Hospital Midwives Research Articles

Trends in influenza vaccination and its determinants among pregnant French women between 2015 and 2020: A single-center study

ABSTRACT In 2016, only 7% of French women had received an influenza vaccination during their pregnancy. In this vaccine-averse country, the possibility of reaching the rates of 50% observed in other countries remains unknown. To measure the rate of influenza vaccination in a French university maternity. To study its evolution and determinants over the last 5 years. Single-center observational study of all women who gave birth during March 2020 in this maternity. Comparison with rates observed in 2015 in the same conditions. Of the 337 women included in the study, 202 received a vaccination during pregnancy (59.9%). After logistic regression, the factors significantly associated with achieving vaccination were the offer of vaccination during pregnancy, odds ratio (ORa) 26.2 [7.0; 98.2]; previous vaccination, ORa 20.3 [9.6; 42.6]; high education level, ORa 2.9 [1.3; 6.2]; delivery of a CERFA government reimbursement form, ORa 2.5 [1.3; 4.8]; a vaccination offer made by a general practitioner, ORa 2.1 [1.0; 4.4] and not by a hospital midwife, ORa 0.3 [0.1; 0.6]. The rate of vaccination increased from 35% to 59.9% between 2015 and 2020 ( p < .001), with a significant increase in the offer of vaccination during pregnancy (+14.6%) - especially by a general practitioner (+17.2%) - and in the rate of women with earlier vaccination (+13.6%). In France, vaccination rates above 50% are possible at a center level. A proposal of vaccination during pregnancy – especially by the general practitioner – seems to be a determining factor in this development.

Context and practices of health advocacy role by nurses in Ghana: A qualitative study

Background &amp; Aim: Nurses play a crucial role in health advocacy, which is both morally obligatory and has significant consequences for the clinician. However, there is a paucity of empirical evidence regarding its context and practices. The location, method, and rationale behind nurses fulfilling their health advocacy duties are crucial in hospital settings. This study explored and described where and under what circumstances nurses fulfill their health advocacy responsibilities in Ghana. Methods &amp; Materials: The study employed an inductive qualitative exploratory descriptive design to gather and analyze data from 24 nurses and midwives. Using a semi-structured interview guide, participants were selected from three regional hospitals in the upper, middle, and southern zones of Ghana, and qualitative content analysis was performed. Results: Nurses and midwives carried out their health advocacy roles both inside and outside of healthcare institutions, using both proactive and reactive advocacy practices to initiate their role performance. Although reactive advocacy roles were reported more, the nurses and midwives identified unfair client treatment, health professionals' errors or omissions of procedure, and social injustice as the driving forces behind their advocacy. Conclusion: Although health advocacy is performed by both nurses and midwives in hospitals and outside the hospitals, they are mostly reacting to situations. Teaching biopsychosocial assessment techniques to students during training and providing them with coaching and mentoring during clinical practice may enhance their ability to assess clients for unmet advocacy needs, enabling them to be proactive in their role performance.

Traumatic experiences, quality of life, and organizational commitment among midwives: A cross-sectional study.

The work of midwives is emotionally challenging. Midwives share moments of joy, when a baby is born, and attend complex events of loss and trauma. Exposure to childbirth complications, emergencies, and loss can affect their professional quality of life and functioning. This aspect of midwives' practice has not been sufficiently researched. To examine the associations between exposures to traumatic events, post-traumatic symptoms, and personal resilience with professional quality of life and organizational commitment among hospital midwives. Participants in this cross-sectional study conducted in 2020 included 131 midwives from three large hospitals in central Israel. Data were collected using a structured self-administered questionnaire that examined socio-demographic characteristics, exposure to traumatic events during childbirth, personal resilience, post-traumatic symptoms, professional quality of life, and organizational commitment. The three most traumatic events for midwives were: neonatal death or feared death, maternal death or feared death, and stillbirth. The more frequent the exposure to traumatic events, the more numerous and intense the post-traumatic symptoms. The more numerous and intense the post-traumatic symptoms, the higher the level of professional burnout and compassion fatigue and the lower the compassion satisfaction. Higher compassion satisfaction and lower professional burnout were associated with higher organizational commitment. Personal resilience, country of birth, post-traumatic symptoms, and organizational commitment predicted compassion satisfaction. Midwives' exposure to traumatic events is associated with the onset of post-traumatic symptoms, impaired professional quality of life, and reduced organizational commitment, and is accompanied by burnout and compassion fatigue. There is a need to address this issue in training programs and to develop organizational support and policies to improve midwives' well-being and quality of care.

