Experiences Of Midwives Research Articles

Effects of obstetric critical care simulation training on core competency and learning experience of midwives: A pilot quasi-experimental study

AimThis study aimed to investigate the effects of maternal critical care simulation training on the core competency and satisfaction of midwives in China. BackgroundMidwives play an important role during the peripartum period. Simulation-based training could be an effective tool in improving the core competency of midwives when managing critical obstetric illnesses. DesignA pilot pre- and post-course, quasi-experimental study in China. MethodIn July 2022, 82 midwives completed a 2-day obstetric critical care simulation training and survey. Core competency was evaluated by a comprehensive score system, including response ability, communication ability, site control ability, critical thinking ability, team cooperation ability, forward-thinking ability, midwifery specialty ability, and error correction ability. We used the Simulation Effectiveness Tool-Modified (SET-M) to evaluate the learning experience and satisfaction. Descriptive analysis, McNemar χ2 test, and subject content analysis were used for data analysis. ResultsAfter the training, the core competency scores showed significant improvements in the case scenarios simulating shoulder dystocia, amniotic fluid embolism, and eclampsia (P < 0.05) but not postpartum hemorrhage (P > 0.05). The scores evaluated by the SET-M were all above 2.5 points. Some midwives preferred extended course duration, expanded course materials, and more active involvement in the simulation exercises. The midwives were generally highly satisfied with the training, but some expressed certain negative emotions, such as anxiety and nervousness. ConclusionThe high quality of scientifically constructed and implemented obstetric critical care simulation training courses could improve the core competency and satisfaction of midwives. Appropriate preparation and professional simulation teachers are required to reduce negative emotions and improve learning outcomes and experience.

Experiences of obstetric nurses and midwives receiving a perinatal bereavement care training programme: A qualitative study.

To explore obstetric nurses and midwifery professionals' experiences with the Perinatal Bereavement Care Training Programme (PBCTP) after implementation. A qualitative descriptive design was used. This qualitative study was conducted at a tertiary level maternity hospital in China. The PBCTP was implemented at Women's Hospital School of Medicine, Zhejiang University from March to May 2022. A total of 127 nurses and 44 midwives were invited to participate in the training. Obstetric nurses and midwives studied a 5-module training programme comprised of eight online theoretical courses and submitted a reflective journal after each session. Semi-structured interviews were conducted with 12 obstetric nurses and four midwives from May to July 2022 as a post-intervention evaluation. Thematic analysis was used in data analysis. A total of 16 participants in this study ranged in age from 23 to 40 years [mean age (SD), 30 (4) years]. Six main themes within participants' experiences of PBCTP intervention were identified: participants' aims of undertaking the training; personal growth and practice changes after training; the most valuable training content; suggestions for training improvement; directions for practice improvement; influencing factors of practice optimization. Nursing and midwifery professionals described the PBCTP as satisfying their learning and skills enhancement needs and supporting positive changes in their care providing for bereaved families. The optimized training programme should be widely applied in the future. More efforts from the hospitals, managers, obstetric nurses, and midwives are needed to jointly contribute to forming a uniform care pathway and promoting a supportive perinatal bereavement care practice.

Volunteering in an emergency project in response to the COVID-19 pandemic crisis: the experience of Italian midwives

ObjectivesDuring the first wave of the COVID-19 pandemic, the Region of Lombardy in Italy and its Regional Emergency Service (Azienda Regionale Emergenza Urgenza [AREU]) created a dedicated 24/7 free phone service to help the Lombard population. After an invitation from their professional order, local midwives collaborated on the AREU project as volunteers to address the needs of women from antenatal to postnatal periods. The aim of this article was to explore the experiences of midwives who volunteered in the AREU project. Study designThis was a qualitative study using an interpretative phenomenological approach (IPA). MethodsThe experiences of midwives volunteering in AREU (N = 59) were explored using audio diaries. Written diaries were also offered as an alternative. Data collection took place between March and April 2020. Midwives were provided with semistructured guidance that indicated the main areas of interest of the study. The diaries were thematically analysed following a temporal criterion; a final conceptual framework was created from emerging themes and subthemes. ResultsThe following five themes were identified: (1) choosing to join the volunteer project, (2) the day-to-day difficulties, (3) strategies to cope with the unexpected, (4) professional relationships and (5) reflecting on the personal experience. ConclusionsThis is the first study to investigate the experiences of Italian midwives who volunteered in a public health project during a pandemic/epidemic. According to participants, taking part in the volunteer activities was informed by and impacted on both their professional and personal lives. Overall, the experiences of midwives who volunteered in AREU were positive and of humanitarian value. Providing midwifery services within a multidisciplinary team for the benefit of public health represented both a challenge and personal/professional enrichment.

