Midwives' lived experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini: a qualitative study.

BACKGROUND: Midwives encounter various difficulties while aiming to achieve excellence in providing maternity care to women with mobility disabilities. The study aimed to explore and describe midwives' experiences of caring for women with mobility disabilities during pregnancy, labour and puerperium in Eswatini. METHODS: A qualitative, exploratory, descriptive, contextual research design with a phenomenological approach was followed. Twelve midwives working in maternal health facilities in the Hhohho and Manzini regions in Eswatini were interviewed. Purposive sampling was used to select midwives to participate in the research. In-depth phenomenological interviews were conducted, and Giorgi's descriptive phenomenological method was used for data analysis. RESULTS: Three themes emerged from the data analysis: midwives experienced physical and emotional strain in providing maternity care to women with mobility disabilities, they experienced frustration due to the lack of equipment to meet the needs of women with mobility disabilities, and they faced challenges in providing support and holistic care to women with mobility disabilities during pregnancy, labour and puerperium. CONCLUSIONS: Midwives experienced challenges caring for women with mobility disabilities during pregnancy, labour and the puerperium in Eswatini. There is a need to develop and empower midwives with the knowledge and skill to implement guidelines and enact protocols. Moreover, equipment and infrastructure are required to facilitate support and holistic maternity care for women with mobility disabilities.

Guidelines for value-sensitive clinical accompaniment in community health nursing.

AIM: The goal of the first part of the study was to explore and describe the experiences of students with regard to value-sensitive clinical accompaniment in community nursing. The purpose of phase two of the research and of this article was to develop guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses in community nursing BACKGROUND: Undergraduate students have reported that owing to different cultures and values, value conflicts are experienced during clinical accompaniment, which affects clinical learning in community nursing negatively. METHOD: A qualitative, exploratory and descriptive research design was done in a specific context; guidelines were formulated as a result of the findings in phase 1. Once the guidelines were formulated the guidelines were validated and refined by presenting them to a panel of experts for validation. The accessible population was experts in the field of community health nursing and the participants that were conveniently selected were asked to validate the guidelines. RESULTS: Three main categories were identified, namely, respect during clinical accompaniment, value-sensitive communication and sensitivity to quality of clinical accompaniment. The validated and refined guidelines were described. CONCLUSION AND IMPLICATIONS FOR NURSE MANAGERS: Guidelines for value-sensitive clinical accompaniment of student nurses by professional nurses as experts in community nursing should be implemented by nurse managers as they are important in any relationship to set the climate for both personal and professional wellbeing.

Women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini.

Background: People living with disabilities are often women and the elderly and those from low-income families. There is paucity in research on women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini. Aim: To explore and describe women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium in Eswatini. Setting: The study was conducted in the Hhohho and Manzini regions in Eswatini, between March 2019 and July 2019. Methods: A qualitative, exploratory, descriptive and contextual research design was followed. Purposive sampling and snowballing techniques were used to sample women with mobility disabilities to participate in the research. Individual interviews were conducted, and Giorgi's method of data analysis was used. Results: Women with mobility disabilities experienced midwives as being brutal, unsupportive and judgemental. In addition, participants reported several maternity care challenges related to a lack of protocol and infrastructure, and they needed to be cared for by experienced midwives during pregnancy, labour and puerperium. Conclusion: Women with mobility disabilities experienced various challenges during pregnancy, labour and puerperium in Eswatini. There is a need to develop guidelines to facilitate support and holistic maternity care for these women. Contribution: The study contributed to the scientific knowledge of women with mobility disabilities' experiences of maternity care during pregnancy, labour and puerperium.

Experience of midwives in providing care to labouring women in varied healthcare settings: A qualitative study.