Psychological well-being and job performance of nurses and midwives amidst COVID-19 in Ghana; a multi-group analysis.

The purpose of this study was to examine the effect of psychological well-being on job performance among nurses and midwives in rural and urban hospitals in Ghana amidst COVID-19. The study adopted a purely quantitative approach, using the explanatory research design. Data were collected from 262 nurses and midwives in two selected hospitals in the Central Region of Ghana. The Structural Equation Modelling was used to analyze the data collected. The results revealed that the levels of psychological well-being and job performance were high in both hospitals amidst the pandemic. Further, it was observed that although psychological well- being had significant influence on job performance among the nurses and midwives in both rural and urban communities, the effect was more significant in the urban settlements. Given these findings, the study recommended that in order to effectively improve the job performance of nurses and midwives, management must adopt policies such as, flexible work arrangements, leave policy, and counselling services to support their psychological well-being.

Opinions of Health Professionals about the Management of Vaginal Deliveries: A Qualitative Research

The research aimed to identify the opinions of health professionals working in the field of obstetrics about the management of vaginal deliveries. The research was carried out with 18 health professionals having active duties in vaginal deliveries at a state university hospital in western Turkey. The maximum variation sampling method, one of the purposive sampling methods, was used. The research data were collected through information form and structured information form. They were analyzed through the thematic analysis method. Ethic Approval was received. Three main themes were identified about the management of vaginal deliveries in this research. (I) opinions of midwives about the management of vaginal deliveries, (II) opinions of nurses about the management of vaginal deliveries and (III) opinions of doctors about the management of vaginal deliveries. The participants (especially midwives and doctors) stated that they overall viewed themselves as a significant activist in the responsibility for vaginal delivery, and midwives could carry out vaginal deliveries due to the workload and the fact that the pregnant women were followed up by midwives. Midwives and nurses emphasized that delivery was not only a medical action but also brought significant responsibilities requiring active care in pregnancy, delivery and the postpartum. The perspective of health professionals was mainly in the direction of the fact that all midwives, who had sufficient education and skills, could carry out vaginal deliveries independently. They agreed that the team who would carry out the delivery should be given continuous institutional training in terms of theory and practice. It is necessary that active studies should be planned on matter of the fact that especially the nurses and midwives in university hospitals could carry out their independent duties and increase their responsibilities for vaginal deliveries as a part of a team.

Impact of Effort-Reward Imbalance and Burnout on the Compliance with Standard Precautions among Nurses and Midwives in Lebanese Hospitals.

Effort-reward imbalance (ERI) refers to the situation where there is a mismatch between the effort that healthcare workers (HCWs) put into their work and the rewards they receive in return. Burnout, on the other hand, is a psychological syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. This study aimed to assess the impact of ERI and burnout on the compliance with standard precautions (SPs) among nurses and midwives in Lebanese hospitals under the economic crisis and after the COVID-19 pandemic. Cross-sectional correlational study, based on self-administered questionnaire data, measuring the compliance with SPs, ERI, and burnout, in addition to the relationship between these factors, was performed among 409 nurses and midwives, working in Lebanese hospitals. ERI was significantly associated with exposure to burnout among nurses and midwives, and burnout was found to be a significant predictor of nurses and midwives' self-reported adherence with SPs. This study highlights the contribution of ERI and burnout to the chain of infection by decreased adherence to infection control SPs of nurses and midwives.

