Strategies to facilitate upscaling midwifery practice in South African public maternity units

Abstract

Background/Aims Various models have been proposed to reduce rates of maternal mortality, aimed at addressing the diverse range of causes. Many of these models focus on using midwifery practice to achieve these goals. The aim of this study was to develop strategies to facilitate upscaling midwifery practice in South African public maternity units. Methods A mixed-methods sequential exploratory research design was implemented using purposive sampling of midwives and postpartum women. Qualitative data were collected from 11 midwives and 11 postnatal women in the Eastern Cape province, while quantitative data were gathered from 314 midwives from across five South African provinces. Data were collected using semi-structured interviews and a self-developed questionnaire. Descriptive statistics were used to analyse quantitative data. Qualitative data were analysed thematically. Results The participants were committed to their work but barriers to practice were a cause of concern. Two strategies for woman-centered care were developed based on the challenges reported by midwives. To assist with up-scaling of midwifery clinical practice in South Africa, the strategies recommended providing an enabling work environment where midwives could be empowered to provide woman-centred care and women were empowered to receive this care and be educated in self-care practices. Conclusions The work environment for midwives in South African public maternity units is, at times, not of an acceptable standard because of concerns related to regulation and training. Recognition of midwifery practice as an autonomous profession will facilitate woman-centred practice.