Mixed methods evaluation & teaching with Guatemalan traditional midwives’ regarding nursing interventions to manage postpartum hemorrhage

Abstract

Purpose: The purpose of this pilot descriptive study was twofold: to explore Guatemalan traditional midwives’ knowledge, attitudes and practices about nursing interventions to manage postpartum hemorrhage (PPH), and to evaluate the effect of a culturally sensitive teaching on traditional midwives’ knowledge of nursing interventions to manage PPH. Methods: Thirteen midwives participated in a one-day teaching at a Refuge International Health Clinic in the remote town of Sarstun, Guatemala. The quasi experimental study used a one-group, pretest posttest design. Researchers relied on a PPH checklist from the American College of Nurse Midwives (ACNM) to evaluate knowledge of PPH interventions before and after the PPH teaching. One 45-minute focus group also was conducted among the midwives. The Long Table Approach was used to develop a matrix of common themes. Results: The culturally sensitive teaching improved traditional midwives’ knowledge and skills about nursing inter- ventions to manage PPH (pretest M=1.385/8, posttest M=4.846/8). In the focus group, midwives revealed several themes that contradicted the literature. Midwives repeatedly denied managing PPH despite a combined 197 years of midwifery experience. Midwives said they trusted local health care providers, and would transfer patients to hospitals in emergencies. Midwives asked for assistance in educating villagers about the importance of prenatal care and of seeking early labor support. Conclusions: Results of this pilot project suggest a culturally sensitive oral teaching in the primary language of participants improves traditional midwives’ ability to manage PPH. Future training should follow a similar format to address the needs of illiterate participants in resource-poor settings, and should include the entire community, not just midwives.