Psychosocial impact of the COVID-19 pandemic on Australian nurses and midwives: a cross-sectional study

Objective: To investigate the psychosocial effects of the COVID-19 pandemic on nurses and midwives working in acute care settings, specifically psychological distress, self-reported concerns, and perceived impact on their work and personal lives. Background: Little is known about the psychosocial impact of the pandemic on nurses and midwives in Australia, a country with a substantially lower number of COVID-19 cases and deaths than many others. Few studies investigating the prevalence of psychological distress among nurses during the pandemic have been conducted in more than one setting, especially in the Australian context. Study design and methods: Cross-sectional survey design (STROBE checklist). Nurses and midwives (n=1,611) at four metropolitan tertiary health services in Melbourne, Australia completed an anonymous online survey between 15 May and 31 August 2020, which assessed symptoms of depression, anxiety and stress (DASS-21); concerns related to COVID-19; and other effects of COVID-19. Space was provided for free-text comments. Results: Approximately one fifth of respondents reported moderate to extremely severe symptoms of depression, anxiety and stress. Fewer years of clinical experience were significantly associated with higher levels of psychological distress. More than half of the respondents were extremely/very concerned about passing COVID-19 on to family members and about their family's health, and almost half were concerned about caring for a patient who had confirmed or suspected COVID-19. Respondents reported that certain precautionary measures such as personal protective equipment (PPE) interfered with their ability to provide optimal patient care. Positive aspects of the pandemic were also reported including a sense of togetherness and cooperation among staff. Conclusion: The COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of nurses and midwives working in acute care settings in Melbourne, Australia, particularly those with less clinical experience. Implications for nursing and health services research, policy and practice: Nurses and midwives, particularly those with less clinical experience, would benefit from additional, targeted wellbeing and support initiatives. For those with less experience, initiatives could include being partnered with more experienced colleagues and educators who can provide practical and emotional support and monitor their stress levels. What is already known about the topic? Nurses and midwives have experienced more psychological distress than other healthcare workers during the COVID-19 pandemic. Most studies about the psychosocial impact of the COVID-19 pandemic on nurses and midwives have been conducted in a single health service. Few studies have concurrently investigated the experiences of nurses and midwives from different health services during the COVID-19 pandemic especially in the Australian context. What this paper adds Despite the relatively low number of COVID-19 cases and deaths in Australia, the COVID-19 pandemic has had a considerable impact on the psychological wellbeing and work and personal lives of Australian nurses and midwives. About one in five of the nurses and midwives surveyed reported moderate to extremely severe symptoms of depression, anxiety and stress during the first wave of the pandemic. Nurses and midwives with fewer years of clinical experience experienced higher levels of psychological distress than those with more experience.

Relationships are the key to a successful publicly funded homebirth program, a qualitative study

