Caring as a Core Concept in Educating Midwifery Learners: A qualitative Study

Caring is the core business of nursing and midwifery; involving a relationship in which the carer is committed to the needs of the one being cared for (Mason-Whitehead; Mcintosh; Bryan et Mason). Caring is the emotion which drives a midwife to care; the motive aimed at assisting someone to grow and self-actualise (Watson). The concern in midwifery is that irrespective of caring being central to the midwifery profession; caring taught in theoretical learning does not always translate into caring behaviour in practice. A qualitative exploratory study examined how midwifery educators impart the skill of caring during theoretical learning and clinical accompaniment; in order to respond to the general complaint made both locally and internationally that midwives are uncaring. The aim was to explore caring during theoretical learning and clinical accompaniment from the perspective of midwifery educators. Participants in the study were midwifery educators teaching midwifery in institutions of learning in Tshwane; South Africa. The naive sketch was used to gather data; wherein one central question was asked and the educators were invited to narrate and respond. Three themes emerged: the meaning of caring; how caring was conveyed during theoretical learning; and how it was conveyed during clinical accompaniment. Although the midwifery educators expressed how they conveyed caring to the learner midwives; it was not evident how caring competencies were assessed in order to ensure caring midwives at the end of training

The Effect of Maternal HIV Status on Perinatal Outcome at Mowbray Maternity Hospital and Referring Midwife Obstetric Units; Cape Town

Objectives. To study the effect of maternal HIV status on perinatal outcome at Mowbray Maternity Hospital (a secondary-level hospital in Cape Town) and its satellite community midwife obstetric units. Design. A retrospective descriptive and comparative study.Setting. Public sector maternity facilities serving historically disadvantaged populations. Subjects. All deliveries at Mowbray Maternity Hospital and its referral midwife obstetric units from January to December 2008. Outcome measures. Stillbirth; early neonatal death; perinatal mortality and neonatal encephalopathy rates in HIV-positive and HIVnegative subjects. Results. There was a total of 18 870 deliveries at the units studied; 3 259 (17.2) of them to HIV-positive mothers. The stillbirth rate in the HIV-positive population was 17.1/1 000 births; compared with 8.3/1 000 in the HIV-negative population (odds ratio (OR); 2.07; 95 confidence interval (CI) 1.5 - 2.8). The early neonatal death rate in the HIV-positive population was 4.6/1 000 live births; compared with 3.1/1 000 in the HIV-negative population (OR 1.46; 95 CI 0.8 - 2.6). The perinatal mortality rate in the HIV-positive population was 21.7/1 000 births; compared with 11.7 in the HIV-negative population (OR 1.91; 95 CI 1.4 - 2.5). A comparison of the pattern of primary obstetric causes of perinatal mortality showed that infection; intra-uterine growth restriction (IUGR) and antepartum haemorrhage (APH) were significantly more common as causes for perinatal death in the HIV-positive population. The risk of neonatal encephalopathy in the HIV-exposed population was 4.9/1 000 live births compared with 2.07 in the HIV-negative group (OR 2.36; 95 CI 1.28 - 4.35). The 1 643 women (8.7 of total deliveries) who were not tested for HIV were at particularly high risk of adverse perinatal outcome. This group included women who had either declined testing or not attended for antenatal care. Conclusion. The perinatal mortality rate in the group of HIV-exposed mothers was significantly higher than that in the HIV-negative group due to a higher stillbirth rate. Infection; IUGR and APH were significantly more common obstetric causes for mortality in the HIV-infected population. The risk of neonatal encephalopathy was also significantly higher in the HIV-positive population

Grand Multiparity: Obstetric Performance in Aminu Kano Teaching Hospital; Kano; Nigeria

Objective: The objective was to review the obstetric performance of booked grand multiparae. Design and Setting: A 5-year prospective observational study of cases between January 1; 2002; and December 31; 2006; was conducted in Aminu Kano Teaching Hospital; a tertiary institution; in Kano; Nigeria. Materials and Methods: The antenatal complications and pregnancy outcomes among booked grand mulitparous women (pregnancy after fifth delivery); who delivered in our labor ward; were compared with those of the booked mulitparae (parae 1-4) who delivered immediately after a grand multipara. Outcome Measures: These were obstetric factors of maternal age and parity; antepartum hemorrhage; fetal malpresentations; and multiple pregnancy. Medical complications were gestational diabetes; hypertension; anemia; and heart disease. Pregnancy outcomes measured were gestational age at delivery; birth weight; mode of delivery; postpartum hemorrhage; and maternal and perinatal mortality. Results: The age range of the grand multiparae was between 22 and 43 years; with a mean age of 29.72 + 2.07 years. The parity range was between 5 and 15; with a mean parity of 7.78 + 0.63. There was increased occurrence of gestational diabetes mellitus (OR = 12.55; CI = 6.72-23.91); hypertension (OR = 3.07; CI = 2.07-4.59); heart disease (OR = 2.01; CI = 0.70-6.08); anemia (OR = 3.16; CI = 1.42-7.24); antepartum hemorrhage (OR = 2.18; CI = 1.22-3.92); fetal malpresentations (OR = 3.04; CI = 2.38-3.88); cephalopelvic disproportion (OR = 2.09; CI = 1.33-3.29); and fetal macrosomia (OR = 2.27; CI = 1.72-3.00) among the grand multiparae compared with multiparae. Conclusion: The effects of these complications were minimized by good antenatal care

Midwives' Experiences of Managing Women in Labour in the Limpopo Province of South Africa

Introduction:The objective of this study was to explore and describe the experiences of midwives managing women during labour at a tertiary care hospital in the Limpopo Province. An exploratory; descriptive; contextual and inductive design was applied to this qualitative research study. Purposive sampling was used to select midwives who were working in the childbirth unit and had managed women during labour. A sample of 12 midwives participated in this study. Data were collected by means of unstructured individual interviews and analysed through an open coding method by the researchers and the independent co-coder. Findings: Categories identified were lack of mutual participation and responsibility sharing; dependency and lack of decision-making; lack of information-sharing; empowering autonomy and informed choices opportunities; lack of open communication and listening; non-accommodative midwifery actions; and lack of human and material infrastructure. To ensure the validity of the results; criteria to measure trustworthiness were utilized. Conclusions: This study has implications for woman-centered care by midwives managing women in labour and provides appropriate guidelines that should be integrated into the Batho-Pele Principles

Woman - centered postabortion care: reference manual

Composed of 13 modules; this reference manual - that offers a comprehensive approach focused on the woman's needs - serves as the learner's guide for a state-of-the-art curriculum on postabortion care that includes the companion publication; woman-centered postabortion care. It essentially aims to prepare health care workers to provide women with high-quality postabortion care services