Objective:The purpose of this study was to explore the perceptions of women about childbirth experiences at the birthing centers (BCs) in Karachi, Pakistan.Design:A qualitative descriptive exploratory approach was employed using semistructured interviews.Participants:A purposive sample of eight women who had used BCs was enrolled from each site.Findings:Five themes emerged from content analysis including: (a) satisfaction with BC, (b) provision of homely environment, (c) promotion of normalcy, (d) facilitation of family support, and (e) protection of privacy.Key Conclusions:Overall, the findings of the study revealed that women who used BCs were satisfied with the services and the environment provided to them by the midwives during the antenatal, intranatal, and postnatal periods. Most of the women appreciated the privacy offered at the BCs. They considered BCs as a safe, accessible, and affordable option for childbirth and encouraged others in the community to opt for it.Implications for Practice:The findings of this study may help to advocate for births at BCs and provide women-friendly maternity care, by giving choice and control to women during childbirth, providing comfort to women by using fewer medical interventions, and promoting normalcy by attending spontaneous vaginal delivery.

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Aims: To explore the perceptions of community midwives about their work experiences after deployment in the rural settings of Chitral, Khyber Pakhtunkhwa, Pakistan. Methods: A qualitative descriptive approach was used, conducting in-depth semi-structured interviews with 13 community midwives. Findings: The three major themes that emerged from the analysis of the data were: (1) rural community midwives' perceptions of their role and competencies, (2) factors facilitating and hindering the rural community midwives' ability to function, and (3) continuation of community midwives' services in the future. Conclusions: The study findings highlighted the factors that empower and obstruct community midwives in providing services in rural areas. The majority of the community midwives felt empowered because of their increased earning capacity and enhanced competencies in performing their roles. However, some of them shared challenges in terms of socio-cultural and financial constraints. These findings have important implications for midwives working in rural areas.

Background Birth asphyxia is one of the significant causes of neonatal deaths in Pakistan. Poor newborn resuscitation skills of birth attendants are a major cause of neonatal mortality in low resource settings across the globe. This study aimed to evaluate the effectiveness of the Simulation-Based High-Frequency training of the Helping Babies Breathe for Community Midwives (CMW), in district Gujrat, Pakistan. Method A pre-post-test interventional study design was used. The universal sampling technique was employed to recruit 50 deployed CMWs in the entire district of Gujrat. The pre-tested module and tools of Helping Babies Breathe (2nd edition) were used in the intervention. Using the High Frequency training approach, three one-day training sessions were conducted for CMWs at an interval of 2 months. During the 2 months interval, participants were monitored and supported to practice their skills at their birthing centers. Knowledge and skills were assessed before and after each session. The McNemar and Cochran’s Q tests were applied for data analysis. Participants’ feedback was also obtained at the end of each training, which was analyzed through descriptive statistics. Results Data from 34 CMWs were analyzed as they completed all three training sessions and assessments. The results were statistically different after each training session for OSCE B (p-value < 0.05). However, for knowledge and OSCE A, significant improvement was observed after training sessions 1 and 2 only. Pairwise comparison showed that pre-assessment at training 1 was significantly different from most of the repeated measures of knowledge, OSCE A, and OSCE B. Moreover, the learners appreciated the overall training in terms of organization, content, material, assessment, and overall competency. Additionally, due to a small sample size of the CMWs, and a short time of the intervention, significant differences in morbidity and mortality outcomes could not be detected. Conclusion The study concluded that a series of training and continuous supportive supervision and facilitation enhances Helping Babies Breathe (HBB) knowledge retention and skills. The study recommends, periodic, structured and precise HBB trainings, with ongoing quality monitoring activities through blended learning modalities would help sustain and scale-up the intervention.

Each year around 529,000 women die worldwide due to harmful consequences of childbirth in developing countries. Thus, this study aimed to explore barriers and facilitators that influence the provision of quality care during labor at maternity centers of Karachi, Pakistan. The qualitative exploratory study design was used to explore such factors from public and private maternity health facilities of Karachi, Pakistan. In-depth interviews were conducted through purposive sampling by using validated semi-structured interview guide. Data was analyzed using content analysis manually. Among major barriers; unhygenic environment, lack of basic equipment, supplies and medicine, unprofessional attitude of staff, physical infrastructre and  shotrage of staff were explored. Among facilitators; Caring and supportive attitude of healthcare personnel during labor were identified. Continuous...