A qualitative study of women and midwives' reflections on midwifery practice in public maternity units in the Eastern Cape, South Africa

Abstract

Background/Aims South Africa has a high rate of maternal and neonatal mortality. Although the global consensus is that quality midwifery care makes an essential contribution to improving maternal and neonatal outcomes, the literature still highlights that quality midwifery care in South Africa is lacking and midwives' voices are not heard. This study aimed to describe the factors affecting clinical practice in public maternity units from the perspectives of women who received care and midwives who provided it. Methods This was an exploratory and contextual qualitative study conducted in public maternity units in the Eastern Cape, South Africa, with midwives and women who received care from these midwives. Non-probability purposive sampling was used to select a suitable sample. Data were collected using semi-structured audio-recorded interviews and analysed with Creswell's spiral data analysis. Results Midwives experienced burdens related to the practice of midwifery care as a result of the shortage of suitable staff and material resources, as well as managerial issues that affected clinical performance. Women experienced negative staff attitudes that influenced the care they received. Conclusions Midwifery practice in public maternity units in the Eastern Cape is affected by multifaceted factors and attention is needed to ways to improve practice. For midwifery to flourish and for women to receive high-quality care, competent midwives and an enabling working environment are needed. There is an urgent need to bring midwifery education in line with international standards, to improve quality of care, end preventable maternal and newborn mortality and stillbirths and deliver the agenda of universal health coverage.