Listening to Midwives Barbara Hanrahan Department of Nursing Education

Phase 1 (Experts) Mothers interviews Midwives narrative sketches Midwives nominal groups Integrated literature review (Experts) 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Background 10 MOUs in Johannesburg Metro Health District Mothers : postnatal day 3 or 10 Midwives at the MOUs – day and night duty Midwives at morbidity and mortality meetings for MOU and feeder clinics. 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

Women’s long term memory of their labour and birth Introduction. Hofmeyr and Nikodem : companionship in labour – medical benefits, dignity and respect Brown : BBI : dignity and respect Simkin : “Just another day in a woman’s life “ Women’s long term memory of their labour and birth Dignity and respect. 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Listening to Midwives 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Narrative Sketches Midwives wrote freely without prompts Their experience of respectful maternity care Mothers, midwives and management / facility 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Nominal Groups Held at each MOU including midwives from feeder clinics ( antenatal care) Identify 5 opportunities for respectful maternity care Identify 5 challenges that hinder respectful maternity care 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION 5 Themes Midwives’ Supportive Behaviors Work Environment Staff Shortages Health System Failures Client Related Factors 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Supportive behaviors 24 supportive behaviors M11 “ “listen and respond in an appropriate manner : M10 “Show motherly love” M8 “Treat the woman as an individual with respect and good care “ 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Midwives Work Environment M6 “ beds are not changed between patients as there is too little linen” M33 “respectful care is lost when there are factors like language barriers and we are overflowing with patients“ M6 “ community perceives midwives as cruel. Patients have an attitude towards midwives” M23 “ if you do well you are not praised which is discouraging” 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Staff Shortages M23 “The women come in with serious maternal conditions – which stretches the work load M13 “2 midwives per shift is not safe M15 “ I fear for the midwives (risk of litigation 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

Health System Failures M12 “ the dynamap is not working and you want to check a BP manually and there is no baumanometer working “ M27 “ The ambulance can take 3 – 4 hours to arrive in which time we may lose a mother or neonate “ M2 “ Stressful when the needs of the patient are not met in time – ambulance takes 3 – 4 hours to fetch a pre eclamptic patient.” 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Client Factors M21 : “Unbooked women and BBA’s put midwives at risk”. M25 : “others come with 2 or 3 previous caesareans and want to deliver at the clinic” M20 : “women come in in advanced labour having taken traditional muti and present with hyperstimulation of the uterus and foetal distress.” 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Conclusion M31 “ Most of the women delivered at our clinic are happy to be delivered by midwives and they trust us.” M16 “Respectful maternity care starts as soon as the woman walks into the facility” 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION Respectful maternity care can be achieved with very few facility based resources if midwives work lives are conducive to patient centered care. The greatest impact is made by the caregiver – the midwives. Thus the need to listen to what the midwives are saying. 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

Challenge for today Find WAYS to OVERCOME disrespect and abuse 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

Groups Flip chart paper plus pens BRAINSTORM 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

Circle key words Discussion Summary 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

WITS DEPARTMENT OF NURSING EDUCATION I pledge to facilitate positive childbirth experiences with the women I care for as a midwife 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION

Thank You Contact Details: Researcher: barbara.hanrahan@wits.ac.za 083 500 0062 11/21/2018 WITS DEPARTMENT OF NURSING EDUCATION