Abstract
Though Midwife-led care remains a key to improving the health status of pregnant mothers, in Ethiopia, maternity care has traditionally been based on a model in which responsibility for care is shared by hospital-based midwives, nurses, general practitioners, and obstetricians. This type of care has been seen as representing a fragmented approach. The aim of this study was to explore health care providers' perceptions and experiences related to Midwife-led continuity of care at primary hospitals in the north Shoa zone Ethiopia. A qualitative approach was selected as the methodology for this study. Data were collected from 25 midwives and 8 integrated emergency surgical officers (IESO) and medical doctors working in maternal health care units in four primary hospitals in the north Shoa zone, Amhara Regional State. Four focus group discussions and eight individual interviews were conducted. The facilitator utilized a set of open-ended questions for the focus group discussion. Semi-structured interview questions were used for the interviews and thematic data analysis was done. The main theme extracted was "Midwives welcome consideration of a Midwife-led model that would provide greater continuity of care, but they expressed concerns about organisation and workload". The midwives said that they would welcome working with the midwife-led care model, as they believed using it could lead to improving the quality of maternal health care, provide greater continuity, and improve coverage, birth outcomes, and maternal satisfaction. The midwives could become more autonomous and be able to take more responsibility for maternity care. The group of 25 midwives and the group of 8 IESO and medical doctors perceived that working procedures and changes in the organization of care in the health facility would have to be studied carefully before any changes can be considered. In this study, we found that replacing the existing system of maternal care with a Midwife-led model would require careful analysis of how this model of care might be implemented in Ethiopia. Further investigation will be of great importance in providing insights that will help in developing a final model.
Highlights
In many countries, midwives are the primary providers of maternity care [1] following what is known as the Midwife-led model of care
We found that replacing the existing system of maternal care with a Midwife-led model would require careful analysis of how this model of care might be implemented in Ethiopia
MLCC models consist of three elements: 1) Care is provided by midwives and they are the lead carers throughout pregnancy, birth and the postnatal period; 2) Continuity of care by a known midwife who works in collaboration with other health professionals 3) Care is based on the midwifery philosophy that pregnancy and birth are physiological life events and is focused primarily on preventive and supportive care rather than exclusively on the identification and treatment of risks and complications [2]
Summary
Midwives are the primary providers of maternity care [1] following what is known as the Midwife-led model of care. An obstetrician has primary responsibility for care following the shared model [2] These are two basic models of maternal care, each practiced with variations [2, 3]. Though Midwife-led care remains a key to improving the health status of pregnant mothers, in Ethiopia, maternity care has traditionally been based on a model in which responsibility for care is shared by hospital-based midwives, nurses, general practitioners, and obstetricians. This type of care has been seen as representing a fragmented approach
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