Maternity Nurses and Midwives in a British Columbia Rural Community: Evolving Relationships

The purpose of this study was to examine the dynamics and evolution of inter-professional relationships between registered midwives and nurses in a rural community where midwifery has become well established over twelve years. Interviews explored the responses of maternity nurses, a nurse manager, and a public health nurse to the integration of midwives in a rural hospital in south east British Columbia. Factors which helped to bring resolution to early concerns were discussed, along with evolving understandings of roles and responsibilities. Participants reflected on the impact of midwifery on job satisfaction and on the character of the maternity unit. Initial concerns following integration included competence and liability, the history of unregistered midwifery in the community, and the loss of job satisfaction for nurses who had a diminished role in the care of labouring women. Nursing shortages and workload issues created some appreciation of the extra help provided by midwives, but also caused some inter-professional tensions. Although close and functional professional relationships developed, significant grey areas remain in the definition of shared roles and responsibilities with midwives.

Core competence of midwives in township hospitals and its influencing factors—A cross-sectional study

ObjectiveThis study aimed to assess the core competence of midwives in township hospitals through a self-assessment questionnaire. The relationship between professional identity and core competence and the factors influencing midwives’ core competence was also investigated. MethodConvenience sampling was conducted in 77 township hospitals in Ganzhou, Jiangxi Province, China, with 150 participants. The questionnaires were distributed online in November 2021. We conducted a descriptive data analysis, a correlation analysis of the two variables of professional identity and core competencies, and multivariate linear regression to analyse the influencing factors, including the sociodemographic information, the Midwife Core Competence Scale, and the Nurses’ Professional Identity Scale scores. ResultsThe mean score for the core competence was 206.43 (±37.45) out of 270. The highest score was for pregnancy care (3.97 ± 0.70) and the lowest was for newborn care (3.72 ± 0.78). The independent sample t-test results and one-way analysis of variance showed that qualifications, midwifery training situation, and midwifery working years had differential effects on midwives’ core competencies (P < 0.05). Multiple linear regression showed that qualifications, midwifery working years, and level of professional identity were influencing factors (P < 0.05). ConclusionsThe core competencies of midwives in township hospitals were lower than those reported in other studies. Advancements in education, midwifery working years, and professional identity may increase midwives’ core competencies.

Pre-eclampsia training needs of midwives in a Ghanaian tertiary hospital: A cross-sectional study

AimThis study aimed to assess the specific clinical and non-clinical training needs of midwives and determine their preferred approach to enhancing performance. BackgroundPre-eclampsia remains one of the leading causes of maternal deaths in low and middle-income countries. Pre-eclampsia-related deaths may be due to reduced midwifery knowledge and inadequate management. Therefore, a training needs assessment is vital in identifying gaps in practice, especially, in poorly resourced settings for maximal use of training resources. DesignA hospital-based cross-sectional study. SettingThe largest tertiary hospital in Ghana. MethodsAn online version of the validated WHO Hennessy-Hicks Training Needs Analysis questionnaire was used to assess midwives’ training needs on the management of pre-eclampsia. The tool has good psychometric properties and was used to assess 1) midwives’ confidence in performing tasks, 2) the importance of the task to their role and 3) their preferred performance improvement approach. Data analysis adhered to the guidelines specified in the Hennessy-Hicks Training Needs Analysis Questionnaire and the priority training requirements of the midwives were assessed through descriptive statistics and a series of independent t-tests. ResultsAmong the 250 midwives who responded, most possessed 1–5 years of experience (74.7 %). All 28 tasks were viewed by midwives as essential responsibilities in pre-eclampsia management. Midwives had the greatest need for training in research/audit and clinical skills domains respectively (p < 0.001, 95 % confidence interval: 1.08–1.47, Cohen’s-D = 1.27; and p < 0.001, 95 % confidence interval: 0.69–1.06, Cohen’s-D = 0.87). The foremost primary training necessity, as recognised by midwives, was undertaking health promotion activities, including antenatal health education (MD= 0.43, 95 % confidence interval: 0.29–0.57). Training courses were identified as the preferred approach to address training needs and improve overall proficiency. ConclusionMidwives in Ghana require comprehensive training covering research and clinical-based competencies to improve pre-eclampsia management. Considering the pivotal role of Ghanaian midwives in safeguarding maternal well-being, there is a compelling need to enhance the calibre of midwifery services. These findings can guide stakeholders in countries with comparable healthcare contexts in creating effective, resource-efficient training programs that avoid counterproductivity, ultimately supporting national initiatives to enhance pre-eclampsia management and the quality of care.

