Midwives’ challenges in the management of postpartum haemorrhage at rural PHC facilities of Limpopo province, South Africa: An explorative study

  • African Health Sciences, Volume 21, No. 1, Year 2021

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Study Justification:
– Postpartum haemorrhage is a leading cause of maternal mortality.
– Midwives play a crucial role in managing postpartum haemorrhage.
– The experiences and challenges faced by midwives in managing postpartum haemorrhage have not been explored in Limpopo province, South Africa.
– Understanding these challenges can help improve the management of postpartum haemorrhage and reduce maternal mortality.
Study Highlights:
– Qualitative research design was used to explore the challenges experienced by midwives in managing women with postpartum haemorrhage.
– 18 midwives working at primary health care facilities in rural areas were interviewed.
– One main theme and five subthemes emerged, highlighting the difficulties and frustrations faced by midwives in managing postpartum haemorrhage.
– Lack of time, shortage of human resources, and difficulty in consulting guidelines were identified as key challenges.
Study Recommendations:
– Midwives should be capacitated through training to improve their skills in managing postpartum haemorrhage.
– Midwives should be supported and supervised to ensure proper execution of postpartum haemorrhage management.
– Successful implementation of maternal health care guidelines is crucial for effective management of postpartum haemorrhage.
Key Role Players:
– Midwives: They need to be trained and supported in managing postpartum haemorrhage.
– Health Care Facilities: They need to provide resources and support for midwives.
– District Executive Managers: They play a role in granting access and permission for research and implementation of recommendations.
– University of Venda: They provided ethical clearance for the study.
Cost Items for Planning Recommendations:
– Training programs for midwives.
– Resources for implementing guidelines (e.g., equipment, medications).
– Supervision and support systems for midwives.
– Research and data analysis costs.
– Administrative and logistical expenses.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on qualitative research and provides insights into the challenges experienced by midwives in managing postpartum hemorrhage. However, the sample size is relatively small (18 midwives) and limited to a specific region (Limpopo province, South Africa). To improve the evidence, a larger sample size and a more diverse range of participants could be included to enhance the generalizability of the findings. Additionally, incorporating quantitative data or mixed methods could provide a more comprehensive understanding of the challenges and potential solutions for managing postpartum hemorrhage.

Background: Postpartum haemorrhage is one of the causes of the rise in maternal mortality. Midwives’ experiences related to postpartum haemorrhage (PPH) management remain unexplored, especially in Limpopo. The purpose of the study was to explore the challenges experienced by midwives in the management of women with PPH. Methods: Qualitative research was conducted to explore the challenges experienced by midwives in the management of women with PPH. Midwives were sampled purposefully. Unstructured interviews were conducted on 18 midwives working at primary health care facilities. Data were analysed after data saturation. Results: After data analysis, one theme emerged “challenges experienced by midwives managing women with PPH” and five subthemes, including: “difficulty experienced resulting in feelings of frustrations and confusion and lack of time and shortage of human resource inhibits guidelines consultation”. Conclusion: The study findings revealed that midwives experienced difficulty when managing women with postpartum haemorrhage. For successful implementation of maternal health care guidelines, midwives should be capacitated through training, supported and supervised in order to execute PPH management with ease.

