An Exploration of Midwives’ Experiences of Reducing Maternal Morbidity and Mortality From Postpartum Haemorrhage (PPH) in Rural Communities in Eastern Nigeria.

Abstract

Background Postpartum haemorrhage (PPH) is one of the major complications of childbirth which results in maternal morbidity and mortality especially in low and middle-income countries like Nigeria. Midwives play a vital role in preventing and managing PPH in Nigerian rural communities. The aim of this study is to understand the experiences of midwives in rural maternity care settings in order to provide appropriate support and improve practice. Methods An exploratory qualitative study of a purposive sample of 15 practicing midwives was carried out using semi-structured interviews from November 2018 to February 2019. Data were transcribed verbatim and analyzed using content analysis. Results Four themes were identified; intervention for preventing PPH, approaches to managing PPH, challenges of preventing and managing PPH, and ways of supporting midwives to overcome the challenges of preventing and managing PPH in rural health care settings. Midwives employed various strategies, such as antenatal education, diagnosis, and treatment of anaemia to prevent PPH. Their understanding of the condition as a life-threatening condition enabled the midwives to provide holistic and effective management that sometimes involved multidisciplinary team approach. However, inadequate resources and delay in seeking health care services militate against their efforts. The midwives also identified the need for continuing education and training as means of enhancing their standard of care. Conclusion These midwives in Nigerian rural health care setting engage in preventive practices and active management of PPH though not without barriers, such as inadequate resources. There is need for the midwives in rural areas to have cultural competence, be provided with adequate resources and participate in ongoing education to be more effective.