Audit of antenatal and delivery care at a midwife obstetric unit, South Africa

Abstract

Background: Poor qualities of antenatal and intrapartum care are associated with poor maternal and neonatal health outcomes. Audit of care is an essential tool to identify gaps for standard protocols and guidelines that can assist with evidence based intervention to ensure consistent quality of care during antenatal and delivery.
 Objectives: To measure the compliance on the specific antenatal and delivery care indicators based on national guidelines.
 Method: A cross-sectional study was conducted of women who had childbirths between January and June 2021 in a midwife obstetric unit. Descriptive statistics were used to describe continuous and categorical variables. Both the mean and standard deviation (SD) were calculated for continuous and proportions for categorical variables.
 Results; The mean age and gestational age of the sample were 26 years and 16 weeks respectively. Teenage pregnancy constituted 13.5%. Most of the antenatal and delivery care indicators had good compliance (> 95%). However, gaps were identified for: recording of Last Menstrual Period (78.5%), syphilis treatment at antenatal booking (72.7%), repeat syphilis test at 32 weeks (43.4%) and completion of basic antenatal care checklist (46.3%) during antenatal care. Lower rate for delivery care indicators were: recording of measurement of length and head circumference of the neonates (76.5%) and use of pain relief (5.4%) to mothers at delivery. The outcome indicators measured were good as Low Birth Weight, delivery complications and neonatal death rates were 11.6%, 10.7% and 1.4% respectively. 
 Conclusions: Though the study found good compliance with antenatal and delivery care provided but the few basic indicators such as basic antenatal checklist, completion of syphilis treatment and use of pain relief were poor. These results are vital for a quality improvement programme including training of midwives on basic antenatal care including maternity care guidelines in PHC facilities. A multi-centre study is also recommended for further study.