‘Naming and faming’ maternity care providers: A mixed-methods study

BackgroundPositive benchmarking can serve as a catalyst for maternity care improvement. AimTo retrospectively benchmark Flemish maternity care providers' qualities, based on women's positive care experiences, and to explore which attributes of the different care providers contribute to these experiences. MethodsA sequential, two-phased mixed-methods study benchmarking the qualities of the community midwife, the hospital midwife, and the obstetrician. An online questionnaire was used to collect the data among pregnant and postpartum women, who rated their care experiences with the various care providers using the Net Promoter Score. Non-parametric and post hoc tests established the differences between types of clinicians and between antenatal, intrapartum, and postpartum Net Promoter Score mean scores. Content analysis was used to construct a final pool of keywords representing attributes of care professionals, accumulated from the promoters’ free text responses. Ranks were assigned to each keyword based on its frequency. FindingsA total of 2385 Net Promoter Scale scores and 1856 free-text responses of 1587 responders were included. The community midwife received the overall highest NPS scores (p < .001). The promoters (n = 1015) assigned community midwives the highest NPS scores (9.67), followed by obstetricians (9.57) and hospital-based midwives (9.51). The distinct benchmarking attributes of community midwives were availability (p < .001), supportiveness (p = .04) and personalised care (p < .001). Being honest (p < .001), empathic (p < .001) and inexhaustible (p = .04) benchmarked hospital midwives. Calmness (p < .001), a no-nonsense approach (p < .001), being humane (p = .01) and comforting (p = .02) benchmarked obstetricians. Discussion/ConclusionThe findings indicate that all care providers are highly valued, but community midwives are ranked the highest. The distinct differences between the care professionals can serve as exemplary performance for professional development and shape the profiles of maternity care professionals.

Knowledge, Health Practices and Policies for Hepatitis for Midwifery and Nurses in Allied and District Hospital Faisalabad

Background: Hepatitis B Virus (HBV) is a critical global health concern with significant morbidity and mortality. Nurses and midwives, as frontline healthcare professionals, are particularly vulnerable to HBV infection. This study focuses on evaluating the knowledge, attitudes, and practices (KAP) related to HBV among these groups in Faisalabad, Pakistan, a region with limited existing research on this topic. Methods: A descriptive, cross-sectional study was conducted in two major public maternity hospitals in Faisalabad (District and Allied hospitals). A structured questionnaire, pre-tested for validity, was administered to assess the KAP towards HBV. Statistical analysis was performed using SPSS Version 21, applying chi-square tests to explore associations between categorical variables. Results: The study sampled 110 healthcare workers (nurses and midwives). Key findings included Knowledge to be 58.2% of participants had an average level of HBV knowledge, Attitudes to be A majority displayed a positive attitude towards HBV prevention, Practices to be 65.5% reported adhering to safe practices. However, a clear percentage of 51.8% had experienced needlestick injuries. Vaccination and PEP found to be only 40.9% completed the HBV vaccination series, and 50% held misconceptions regarding HBV post-exposure prophylaxis. Conclusion: The study reveals a considerable awareness of HBV among nurses and midwives in Faisalabad hospitals, yet highlights critical gaps in both knowledge, particularly concerning PEP, and practices, as evidenced by high rates of needlestick injuries and low vaccination completion. These findings call for intensified efforts in occupational safety, education on HBV, and increasing vaccination coverage among healthcare workers.

A socioecological description of the influencing factors to midwives' management of preeclampsia in a Ghanaian tertiary hospital.

