Describing midwives’ perceptions of maternal postnatal care role within a level one district hospital in eThekwini, KwaZulu-Natal.

Abstract

Background The quality of maternal postnatal care is reported to have decreased resulting in maternal deaths (WHO, 2013: 722), with the majority that occurred in sub-Saharan Africa between 2000 and 2008 were as a result of complications that were further exacerbated by the compromised quality of postnatal maternal care particularly between 24-72 hours post-delivery (WHO, 2013: 721). Postnatal care, in the first 72 hours post-delivery, is crucial to the survival of mother (WHO, 2012a:18). Aim/Purpose The purpose of the study was to describe hospital based midwives’ perceptions of their role within maternal postnatal care in a level one hospital in eThekwini, KwaZulu-Natal in order to improve maternal health outcomes. Methodology Motivated by constructivist paradigm, qualitative approach and descriptive research design were used to describe midwives’ perception of maternal postnatal care role within a level one district hospital, in eThekwini, KwaZulu-Natal. A two-part sampling process involved convenience sampling for the level one hospital, followed by purposive sampling to select ten registered midwives working in the maternity unit. Through one-on-one interviews, an interview schedule guided an advanced psychiatric nurse to use open ended, probing questions to meet the three objectives. Data saturation was reached after eight interviews. Inductive approach of content analysis was used to analyse the data transcribed from the audio recordings. (Elo and Kyngäs, 2008: 107). Results The following categories and sub-categories emerged which address the objectives of the study. Category 1 ‘care is good…but’ described midwives’ perceptions of their postnatal maternal care knowledge of the national guidelines.(Sub-category A: Yes we know the guidelines) however administrative tasks impacted on time spent with direct patient care (Sub-category B: Paper work vs. Patient). Category 2 ‘(general responsibilities) reflected the midwives’ perceptions of their role in providing postnatal maternal care to mothers to and student midwives (Sub-category A: Teaching and supervision; Sub-category B: Post discharge advice and care; Sub-category C: Midwives responsibilities). Category 3 – described “the other people involved in Postnatal Maternal Care”, such as HIV Counsellors and Social workers and their “Reliance of Support” (Sub-Category A). Category 4 and 5 answer the third objective in describing the factors affecting postnatal care in the level one hospital. Category 4 described the “Positive factors” that facilitate midwives’ role in providing effective post-natal maternal care (Sub-category A: Language factor; Sub-category B: Team work), while Category.5 described the “negative factors” that hindered midwives’ role in providing effective post-natal maternal care (Sub-Category A: shortage of staff; Sub-category B: Shortage of equipment). Conclusion In order for the realization of quality care outcomes, namely decreased maternal mortality and morbidity, the process standards need to be in place. Despite the presence of The Guidelines for Maternity Care in South Africa (2015) and midwives reporting themselves to know these guidelines gaps were evident that midwives descriptions of their practice that suggested a failure to reflect an awareness and preparation for postnatal dangers in the descriptions of their teaching function and other roles. Further structure standards of inadequate staffing and availability of beds and equipment were perceived to be lacking. It is concerning that National Guidelines for Maternity Care (2015) are not fully adhered to in the postnatal care the setting which is restricted by the process standards of administrative demands, in its contribution to South Africa meeting its international obligation to cutting maternal mortality. Despite the circumstances that midwives found themselves, this study has provided insight into midwives’ differing perceptions of postnatal maternal care in level one hospital in eTheknini KwaZulu Natal. Key words: Maternal postnatal care, Midwives, Midwives’ perceptions, health care services and level one hospital.