BACKGROUND: Midwives are essential to timely, effective, family-centred care. In South Africa, patients have often expressed dissatisfaction with the quality of midwifery care. Negative interpersonal relationships with caregivers, lack of information, neglect and abandonment were consistent complaints. Less is known about how midwives experience providing care. AIM: This research explored and described the experiences of midwives in providing care to labouring women in varied healthcare settings. SETTING: Midwives practicing in the Gauteng province, South Africa, in one of three settings: private hospitals, public hospitals or independent maternity hospital. METHODS: A convenience sample of midwives (N = 10) were interviewed. An exploratory and descriptive design, with individual semi-structured interviews conducted, asked a primary question: 'How is it for you to be a midwife in South Africa?' Transcribed interviews were analysed using thematic coding. RESULTS: Five themes were found: proud to be a midwife, regulations and independent function, resource availability, work burden and image of the midwife. CONCLUSION: Midwives struggle within systems that fail to allow independent functioning, disallowing a voice in making decisions and creating change. Regardless of practice setting, midwives expressed frustration with policies that prevented utilisation consistent with scope of practice, as well as an inability to practice the midwifery model of care. Those in public settings expressed concern with restricted resource appropriation. Similarly, there is clear need to upscale midwifery education and to establish care competencies to be met in providing clinical services. CONTRIBUTION: This research provides evidence of the midwifery experience with implications for needed health policy change.

Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe.

BACKGROUND: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% - 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases. AIM: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV. SETTING: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe. METHODS: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed. RESULTS: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support. CONCLUSIONS: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV.

Birth stories from South Africa: Voices unheard.

BACKGROUND: The manner that birth events unfold can have a lasting impact on women. Giving voice to women's experiences is key in the creation of care that embodies humanistic, family-centred service. AIM: The aim of this research was to describe the experiences of women receiving care during childbirth. METHODS: The design was qualitative and descriptive using thematic analysis to analyse women's birth stories. A purposive sample of women (N=12) who had recently given birth in South Africa was selected. Participants were recruited who had delivered across a variety of settings: public, private, and maternity hospital, as well as at home. Data were collected using in-depth interviews and field notes. FINDINGS: Four themes were noted: cocoon of compassionate care, personal regard for shared decision-making, beliefs about birth, and protection. Themes demonstrated both caring and non-caring behaviours including feelings of sadness, loneliness and being unwanted, being scared and uncertain, and overall dissatisfaction with the birth experience. Irrespective of setting, patients felt the absence of shared decision-making; the exception was where care was with midwives in an independent maternity hospital or at home. DISCUSSION: A period of high vulnerability, birth is often met with care perceived as non-caring and lacking in compassion. Many women reported failure to be included as a partner in decision-making where birth occurred in private or public hospital settings. Where a midwifery model of care was in place, experiences were uniformly positive. CONCLUSIONS: Fundamental change is needed in midwifery education and scope of practice, with overhaul of health system resourcing.

Reconceptualising failure to rescue in midwifery: a concept analysis.

AIM: to reconceptualise the concept of failure to rescue, distinguishing it from its current scientific usage as a surveillance strategy to recognise physiologic decline. BACKGROUND: failure to rescue has been consistently defined as a failure to save a patient׳s life after development of complications. The term, however, carries a richer connotation when viewed within a midwifery context. Midwives have historically believed themselves to be the vanguards of normal, physiologic processes, including birth. This philosophy mandates careful consideration of what it means to promote normal birth and the consequences of failure to rescue women from processes which challenge that outcome. DATA SOURCES: the Medline, CINAHL, PsycINFO, PubMED, Web of Science and Google Scholar databases were searched from the period of 1992-2014 using the key terms of concept analysis, failure-to-rescue, childbirth, midwifery outcomes, obstetrical outcomes, suboptimal care, and patient outcomes. English language reports were used exclusively. The search yielded 45 articles which were reviewed in this paper. REVIEW METHOD: a critical analysis of the published literature was undertaken as a means of determining the adequacy of the concept for midwifery practice and to detail how it relates to other concepts important in development of a conceptual framework promoting normal birth processes. FINDINGS: failure to rescue within the context of the midwifery model of care requires robust attention to a midwifery managed setting and surveillance based on a caring presence, patient protection, and midwifery partnership with patient. CONCLUSION: clarifying the definition of failure to rescue in childbirth and defining its attributes can help inform midwifery providers throughout the world of the ethical importance of considering failure to rescue in clinical practice. Relevance to midwifery care mandates use of failure to rescue as both a process and outcome measure.