In low-resource settings, midwives are the first contact for women with preeclampsia and lead the coordination of care. Unfavourable preeclampsia outcomes create a burden for women, families, and the health system. It is therefore important to understand the unique context of midwives' practice and the complex factors that influence the delivery of maternal healthcare. This qualitative study explored the perspectives of key stakeholders in a tertiary hospital in Ghana regarding the facilitators and barriers influencing midwives' provision of preeclampsia care using a socioecological model. Semi-structured interviews were conducted with 42 participants comprising senior managers (n = 7) and hospital midwives (n = 35) in 2021. Thematic analysis used Braun and Clarke's six-step method, and the findings were organised within four levels of the socioecological model: individual, interpersonal, organisational, and public policy. Two main themes were identified: 1) Facilitators of preeclampsia management, and 2) Barriers to preeclampsia management. Facilitators were identified at three levels (individual, interpersonal, and organisational) and included midwives' knowledge of preeclampsia; midwives' self-efficacy; midwives' skillset to enhance preeclampsia care; collaborative practice; and strategies for preeclampsia care quality improvement. At the individual level, the barriers were inadequate pre-service preparation, lack of evidence-based midwifery care, and colleagues' work attitudes. Hierarchical decision-making and staff views of women's risk perceptions were identified as barriers at the interpersonal level. At the organisational level, the barriers were: scarce resources and staff shortages, and a lack of midwifery-specific guidelines. Two barriers were identified within the public policy level: the high cost of preeclampsia care and issues with the referral system. Multi-faceted factors play a significant role in midwives' management of preeclampsia. Hence context-specific multi-level interventions have the potential to improve the quality-of-care women in Ghana receive.

Intravenous fluid administration practice among nurses and midwives working in public hospitals of central Ethiopia: A cross-sectional study

Intravenous fluid administration is the most common invasive procedure widely practiced in hospital settings. Globally, approximately 25 million people receive intravenous fluid therapy. Different factors affect nurse's intravenous fluid administration practices; that it may influences on the patient's outcome, increase morbidity and mortality. Previous study indicates that healthcare providers especially in developing countries have skills gap related to intravenous fluid administration. The purpose of this study was aimed to assess the intravenous fluid administration practices and its associated factors among nurses and midwives working in public hospitals of West Shewa zone, Central Ethiopia. Materials and methodsAn institution-based cross-sectional study design was employed among 396 nurses and midwives in public hospitals in West Shewa zone, Central Ethiopia, from March 1 to 31, 2019. A Simple random sampling was used to select study participants using structured self-administered questionnaire, and observational checklist. The logistic regression model was used to identify association, and odds ratio was used to test the strength of the associations with outcome variable and predictor variables. ResultsIn this study, 59.3% (95%CI = 54.7%–64.5%) participants was had inadequate intravenous fluid administration practice. Inadequate knowledge (AOR 2.1; CI 95% = 1.36–3.36), being untrained (AOR 1.7; 95% CI = 1.04–2.86), unavailability of supervision (AOR 1.8; CI 95% = 1.14–2.99), and absence of incentives and promotion for nurses and midwives (AOR 2.1; CI 95% = 1.19–3.62) were significantly associated with outcome variable. ConclusionNearly seven in ten participants in the study setting were inadequate intravenous fluid practice. Inadequate knowledge, training, and absence of supervision by senior staffs, and absence of incentives and promotion for nurses and midwives were the main factors affecting intravenous fluid administration practice. Refresher courses, supervision, incentives and promotions were needed to nurses and midwives for an improvement of the intravenous fluid administration practice.

Job satisfaction of Japanese midwives in the Tokyo metropolitan area.

