1. Listening to Midwives
Barbara Hanrahan
Department of Nursing Education

2. Phase 1 (Experts) Mothers interviews Midwives narrative sketches
Midwives nominal groups
Integrated literature review
(Experts)
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WITS DEPARTMENT OF NURSING EDUCATION

3. 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.
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WITS DEPARTMENT OF NURSING EDUCATION

4. 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.
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WITS DEPARTMENT OF NURSING EDUCATION

5. WITS DEPARTMENT OF NURSING EDUCATION
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6. WITS DEPARTMENT OF NURSING EDUCATION
Listening to Midwives
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7. WITS DEPARTMENT OF NURSING EDUCATION
Narrative Sketches
Midwives wrote freely without prompts Their experience of respectful maternity care Mothers, midwives and management / facility
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8. 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
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WITS DEPARTMENT OF NURSING EDUCATION

9. WITS DEPARTMENT OF NURSING EDUCATION
5 Themes
Midwives’ Supportive Behaviors Work Environment Staff Shortages Health System Failures Client Related Factors
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WITS DEPARTMENT OF NURSING EDUCATION

10. 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 “
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11. 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”
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WITS DEPARTMENT OF NURSING EDUCATION

12. 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
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WITS DEPARTMENT OF NURSING EDUCATION

13. 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.”
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WITS DEPARTMENT OF NURSING EDUCATION

14. 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.”
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WITS DEPARTMENT OF NURSING EDUCATION

15. 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”
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WITS DEPARTMENT OF NURSING EDUCATION

16. 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.
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17. Challenge for today Find WAYS to OVERCOME disrespect and abuse
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18. Groups Flip chart paper plus pens BRAINSTORM
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19. Circle key words Discussion Summary
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20. WITS DEPARTMENT OF NURSING EDUCATION
I pledge to facilitate positive childbirth experiences with the women I care for as a midwife
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WITS DEPARTMENT OF NURSING EDUCATION

21. Thank You Contact Details: Researcher: barbara.hanrahan@wits.ac.za
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WITS DEPARTMENT OF NURSING EDUCATION