BackgroundIn Australia, publicly-funded homebirth is a relatively new option for women and their families. Two years after the inception of two publicly funded homebirth services in Victoria in 2009, a study found that midwives’ experiences were more positive than doctors. There is no recent evidence on the perspectives of midwives and doctors of publicly-funded homebirth programs. AimTo explore the experiences of midwives and doctors participating in or supporting one publicly-funded homebirth program in Australia. MethodsAn interpretive descriptive approach was used following individual in-depth interviews via ‘Zoom’. Participants included midwives and doctors who provide or support the homebirth service at a large metropolitan health service in Melbourne’s western suburbs. Data were thematically analysed. FindingsInterviews were conducted with 16 homebirth midwives, six hospital-based midwives, and nine doctors. One central theme and three sub-themes demonstrate that effective relationships are critical to a successful publicly-funded homebirth program. Collaboration, teamwork, and mutual respect across professions were reported to be integral to success. The midwife-woman relationship was highly valued and especially important to provide continuity during transfers to the hospital where this occurred. DiscussionEffective relationships underpin collaborative practice and are critical for safe healthcare. Shared common learning opportunities such as simulation training sessions and multi-professional forums to discuss cases were perceived to assist the development of these relationships. ConclusionEffective relationships within and between midwives and doctors are key to collaborative practice, which underpins a successful publicly-funded homebirth service. Health services can support this by maintaining a respectful and supportive culture amongst staff.

Describing the lived experiences of nurses and midwives in caring for mothers and families during a fetal loss

Background: Pregnancy is often anticipated as a positive experience for women with the expectation of having a healthy infant in the end. However, some pregnancies end in fetal loss, which can have profound effects on parents and families and is characterized by shock, anger, emptiness, helplessness, and loneliness. Aims: The study aimed to describe the lived experiences of nurses and midwives regarding care provided for mothers and families during the fetal loss at King Abdul-Aziz Medical City, Western region. Setting and Design: The study setting was the labor and delivery units at King Abdul-Aziz Medical City, Western region, Saudi Arabia. Husserl's phenomenological approach was used. Materials and Methods: Purposive sampling included 11 nurses and midwives were included. Data were collected through in-depth interviews that were audio reordered and then transcribed verbatim. Statistical Analysis: Thematic analysis using Giorgi's data analysis steps was used. Results: Two themes emerged regarding the experiences of nurses in caring for mothers and families who experience fetal loss, namely emotional turmoil with subthemes, heavy heart, feeling helpless, lack of self-control, feeling guilty, feeling extreme sadness, feeling isolation; and barriers with subthemes culture, lack of nursing care, and limited skill. Conclusion: Two major themes emerged from the study that highlighted that nurses found caring for patients and families after a fetal loss a challenging experience and, at times, were unable to manage their own emotions.

The midwife's experience in mantaining the psychoneuroendocrine balance of women in labour during the COVID-19 pandemic: a phenomenological study

The midwife's experience in mantaining the psychoneuroendocrine balance of women in labour during the COVID-19 pandemic: a phenomenological study

Midwives’ experiences of utilising personal protective equipment during the COVID-19 pandemic: a qualitative descriptive study

Background: Coronavirus has placed a lot of strain on the healthcare system. As a result, major changes have occurred in the way healthcare is delivered, including pregnancy care delivery. Within the Irish healthcare system, the response to the COVID-19 pandemic has demanded frequent and ongoing adjustments to midwifery practice and the provision of personal protective equipment (PPE) and its usage have come under serious scrutiny during the COVID-19 pandemic. Aim: To explore midwives experiences of utilising PPE during the COVID-19 pandemic. Methods: A qualitative descriptive study utilising a purposive sampling of 10 midwives who participated in in-depth semi-structured interviews, highlighting their experiences of utilising PPE during the COVID-19 pandemic. Data obtained was analysed using the Braun and Clarkes framework and reported in line with the consolidated criteria for qualitative research reporting (COREQ). Results: Analysed data resulted in five themes, eight subthemes and 18 codes. The themes identified represent the participants experiences and highlight the; importance of effective communication, fear and anxiety of contracting and spreading the virus, value of peer support as a coping strategy, impact of lack of resources in the midwifery practice, and education and training effectiveness. Conclusion: The introduced strict mandatory infection prevention and control measures, predominantly the wearing of PPE, took effect with concurrent increased stress and anxiety, while caring for pregnant women.

The Experiences of Midwives in Caring for Vulnerable Pregnant Women in The Netherlands: A Qualitative Cross-Sectional Study.