The qualitative descriptive exploratory research design was used to describe the challenges experienced by midwives in the management of women with Post-Partum Haemorrhage (PPH). The reason for choosing this method was to obtain more information on how midwives managed women who experienced PPH. This study was conducted from the rural Primary Health Care (PHC) facilities of the two-selected district at Limpopo province. PPH was ranked number two amongst other preventable conditions responsible for maternal mortality rate in South Africa hence, the two districts had a high maternal mortality rate of 235 per 100 000 live birth caused by preventable conditions such as PPH. The population for this current study consisted of midwives with one-year of experience working at primary health care (PHC) facilities rendering maternal health care services. A non-probability, the heterogeneous purposive sampling method was used to sample participants who had the same characteristics desired to meet the objectives of the study from fourteen PHC facilities. These are midwives who are rendering maternal health care services and PHC facilities. Only midwives working at PHC facilities of the two selected districts of Limpopo province with one-year experience rendering maternal health care services were included in this study. The following midwives were excluded from these study: those who just qualified with less than one year in maternal health care settings but working at PHC level; those who are working at the hospitals and other districts in Limpopo province and those working in other provinces. An interview guide was constructed with one central question; “What are the challenges experienced in the management of women with PPH”, this question was followed by probing for more information on the management of women guided by the answers given by participants. The researcher conducted an in-depth face-to-face interview with the participants at their workplace, which lasted for 30–45 minutes depending on how participants expressed their management of women who experienced PPH. Data were collected from March to June 2017. Data were collected until saturation was reached by the eighteenth (18) participants. Field notes and voice recorders were used during data collection with the permission of participants. Data analysis began during data collection were similar information grouped together. The researcher transcribed each participant’s interview at the end of data collection and continue to analyse data using eight steps of Tesch’s open coding methods. The researcher (TIR) read all the transcripts, grouped similar ideas together as codes, send to (MSM & LM) to rechecked data again in order to categories new codes and finally themes and sub-themes were constructed with the help of the independent coder who was in agreement with the analysed data.11 Measures to ensure trustworthiness were applied where the researcher remained in the field for a long-time during data collection until data were saturated. Transcripts of analysed data were – submitted to the independent coder who further analysed the collected data. Datwas presented in (table 2) as two themes and five sub-themes. To ensure transferability, the researchers provided methodological evidence that the research study’s findings could be applicable to other contexts, situations, times, and populations.12. Themes and sub-themes indicating challenges faced by midwives in relation to the Management of PPH (n=18) Ethical clearance was obtained from the University of Venda (SHS/16/PBC/34/1910) and permission to conduct the study and was obtained from the Limpopo Provincial Department of Health (Ref: 4/2/2). District Executive managers granted the researchers permission to gain access and entry to PHC facilities at Vhembe and Mopani. Participants signed a consent form after all the procedures, the purpose of the study was explained to them. Information on withdrawal and refusal to participate was also explained. Confidentiality and anonymity were maintained by assigning a code to each participant.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can allow midwives to remotely consult with specialists and receive guidance on managing women with postpartum hemorrhage. This can help overcome the challenges of limited time and shortage of human resources inhibiting guidelines consultation.

2. Training and capacity building: Providing comprehensive training programs for midwives on the management of postpartum hemorrhage can enhance their skills and confidence in handling such cases. This can be done through workshops, simulation exercises, and ongoing professional development opportunities.

3. Supervision and mentorship: Establishing a system of regular supervision and mentorship for midwives can provide them with guidance, support, and feedback in managing women with postpartum hemorrhage. This can help ensure that they are executing PPH management effectively and with ease.

4. Mobile health (mHealth) applications: Developing mobile health applications specifically designed for midwives can provide them with access to up-to-date guidelines, protocols, and decision support tools for managing postpartum hemorrhage. These apps can also facilitate communication and collaboration among midwives and other healthcare providers.

5. Community-based interventions: Implementing community-based interventions, such as community health workers or trained volunteers, can help improve access to maternal health services in rural areas. These individuals can provide education, support, and referrals for women experiencing postpartum hemorrhage, ensuring timely and appropriate care.

It is important to note that these recommendations are based on the information provided and may need to be tailored to the specific context and resources available in the Limpopo province of South Africa.
AI Innovations Description
Based on the information provided, the recommendation to improve access to maternal health would be to focus on capacitating midwives through training, support, and supervision in order to enhance their ability to manage postpartum hemorrhage (PPH) effectively. This recommendation is based on the findings of the study, which revealed that midwives experienced difficulties in managing women with PPH. By providing midwives with the necessary knowledge, skills, and resources, they will be better equipped to handle PPH cases, ultimately improving maternal health outcomes.

