Providing quality care for women with vasa praevia: Challenges and barriers faced by Australian midwives

Abstract

ObjectiveTo explore the barriers to providing quality maternity care for women with vasa praevia as identified by Australian midwives. DesignA qualitative descriptive study using semi-structured in-depth telephone interviews. SettingAustralian maternity system. MethodsMidwives were recruited from across Australia. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. ParticipantsTwenty midwives from five Australian states practising in 15 different public or private hospitals who had cared for at least one woman with vasa praevia during 2010–2016 were interviewed. More than half of the participants held senior positions. Twelve were involved in a neonatal death or ‘near-miss’ due to vasa praevia. FindingsTwo categories and five themes were identified in relation to barriers to the provision of quality care. Practitioner-level barriers included two themes: identifying lack of midwifery education and lack of knowledge. System-level barriers included lack of a local policy to guide practice, limited information for women, and paucity of research about vasa praevia. ConclusionMidwives experienced a number of barriers in caring for women with vasa praevia. Offering more comprehensive pre-registration and continuing professional education to midwives, developing local protocols, and providing clear written information for women may improve the provision of quality care. Implications for practiceMidwives have a critical role in caring for and supporting women with vasa praevia. Improving midwives’ knowledge with contemporary evidence and clinical guidelines could enable them to deliver safer maternity care and improve a women's journey through this potentially catastrophic condition.