Vulnerable pregnant women have an increased risk for preterm birth and perinatal mortality. This study identifies the perspectives, perceived barriers, and perceived facilitators of midwives toward current care for vulnerable pregnant women in the Netherlands. Knowing those perspectives, barriers, and facilitators could help increase quality of care, thereby reducing the risks of preterm birth and perinatal mortality. Midwives working in primary care practices throughout the Netherlands were interviewed. Semi-structured interviews were conducted remotely through a video conference program, audio recorded, transcribed verbatim, and coded based on the theoretical domains framework and concepts derived from the interviews, using NVivo-12. All midwives provided psychosocial care for vulnerable pregnant women, expected positive consequences for those women resulting from that care, considered it their task to identify and refer vulnerable women, and intended to improve the situation for mother and child. The main barriers perceived by midwives were too many organizations being involved, inadequate communication between care providers, lack of time to care for vulnerable women, insufficient financing to provide adequate care, and uncooperative clients. The main facilitators were having care coordinators, treatment guidelines, vulnerability detection tools, their own knowledge about local psychosocial organizations, good communication skills, cooperative clients, consultation with colleagues, and good communication between care providers. The findings suggest that midwives are highly motivated to care for vulnerable women and perceive a multitude of facilitators. However, they also perceive various barriers for providing optimal care. A national guideline on how to care for vulnerable women, local overviews of involved organizations, and proactive midwives who ensure connections between the psychosocial and medical domain could help to overcome these barriers, and therefore, maximize effectiveness of the care for vulnerable pregnant women.

Midwife empathy and its association with the childbirth experience: a cross-sectional study

BackgroundAlthough pregnancy and childbirth comprise a life-course that most midwives experience, whether their own experiences of childbirth resonate with other women during childbirth remains to be determined. In this study, we therefore characterized midwives’ empathic capabilities and defined their underlying factors.MethodWe conducted a cross-sectional study with data from 464 midwives in Guangdong, China, that were collected through the “Chinese version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP).” This questionnaire contains sections related to midwife demographics and delivery characteristics. We then implemented multivariate logistic regression analysis to identify empathy-related factors.ResultsOur analysis revealed 303 (65.3%) participants in the high-empathy group while 161 (34.7%) were in the middle-empathy group. Compared with the reference groups, these results indicated that higher empathy was associated with an elevated educational level (OR, 1.83; 95% CI, 1.04–3.25), high monthly salary (OR, 2.30; 95% CI, 1.11–4.80), and no shift work (OR, 2.89; 95% CI, 1.09–7.63). The odds of a high empathy score were higher for midwives who experienced two childbirths (2.27, 1.11–4.66) and for those who had children under the age of 3 years (2.81, 1.34–5.92).ConclusionMidwives possess a moderate-to-high level of empathy, and the greater the number of childbirths they experienced and the younger their children, the higher their reported empathy score. This study contributes novel information regarding the empathic behavior of midwives toward women who give birth in China.

Transition experiences of Middle Eastern midwives into Australian practice: A multiple case narrative study.

To explore transition experiences of Middle Eastern qualified midwives into practice in Australia. This was a qualitative study using multiple case narrative approach underpinned by structuration theory. A total of 19 Middle Eastern qualified midwives from different states of Australia participated in this study. Individual semi-structured interviews were conducted between November 2020 and September 2021, digitally recorded and then transcribed. Transcriptions were analysed in three stages, with three main categories generated in the second stage and a core category that was developed in third. Entering the Australian workforce, Middle Eastern qualified midwives had to reframe their professional identities to fit the new system by adjusting to three aspects of the practice, including preparation for practice, scope of practice and context of practice. While they were prepared by medically oriented curricula, worked in systems that had limitations for midwives to practise in antenatal and postnatal and lacked regulation standards, they learned to practise autonomously in their full scope in a standardized context in Australia. Middle Eastern qualified midwives in Australia re-evaluated their practice in their home countries, realized the gaps and adjusted to new ways of practising in Australia. To effectively use the potential of Middle Eastern midwives for workforce sustainability in Australia, support should be available to enable them to develop the necessary competencies for safe practice in Australia including provision of context-specific transition programmes prior to registration and supporting mentorship after their integration into the Australian healthcare workforce. Patient or public contribution does not apply to this study as its purpose was to explore the transition experiences of Middle Eastern qualified midwives themselves.