We explore job satisfaction among Japanese midwives working in different institutions within the Tokyo metropolitan area and relate this to midwives' age. The study involved a questionnaire survey of 423 midwives working in 113 general hospitals, 70 clinics, and 58 midwifery centers in the Tokyo Metropolitan Area of Japan. The questionnaire consisted of items related to demographic and job satisfaction. Questionnaires were returned by 199 participants (47%). Of the 199 midwives, 142 worked in general hospitals (71%), 26 worked in maternity clinics (13%), and 31 worked in midwifery centers (16%). Factor analysis extracted six job satisfaction factors labelled as: F1 'midwifery services', F2 'interpersonal relations', F3 'rewarding and autonomy', F4 'working environment', F5 'working conditions', and F6 'collaboration with doctors'. Job satisfaction scores for all factors were the highest among midwives working in midwifery centers, followed by those working in maternity clinics and hospitals. Job satisfaction of F1 and F3 of those working in midwifery centers was significantly higher than those working in hospitals and maternity clinics for the younger age group, while the scores of those working in maternity clinics became higher and closer to those working in midwifery centers for other age groups. Job satisfaction of midwives varies by different institutions, particularly lowest for those working in hospitals than those working in midwifery clinics and centers. It is necessary to devise useful strategies for midwives in hospitals to enhance their satisfaction with midwifery services and to feel rewarded by and autonomy at work.

Working with private hospital midwives in Victoria, Australia to identify practice change priorities: Outcomes of a Delphi study

Objective/aimIn this study, we invited midwives working at one metropolitan private hospital in Victoria, Australia to identify their workplace change needs and priorities for research. MethodsIn this two-round Delphi study, all midwifery staff within the maternity unit of a private hospital in Melbourne, Australia were invited to participate. In round one, participants joined face-to-face focus groups to put forward their ideas for workplace change and research ideas, and these data were developed into themes. In round two, participants ranked the themes in priority order. FindingsThe top four themes identified by this cohort of midwives were: ‘Ways of working – investigating alternate ways of working to enable greater flexibility and opportunities’; ‘Understanding midwifery – working with the executive team to highlight the nuances of maternity care’; ‘Education – increase in staff in the education team to provide a greater presence and opportunity for education’; and ‘Postnatal specific – review ways of working in postnatal areas’. Key conclusionsA number of priority research and change areas were identified which, if implemented, would strengthen both midwifery practice and midwife retention in this workplace. The findings will be of interest to midwife managers. Further research to evaluate the process and success of implementing the actions identified in this study would be valuable

Prevalence and Associated Factors of Burnout among Midwives in Governmental Hospitals, Eastern Amhara, Ethiopia, 2022

Prevalence and Associated Factors of Burnout among Midwives in Governmental Hospitals, Eastern Amhara, Ethiopia, 2022

Female Genital Mutilation: A Religio-cultural Sensitive Issue Determining Maternal Healthcare Choices among Somali Women in Dadaab Refugee Camp, Kenya

This paper focuses on Kenya’s development challenges in maternal health care, especially the impact of traditional birth attendants (TBAs) and female genital mutilation (FGM) among the refugees. The study identifies four objectives: to discuss the persistence of FGM among Somali women in Ifo Refugee Camp; to establish the hospital process of providing maternal health care to mothers who have gone through FGM; to find out the level of preparedness of the midwives to handle mothers with religio-cultural concerns such as prayer and non-involvement of male nurses; and how the practice of FGM contributes to the preference of TBA by mothers. This study assumes that midwives’ training may not have effectively addressed FGM, a social-cultural sensitive issue affecting childbirth and care. The specific support of midwives in refugee camps contexts also remains limited. A qualitative research approach was used in the study, involving Snowballing sampling method, in-depth interviews, and focus group discussions (FGDs). These methods brought out pertinent issues that make TBAs the preferential option for some mothers despite the presence of level 4 category hospitals in the refugee camps. In case of birth complications, the mother’s choice for TBA delays the family’s decision to take her to the hospital and for healthcare workers to save mother and child. The shortage of midwives and the presence of male midwives in hospitals make some Somali mothers seek assistance from TBAs. There is a need to contextualize midwifery training by enhancing the curriculum with evidence-based/mother-centered skills.

