Perspectives of South African women and midwives on clinical practice in public maternity units: facilitating the scaling-up of such clinical practices
- Authors: Wibbelink, Margreet
- Date: 2019
- Subjects: Physician practice patterns , Midwives -- South Africa -- Attitudes Pregnant women -- South Africa -- Attitudes Midwifery -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/44422 , vital:37168
- Description: Despite a steady drop globally in maternal and newborn deaths since 1990, thousands of women and newborns still die each year during pregnancy and childbirth. South Africa, together with other countries, failed to achieve the Millennium Development Goal of reducing maternal mortality by three quarters by 2015. This is despite the positive efforts made in the country towards achieving these goals. However, much more still needs to be done. For that reason, proper and safe care of labouring women remains the identified major focus to prevent these deaths. The current study was the culmination of an investigation into the problem of poor performance regarding maternal and perinatal outcomes as identified by the researcher. The aim of this research study was to understand the experiences and perceptions of the women and the midwives regarding the clinical practices in public maternity units in South Africa in order to facilitate the scaling-up of the midwifery practice. A mixed-methods (sequential exploratory) design was used to answer the research question and objectives, and the study was conducted in three phases. In Phase One, a qualitative research design was implemented. The population were all the midwives in the Eastern Cape who had been working in public maternity units and women who had delivered in those settings. Non-probability purposive sampling with inclusion criteria assisted in selecting a suitable sample. Data collection was done using semi-structured audio-recorded interviews from eleven public sector midwives and eleven women receiving care from the midwives in the Eastern Cape, a province of South Africa. On data analysis, three themes emerged, namely participants had diverse experiences of the midwifery practice, midwives highlighted the burden with regard to the shortage of skilled midwives, and midwives identified managerial issues that affect their performance. Phase Two of the study comprised the quantitative research. The population was the midwives in South Africa who were working in public maternity units and nonprobability purposive sampling criteria were used to select participants. Data collection was done by means of a survey that used a tool adapted from the Hennessy-Hicks Training Needs Analysis Questionnaire. Questions for the survey tool were based on the results of Phase One. A total number of 314 questionnaires were completed, returned and analysed. Phase Three of the study comprised the integration of the results of the first two phases. The study found that midwives were committed to provide quality care but major factors needed to be addressed to facilitate scaling-up of clinical midwifery practices. The midwifery profession needed to be strengthened and an enabling working environment provided. Based on the results of the study as well as the theoretical, conceptual and contextual framework, two strategies were developed: Strategy 1: Empowering midwives to deliver woman-centred care in public sector maternity units Strategy 2: Creating an enabling work environment in order to deliver womancentred care in public sector maternity units.
- Full Text:
- Date Issued: 2019
- Authors: Wibbelink, Margreet
- Date: 2019
- Subjects: Physician practice patterns , Midwives -- South Africa -- Attitudes Pregnant women -- South Africa -- Attitudes Midwifery -- South Africa
- Language: English
- Type: Thesis , Doctoral , DCur
- Identifier: http://hdl.handle.net/10948/44422 , vital:37168
- Description: Despite a steady drop globally in maternal and newborn deaths since 1990, thousands of women and newborns still die each year during pregnancy and childbirth. South Africa, together with other countries, failed to achieve the Millennium Development Goal of reducing maternal mortality by three quarters by 2015. This is despite the positive efforts made in the country towards achieving these goals. However, much more still needs to be done. For that reason, proper and safe care of labouring women remains the identified major focus to prevent these deaths. The current study was the culmination of an investigation into the problem of poor performance regarding maternal and perinatal outcomes as identified by the researcher. The aim of this research study was to understand the experiences and perceptions of the women and the midwives regarding the clinical practices in public maternity units in South Africa in order to facilitate the scaling-up of the midwifery practice. A mixed-methods (sequential exploratory) design was used to answer the research question and objectives, and the study was conducted in three phases. In Phase One, a qualitative research design was implemented. The population were all the midwives in the Eastern Cape who had been working in public maternity units and women who had delivered in those settings. Non-probability purposive sampling with inclusion criteria assisted in selecting a suitable sample. Data collection was done using semi-structured audio-recorded interviews from eleven public sector midwives and eleven women receiving care from the midwives in the Eastern Cape, a province of South Africa. On data analysis, three themes emerged, namely participants had diverse experiences of the midwifery practice, midwives highlighted the burden with regard to the shortage of skilled midwives, and midwives identified managerial issues that affect their performance. Phase Two of the study comprised the quantitative research. The population was the midwives in South Africa who were working in public maternity units and nonprobability purposive sampling criteria were used to select participants. Data collection was done by means of a survey that used a tool adapted from the Hennessy-Hicks Training Needs Analysis Questionnaire. Questions for the survey tool were based on the results of Phase One. A total number of 314 questionnaires were completed, returned and analysed. Phase Three of the study comprised the integration of the results of the first two phases. The study found that midwives were committed to provide quality care but major factors needed to be addressed to facilitate scaling-up of clinical midwifery practices. The midwifery profession needed to be strengthened and an enabling working environment provided. Based on the results of the study as well as the theoretical, conceptual and contextual framework, two strategies were developed: Strategy 1: Empowering midwives to deliver woman-centred care in public sector maternity units Strategy 2: Creating an enabling work environment in order to deliver womancentred care in public sector maternity units.