The healthcare system and client failures contributing to maternal mortality in rural Kenya

BackgroundThe global maternal mortality ratio is estimated at 211/100 000 live births in 2017. In Kenya, progress on reducing maternal mortality appears to be slow and persistently higher than the global average, despite efforts by the government’s provision of free maternity services in both private and public facilities in 2013. We aimed to explore and describe the experiences of midwives on maternal deaths that are associated with the healthcare system and client failures in Migori, Kenya.MethodsAn explanatory, qualitative approach method was adopted. In-depth interviews were conducted with the purposively selected midwives working in peripartum units of the three sampled hospitals within Migori County in Kenya. The hospitals included two county referral hospitals and one private referral hospital. Saturation was reached with 37 respondents. NVivo 11 software was used for analysis. Content analysis using a qualitative approach was adopted. Accordingly, the data transcripts were synthesised, coded and organised into thematic domains.ResultsIdentified sub-themes: sub-optimal care, staff inadequacy, theatre delays, lack of blood and essential drugs, non-adherence to protocols, staff shortage, inadequate equipment and supplies, unavailable ICU wards, clients’ ANC non-adherence.ConclusionIn conclusion, the study notes that the healthcare system and client failures are contributing to maternal mortality in the study setting. The major failures are across the pregnancy continuum starting from antenatal care, and intrapartum to post-natal care. This can illustrate that some pregnant mothers are getting sub-optimal care reducing their survival chances. To reduce maternal mortality in Migori County, the key highlighted healthcare system and client failures should be addressed through a multidisciplinary approach mechanism.

Support in the Battle against COVID-19: A National Qualitative Study among Midwives in Indonesia

The outbreak of the novel coronavirus disease (COVID-19) in 2019 was met with various responses globally in an effort to reduce its spread. Despite these efforts, however, low- and middle-income countries like Indonesia are still being confronted with challenges, especially the healthcare providers who are frontline workers in the struggle. The current study aimed to explore the support expected by and provided to Indonesian midwives and pregnant women during the COVID-19 pandemic. The research method used was a descriptive-interpretative qualitative research design. The data was collected through conducting in-depth interviews with 24 midwives who were purposively sampled and evenly recruited across all regions and all areas of midwifery practice in Indonesia. The recorded interviews were coded and themes were identified, after which a thematic analysis was done. Two main themes emerged and nine sub-themes were identified from the main themes. The study findings offered new insights into the individual and collective experiences of midwives from various regions in Indonesia. They had to adjust by leveraging the internet and mobile telephones in order to continue delivering standard care to pregnant women amid the pandemic. In addition, the midwives saw the need to provide food and financial support to pregnant women. However, despite the end of the pandemic being in sight in September 2022, there is a need to continue to support midwives and pregnant women in the disruption caused by the pandemic. Government agencies and non-governmental organisations (NGOs) should plan interventions targeted at providing specific support to midwives and pregnant women.

Managers' perception of older nurses and midwives and their contribution to the workplace-A qualitative descriptive study.

The aim of this study was to explore healthcare managers' perceptions about older nurses' and midwives' and their contribution to the workplace. A qualitative descriptive methodology. Twenty healthcare managers working in Australia participated in semi-structured interviews. Data were collected between April 2019 and April 2021. Interviews were recorded, transcribed and then analysed using thematic analysis. All healthcare managers said older nurses and midwives contributed to the workplace through their experience and knowledge. Managers viewed them as a different type of worker and while there were some positive aspects to this, it was mostly negative. Although managers identified a broad age range for the older nurses or midwives, there was a common perception that if they were no longer able to perform their duties, they should leave the workforce. Healthcare managers' perceptions towards older nurses and midwives are mostly negative, and their understanding of older workers' contribution is contradictory and poor. These negative views co-exist with the lack of agreement on who is the older worker, which explain the reluctance of healthcare organizations to invest in their older workforce. Future research is needed to better understand the unique contribution of older nurses and midwives in healthcare and how they can be supported at work. The global ageing population will result in a rise in complex age-related health issues and will require an experienced and knowledgeable workforce. Given the greater experience of older nurses and midwives they are an important part of the health workforce. Yet managers' perception of the contribution by older nurses and midwives were often negative. The findings of this study highlight the need for organizational change so that the contribution of older nurses and midwives is recognized and supported by managers.