To implement this recommendation, the following steps can be taken:

1. Develop and implement comprehensive training programs: Design training programs that specifically address the challenges identified in the study, such as difficulties in managing PPH, feelings of frustration and confusion, and lack of time and human resources for consulting guidelines. The training should focus on enhancing midwives’ knowledge and skills in PPH management, including early recognition, assessment, and appropriate interventions.

2. Provide ongoing support and supervision: Establish a system for ongoing support and supervision of midwives in PPH management. This can include regular check-ins, case discussions, and mentorship programs to ensure that midwives have the necessary guidance and resources to effectively manage PPH cases.

3. Strengthen healthcare infrastructure: Address the shortage of human resources and time constraints by advocating for increased staffing and resources at primary health care facilities. This can include hiring additional midwives, providing adequate equipment and supplies, and improving the overall infrastructure of the facilities.

4. Collaborate with stakeholders: Engage with relevant stakeholders, such as government health departments, professional associations, and non-governmental organizations, to garner support and resources for implementing the recommended interventions. Collaboration can help ensure the sustainability and effectiveness of the initiatives.

5. Monitor and evaluate the impact: Establish a monitoring and evaluation system to assess the impact of the interventions on maternal health outcomes. This can include tracking PPH rates, maternal mortality rates, and midwives’ knowledge and confidence in managing PPH. Regular evaluation will help identify areas for improvement and guide future interventions.

By implementing these recommendations, access to maternal health can be improved by strengthening the capacity of midwives to effectively manage PPH cases, ultimately reducing maternal mortality rates and improving overall maternal health outcomes.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Capacity Building: Provide training and support for midwives in the management of postpartum hemorrhage (PPH). This can include workshops, simulation exercises, and ongoing supervision to ensure that midwives have the necessary skills and knowledge to effectively manage PPH cases.

2. Guidelines Consultation: Address the challenges midwives face in accessing and consulting guidelines for PPH management. This can be done by ensuring that guidelines are easily accessible, user-friendly, and available in the local language. Additionally, providing adequate time and resources for midwives to consult guidelines during their work shifts can help improve their confidence and effectiveness in managing PPH.

3. Human Resource Allocation: Address the shortage of human resources by increasing the number of midwives in rural primary health care facilities. This can be achieved by recruiting and training more midwives, as well as providing incentives to encourage midwives to work in rural areas.

4. Supervision and Support: Implement a system of regular supervision and support for midwives to ensure that they receive guidance and feedback on their PPH management practices. This can be done through regular visits by experienced supervisors or through the use of telemedicine technologies for remote support.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify specific indicators that can measure the access to maternal health, such as the number of PPH cases managed by midwives, the time taken to initiate treatment, and the maternal mortality rate.

2. Collect baseline data: Gather data on the current state of access to maternal health, including the number of midwives, their training levels, and the challenges they face in managing PPH.

3. Introduce the recommendations: Implement the recommended interventions, such as capacity building programs, improved guidelines access, increased human resources, and supervision and support systems.

4. Monitor and evaluate: Continuously monitor the implementation of the recommendations and collect data on the identified indicators. This can be done through routine data collection, surveys, and interviews with midwives and other stakeholders.

5. Analyze the data: Analyze the collected data to assess the impact of the recommendations on access to maternal health. Compare the baseline data with the post-intervention data to identify any improvements or changes.

6. Adjust and refine: Based on the findings, make adjustments and refinements to the interventions as needed. This can include addressing any remaining challenges or scaling up successful strategies.

7. Repeat the process: Continuously repeat the monitoring and evaluation process to ensure ongoing improvement in access to maternal health.

By following this methodology, it will be possible to simulate the impact of the recommendations on improving access to maternal health and make evidence-based decisions for further interventions.


Statistics:
Citations: 3
Identifiers:
DOI: 10.4314/ahs.v21i1.40
ISSN: 16806905
Research Areas:
Health System and Policy, Maternal and Child Health, Quality of Care, Workforce
Study Countries:
South Africa
Study Design:
Cross Sectional Study, Exploratory Study, Grounded Theory
Study Approach:
Qualitative
Participants Gender:
Female
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