- Full Text:
- Date Issued: 2019
Perceptions of private sector midwives and obstetricians regarding collaborative maternity
- Authors: Wibbelink, Margreet
- Date: 2014
- Subjects: Maternal health services , Maternal health care teams
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10067 , http://hdl.handle.net/10948/d1020979
- Description: The World Health Organization (WHO) states that no region in the world is justified in having a caesarean section rate greater than 10-15 percent, calculated as the number of caesarean deliveries over the total number of live births. There is however, an international increase in the rate of caesarean section deliveries and this is a concern to midwives. The increase is evident in South Africa as well. Currently the rate of caesarean section deliveries in the private sector can be as high as 70 percent per total number of live births per year. As a result, the public often perceives giving birth surgically in South Africa as ‘normal’ and ‘safer’ than vaginal delivery, even for low-risk pregnancies. The lack of involvement of midwives in the care of pregnant women in the private sector is indicated as one of the reasons related to the high caesarean section delivery rates. This motivated the researcher to undertake a study to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. A literature review to support the study identified research done previously regarding collaborative maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was used. The researcher conducted semi-structured one-to-one interviews to collect information rich data. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as autonomy, non-maleficence, beneficence and justice. The interviews were transcribed and Creswell’s’ data analysis spiral was used as a guide for the data analysis. Themes and sub-themes were identified and grouped together to form new categories. An independent coder assisted with the coding process. Data analysis results revealed the following results Participants perceived a collaborative working relationship as being beneficial to maternity care. Participants identified that there might be critical impediments that need to be faced in order to realize collaborative maternity care. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four criteria namely credibility, transferability, dependability and conformability. The information obtained from this study assisted in developing guidelines to facilitate the implementation of collaborative maternity care between midwives and obstetricians in private practice in South Africa. The objective of the study was thus met.
- Full Text:
- Date Issued: 2014
- Authors: Wibbelink, Margreet
- Date: 2014
- Subjects: Maternal health services , Maternal health care teams
- Language: English
- Type: Thesis , Masters , MCur
- Identifier: vital:10067 , http://hdl.handle.net/10948/d1020979
- Description: The World Health Organization (WHO) states that no region in the world is justified in having a caesarean section rate greater than 10-15 percent, calculated as the number of caesarean deliveries over the total number of live births. There is however, an international increase in the rate of caesarean section deliveries and this is a concern to midwives. The increase is evident in South Africa as well. Currently the rate of caesarean section deliveries in the private sector can be as high as 70 percent per total number of live births per year. As a result, the public often perceives giving birth surgically in South Africa as ‘normal’ and ‘safer’ than vaginal delivery, even for low-risk pregnancies. The lack of involvement of midwives in the care of pregnant women in the private sector is indicated as one of the reasons related to the high caesarean section delivery rates. This motivated the researcher to undertake a study to explore and describe the perceptions of private sector midwives and obstetricians regarding the feasibility of collaboration in maternity care. A literature review to support the study identified research done previously regarding collaborative maternity care. The study followed a qualitative, exploratory, descriptive, contextual design. The research population included midwives and obstetricians in the private sector in the Eastern Cape. Non-probability, purposive sampling was used. The researcher conducted semi-structured one-to-one interviews to collect information rich data. The researcher ensured that the study was conducted in an ethical manner by adhering to ethical principles such as autonomy, non-maleficence, beneficence and justice. The interviews were transcribed and Creswell’s’ data analysis spiral was used as a guide for the data analysis. Themes and sub-themes were identified and grouped together to form new categories. An independent coder assisted with the coding process. Data analysis results revealed the following results Participants perceived a collaborative working relationship as being beneficial to maternity care. Participants identified that there might be critical impediments that need to be faced in order to realize collaborative maternity care. The researcher ensured the validity of the study by conforming to Lincoln and Guba’s model of trustworthiness, which consists of the following four criteria namely credibility, transferability, dependability and conformability. The information obtained from this study assisted in developing guidelines to facilitate the implementation of collaborative maternity care between midwives and obstetricians in private practice in South Africa. The objective of the study was thus met.
- Full Text:
- Date Issued: 2014
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