Supporting young women with menstrual pain – Experiences of midwives working at youth clinics

BackgroundMenstrual pain is relatively common among young girls. Many girls turn to youth clinics when seeking care for menstrual problems. ObjectiveThe objective of the study was to describe midwives’ experiences of supporting girls with menstrual pain. MethodsThis is a qualitative study with an inductive approach. Semi-structured interviews were conducted with 15 midwives working at Swedish youth clinics. Interviews were held inSeptember 2021. The recordings were transcribed and analyzed using thematic analysis. ResultsTwo main themes, consisting of three subthemes each, emerged: Guiding and educating young women about menstrual pain and Striving toward pain relief. It was important to the midwives to increase young women’s knowledge of menstrual pain and coping strategies, and to guide them in finding a method for menstrual pain relief. Hormonal contraceptives were often a natural choice and an effective method for pain relief, although the midwives occasionally faced resistance from young women or their mothers when recommending this. The midwives also referred to a gynecologist if needed. ConclusionThe results highlight that midwives working at youth clinics have an important role in the care of young women with menstrual pain. The midwives found it important to increase young women’s knowledge about menstrual pain and coping strategies, since they had noticed knowledge gaps in these areas. The results suggest a need to improve education about menstrual pain and coping strategies for young women, preferably in school and in cooperation with healthcare professionals.

Midwives experiences of interventions to improve breast expression following preterm birth: A qualitative study

ObjectivePreterm birth impacts approximately 10% of women globally. Midwives are often the first point of care after the birth of a preterm infant providing mothers with information and support for breast expression. However, despite guidelines that suggest expression within the first hour of birth, most first expressions occur much later. This study aimed to seek an understanding of midwives’ experiences with the first expression for mothers of preterm infants, including the barriers and facilitators that midwives may face. DesignA qualitative design using semi-structured interviews via focus groups. Thematic analysis was used to identify relevant themes and sub-themes. ParticipantsParticipants included midwives providing care to women in preterm labour and birth at a tertiary maternity hospital in Australia (N=12). All participating midwives cared for mothers of preterm infants between 28 and 35 weeks’ gestation up to six hours following birth. FindingsTwo major themes resulted from the data, including the changing expectations of infant feeding and the responsibility versus expectation to support a woman to express in the first hour of birth with other competing clinical and organisational tasks. Key conclusions and implications for practiceWhilst individual philosophies on the benefits of human milk were positive, expressing in the birth suite was dictated by essential clinical tasks and by the institutions value placed on expressing in the first hour. Clear objectives to undertake expressing within the first hour or within the birth suite stay, need to be included in policy and supported by management and team leaders, to increase early expressing rates.

Experiences of midwives regarding provision of culturally competent care to women receiving maternal care in South Africa

Due to the cultural diversity in South Africa, midwives are challenged to provide culturally competent, congruent, and sensitive maternal care. Using a qualitative descriptive design, this study aimed to explore and describe the experiences of midwives providing culturally competent care to women receiving maternal care within overburdened public hospitals. Purposive sampling of thirty-four (n = 34) midwives employed to provide maternal care (antenatal, intrapartum, and postpartum) at five public hospitals in the North West Province of South Africa was done. Semi-structured interviews were conducted in English and transcribed verbatim. Data was analysed thematically with the assistance of an independent co-coder. Data revealed that midwives viewed communication as a key component of cultural competence. Midwives do not necessarily understand the concept “cultural competence.” It is recommended that a policy of culturally competent maternal care be developed and implemented by midwives in practice.

Resistance in health and healthcare: Applying Essex conceptualisation to a multiphased study on the experiences of Australian nurses and midwives who provide abortion care to people victimised by gender-based violence.