A Job analysis of Hospital Midwives: A DACUM Analysis

Purpose: This study aimed to analyze the tasks of midwives who lead natural childbirth in hospitals using the DACUM technique.Methods: Data were collected from 42 hospital midwives between August 23 to October 12, 2022, and the importance, frequency, and professional difficulty of hospital midwives' tasks were assessed. The collected data were analysed using the IBM SPSS Statistics ver. 22.0 program as the average and standard deviation for the importance, difficulty, and frequency of performance the analyzed tasks. The importance, difficulty, and frequency of performance each task were indicated as high, medium, or low,; furthermore, the importance and difficulty were multiplied and analyzed using the coefficient of determination.Result: Midwives’ tasks in natural childbirth in hospitals were classified into 8 duties, 138 tasks, and 49 task elements. Duties were classified into ‘before childbirth,’ ‘during childbirth,’ ‘after childbirth,’ ‘management of high-risk pregnant women,’ ‘goods management,’ ‘administrative work,’ ‘self-development,’ and ‘newborn care.’ The most important and difficult tasks with the highest coefficient of determination were performing neonatal resuscitation if necessary (11.25), transporting and managing emergency patients (10.46), requesting hospitals to transfer patients in case of emergency (10.43), and transferring patients to a tertiary hospital in case of maternal of neonatal emergency (10.30).Conclusion: In this novel study in Korea, the role of a midwife in a hospital for natural childbirth were defined, and task according to duties were analyzed.

Improving the Quality of Maternity Care through the Introduction of Professional Midwives and Mentoring in Selected Sub-District Hospitals in Bangladesh: A Mixed Method Study Protocol.

Introduction: Bangladesh introduced professional midwives in 2018 to address gaps in sexual and reproductive health services, focusing on improved maternity care. Facility mentoring has been introduced in selected facilities within the government to enable midwives as they move into their new roles. Objectives: To describe a protocol (1) to determine if introducing international standard midwives in rural sub-district hospitals in Bangladesh, both with and without facility mentoring, improve the availability and quality of maternal and newborn health care compared to the facility without midwives; and (2) to explore the experiences of the midwives, and the maternity staff and managers that they joined, following their introduction. Methods: This will be a mixed-methods study to examine differences between selected hospitals grouped into three categories: without midwives (only nurses), with midwives, and both with midwives and mentorship. Hospital selection will be based on choosing those with the highest birth caseload. The quantitative component will consist of facility observations and clinical data extraction to assess their (hospital and midwives) readiness (birth preparedness and complication readiness) and clinical care to explore whether facilities with newly introduced midwives have improved availability and quality of care. We will use facility assessment tools to extract clinical data. In addition, we will use a structured open-ended interview guideline to conduct focus groups and in-depth interviews to understand the perceptions, attitudes, and experiences among maternity staff (e.g., nurses and paramedics) and health managers (e.g., facility manager, residential medical officer, consultants), as well as the midwives themselves toward the newly introduced midwives and the quality of care. We plan to use a fixed effect logistic regression to compare the relationship between variables in the three hospital types for each observed data point. For analyzing qualitative data, we will adopt content analysis and use NVivo to identify themes related to perceptions, attitudes, and experiences. Expected results: The introduction of professional midwives may improve the quality of maternal health care in rural settings. The addition of a mentoring program can support midwives in transitioning into their new roles and introduce improved care quality.

Decreased Motivation as a Reason for Switching Normal Labor from Obstetricians to Midwives in Hospitals

Based on the regulations, normal delivery with complications referred to a mother and child hospital is not under the right and obligation of the midwife as a maternity leader but must be led by an obstetrician. However, 58% of the normal deliveries were referred to midwives at Puri Bunda Mother and Child Hospital. This study aimed to explore the cause of the transfer of leadership in normal deliveries from obstetricians to midwives as the basis for developing solutions to the problems. This research was qualitative with a case study approach. Data were collected through focus group discussions, unstructured observations, and in-depth interviews. The total number of participants involved in this study was 16 people. Focus group discussions were conducted with midwives in the delivery room. In-depth interviews were conducted with the hospital director, the head of the delivery room, and obstetricians who provide normal delivery services. The results showed no guidelines and policies regarding the transfer of normal deliveries.