first-order key concepts and meanings from included studies to generate second-and third-order concepts.A grid was made to identify core findings and compare them reciprocally.Results:Thirty-six qualitative studies met the inclusion criteria.The literature comprised of 32 first key concepts.Eight second-order constructs emerged,and three third-order interpretations were generated.The three overarching themes were:(1)midwives perceived themselves as providing culturally competent and high quality women-centered care;(2)they valued their profession but saw it as complex and challenging;(3)as health professionals,they reported a variety of organizational,cultural,and professional barriers to providing women-centered care.Conclusions:While performing a specific task in the task shifting context,midwives perceived their crucial roles and responsibilities,along with achieved value and reward.However,due to a range of existing barriers,the caring task posed great challenges in completely implementing women-centered care.It is essential for systems to identify and eliminate these barriers early,to consider midwives’emotional well-being,and to develop overall strategies to better support the midwifery workforce.Policy makers and administrators should establish a supportive environment to facilitate midwives to perform women-centered caring tasks in more effective and efficient ways.

Evaluation of the Adequacy between the Workload and the Number of State Midwives and Maieuticians Practicing in the Gynecology-Obstetrics Departments of the University Hospitals of Burkina Faso

Objective: To evaluate the adequacy between the workload and the number of midwives and state midwives practicing in the gynecology-obstetrics services of the university hospitals of Burkina Faso. Methodology: This is a multicenter study conducted in 4 university hospitals representing this country (for brevity referred here to as A, B, C, and D) from May 1, 2018, to April 30, 2019. The Workload Indicators of Staffing Need (WISN) method was used to analyze the workload. Results: Dystocic delivery was the activity that took the most time. Inpatient activities were the most performed in terms of volume. At the University Hospitals D and C, there was an over-staffing of midwives and maïeuticians with a ratio of 1.93 and 2.12 respectively. At University Hospital B, the workload was in line with the existing number of State midwives and maieuticians. A low workload pressure (04%) was found at the University Hospital A. Conclusion: In most of the University Hospital Centers, there was no match between the workload and the number of midwives and maïeuticians. These results highlight the need for redeplayment of midwives and maïeuticians in order to ensure good health coverage for midwives and maïeuticians.