In this article, we explore the act of resistance by nurses and midwives at the nexus of abortion care and gender-based violence. We commence with a brief overview of a multiphased extended grounded theory doctoral project that analysed the individual, situational and socio-political experiences of Australian nurses and midwives who provide abortion care to people victimised by gender-based violence. We then turn to Essex's conceptualisation of resistance in health and healthcare and draw upon these concepts to tell a unifying and cohesive story about how nurses and midwives exercise their politics. Vignettes taken from the three study phases are provided for demonstrative purposes. Finally, we discuss the potential of resistance in health and healthcare as a postmodern feminist research tool to analyse acts by nurses and midwives that could be categorised as political.

Management of postpartum hemorrhage by midwives in selected healthcare facilities in Ekiti State: An exploratory qualitative study

ObjectivesMaternal mortality continues to pose a critical challenge in obstetric practice, with postpartum haemorrhage as one of the major causes. This study aimed to explore the lived experiences of midwives regarding the management of postpartum haemorrhage (PPH). MethodsThe study employed a qualitative phenomenological approach. Participants were selected using purposive sampling technique, and 15 participants were recruited for the study. Data collection was done using a semi-structured interview guide for in-depth interviews. The interviews were audio-recorded, and data analysis was done using thematic analysis. ResultsTwo themes emerged from the analysis, including 1) management practices adopted against PPH and 2) hospital protocol for the management of PPH. The major management practices adopted by the midwives were using uterotonics, especially oxytocin, and other management practices such as anti-shock garments, stimulation of contractions by rubbing the uterus, and assessment of the cause of bleeding and suturing of lacerations. It was also deduced that different healthcare facilities had policies for managing postpartum haemorrhage. Barriers affecting the effective management of PPH were understaffing, unavailability of suitable facilities and equipment, restrictions on nurses/midwives in managing PPH, unfavourable hospital policy and lack of communication among the healthcare team. ConclusionThe participants’ experiences suggest they are somewhat satisfied with PPH management in their facilities. However, barriers such as understaffing, unavailability of equipment, poor communication among healthcare teams and restrictions on nurses in PPH management should be addressed to improve midwives' experiences in PPH management.

Perceptions and experiences of Congolese midwives implementing a low-cost battery-operated heart rate meter during newborn resuscitation.

Background900,000 newborns die from respiratory depression each year; nearly all of these deaths occur in low- and middle-income countries. Deaths from respiratory depression are reduced by evidence-based resuscitation. Electronic heart rate monitoring provides a sensitive indicator of the neonate's status to inform resuscitation care, but is infrequently used in low-resource settings. In a recent trial in the Democratic Republic of the Congo, midwives used a low-cost, battery-operated heart rate meter (NeoBeat) to continuously monitor heart rate during resuscitations. We explored midwives' perceptions of NeoBeat including its utility and barriers and facilitators to use.MethodsAfter a 20-month intervention in which midwives from three facilities used NeoBeat during resuscitations, we surveyed midwives and conducted focus group discussions (FGDs) regarding the incorporation of NeoBeat into clinical care. FGDs were conducted in Lingala, the native language, then transcribed and translated from Lingala to French to English. We analyzed data by: (1) coding of transcripts using Nvivo, (2) comparison of codes to identify patterns in the data, and (3) grouping of codes into categories by two independent reviewers, with final categories determined by consensus.ResultsEach midwife from Facility A used NeoBeat on an estimated 373 newborns, while each midwife at facilities B and C used NeoBeat an average 24 and 47 times, respectively. From FGDs with 30 midwives, we identified five main categories of perceptions and experiences regarding the use of NeoBeat: (1) Providers' initial skepticism evolved into pride and a belief that NeoBeat was essential to resuscitation care, (2) Providers viewed NeoBeat as enabling their resuscitation and increasing their capacity, (3) NeoBeat helped providers identify flaccid newborns as liveborn, leading to hope and the perception of saving of lives, (4) Challenges of use of NeoBeat included cleaning, charging, and insufficient quantity of devices, and (5) Providers desired to continue using the device and to expand its use beyond resuscitation and their own facilities.ConclusionMidwives perceived that NeoBeat enabled their resuscitation practices, including assisting them in identifying non-breathing newborns as liveborn. Increasing the quantity of devices per facility and developing systems to facilitate cleaning and charging may be critical for scale-up.