ABSTRACT
BACKGROUND: Women of childbearing age feel great about giving birth, but the pain could be excruciating depending on their pain tolerances. Midwives requires obstetrical knowledge and skills such as pain management during labour and safety. We explored midwives' perspectives on the utilisation of pharmacological pain alleviation interventions during labour in selected hospitals in Matjhabeng Municipality, Free State province, South Africa. A qualitative study was undertaken, involving a sample of ten midwives, using a semi-structured interview guide. The interviews were audio-recorded and transcribed verbatim. Tesch's open coding data analysis method was applied to analyse the data. The midwives were restricted to use Pethidine and Phenergan prescribed by doctors for labour pain relief, which disrupted labour pain management and obliged them either to wait for a physician or follow telephone instructions. According to the midwives, women taking Pethidine and Phenergan encountered adverse effects and discomfort. Midwives identified high workload, inadequate personnel, lack of skill and knowledge, lack of medication availability, and lack of infrastructure as the primary challenges of administering pharmacological methods to women in labour. The lack of standing orders, which delays the administration of medications pending a physician's prescription, constituted an additional difficulty. In the instance that Pethidine and Phenergan were unavailable or ineffective for some women, the midwives recommended that women be administered alternative pharmacological pain relievers. They also advocated for institutionalization of pharmacological guidelines allowing them to use their discretion when treating labour pain. Midwives can only utilise a few standardised and regulated pharmacological medications for labour pain management. The midwives' ability to administer pharmacological pain relief during labour was hampered by a high workload burden, insufficient staff, lack of skill and understanding, drug unavailability, and inadequate infrastructure. Midwives advocated for supported guidelines that would allow them to treat labour pain at their discretion. Intersectoral stakeholders are required to improve midwife skills and attitudes. Health facilities need to train and supply analgesics to midwives. Midwives ought to be familiar with pharmacological pain relievers.
ABSTRACT
BACKGROUND: Midwives have a strategic role to inform, educate, and encourage pregnant women to maintain an active lifestyle during pregnancy. AIM: This study explored a cohort of midwives' perspectives on providing prenatal physical activity education and counseling during pregnancy. SUBJECTS AND METHODS: Seventeen midwives participated in semistructured interviews which were audio-recorded and transcribed verbatim. A thematic analysis approach was applied to the transcribed qualitative data. RESULTS: Midwives rarely provide physical activity education and counseling to pregnant women, citing lack of knowledge on which physical activity to recommend, and the duration and intensity of the physical activity as reasons. Walking is the only physical activity recommended during antenatal sessions. Barriers to providing physical activity education and counseling include shortage of midwives, busy work responsibilities, nonavailability of exercise equipment, and nonprioritization of antenatal physical activity. The midwives also cited overwhelming work responsibilities resulting in extreme fatigue rendering them hardly able to counsel the women. They advocated for the introduction of exercise classes in antenatal health care and the training of midwives on exercises to improve the uptake of midwives' knowledge regarding prenatal exercise and their engagement with pregnant women during antenatal consultations. CONCLUSIONS: The midwives lacked knowledge of physical activity during pregnancy and rarely provided such education and counseling. They advocated the need for training and workshops on maternal physical activity. Our findings suggest that physical activity should be integrated into the midwifery/nursing curriculum to empower midwives and other health providers to offer evidence-based physical activity education and counseling to women during antenatal health care as part of the primary health-care service.
