Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments

Homer, Caroline; Turkmani, Sabera; Wilson, Alyce N.; Vogel, Joshua P.; Shah, Mehr Gul; Fogstad, Helga; Langlois, Étienne V

doi:10.1136/bmjgh-2021-006872

Cited by 22 publications

(34 citation statements)

References 49 publications

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“…Staff shortage has existed for many decades and harms the quality of care. Miseda et al (29) concur with the study's ndings and indicate that the shortage of healthcare workers has signi cantly restrained the realisation of healthassociated Millennium Development Goals (MDG). A shortage of midwives is a severe obstacle to providing quality maternal and child health services (30).…”

Section: Themes and Sub-themessupporting

confidence: 56%

Midwives’ perceptions regarding clinical support by nursing managers in a Tshwane hospital

Jantjies,

Zenani,

Serapelwane

2024

Preprint

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Background Despite the benefits of support on the quality of maternal care, there is a general lack of support, which proved to have a less desired effect on the level of quality care within maternal units. To ensure the midwives operate to a high standard to ensure quality and patient safety in maternal care, support from the nursing managers creates a positive psychological environment to cope and manage themselves in the complex nature of the maternity unit. The study aimed to explore and describe midwives' perceptions regarding clinical support by nursing managers in a Tshwane hospital. The study described recommendations regarding the kind of clinical support required by midwives from the nursing managers in rendering maternal care. Methods The study used Qualitative, explorative, descriptive, and contextual research design to achieve the aim and objectives. The study used purposive sampling to select participants with insight and experience on the phenomenon. Before conducting the research, the researcher sought ethical permission from the NuMIQ research focus area and the North-West University Health Research Ethics Committee. Unstructured, in-depth individual interviews were conducted to collect data. Data was analysed using thematic analysis. Results Four themes emerged from the findings of this study, namely challenges related to lack of resources, emotional distress, lack of support, and recommended measures for support. Conclusion Quality and patient safety in maternity care is dependent on comprehensive clinical support for the midwives. Therefore, clinical support from the nursing managers enables the midwives to mitigate the challenges experienced in maternity units. Moreover, clinical support from nursing managers limits emotional distress and physical burnout that contributes to poor mental health and lack of job satisfaction in midwives. Those factors predispose the attrition rate of midwives and lead to the occurrence of adverse events in maternal care, which affects the well-being of patients in the maternity units. Therefore, there is a need for midwives to receive clinical support from nursing managers.

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Section: Themes and Sub-themessupporting

confidence: 56%

Midwives’ perceptions regarding clinical support by nursing managers in a Tshwane hospital

Jantjies,

Zenani,

Serapelwane

2024

Preprint

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 99%

“…Globally, research has shown that midwives are not yet adequately utilized in humanitarian crises; therefore, guidelines and strategies are urgently needed to incorporate the scope of midwifery practice in providing essential and lifesaving SRHR services. 23,24 In the aftermath of severe flooding in Bangladesh, this project demonstrated a successful SRHR service delivery mechanism through deploying midwives in the rural health facilities. It demonstrated how health systems can be made resilient to climate-induced natural disasters by the systematic deployment of midwives to the lowest-tier health centers closest to the communities, allowing them to champion and safeguard uninterrupted SRHR for women and girls.…”

Section: Summary and Recommendationsmentioning

confidence: 99%

Responding to Humanitarian Crises: Midwifery Care in Bangladesh

Purno

Biswas

Anderson

et al. 2023

J Midwife Womens Health

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Sexual and reproductive health and rights (SRHR) is often a neglected topic of intervention in humanitarian crises despite its wide‐ranging impact on women and girls’ well‐being. Increasing frequency of climate‐induced natural disasters calls for an urgent need to identify innovative practices for sustainable and effective humanitarian preparedness and response to ensure SRHR of affected populations. One such innovation is the empowerment of midwives in disaster response program planning and implementation. This article describes how midwives deployed to rural primary health centers provided quality SRHR services, particularly for labor and birth assistance and initial management of perinatal emergencies and referral in the aftermath of the 2022 flooding in northern and northeastern Bangladesh. Supportive supervision from physicians, adequate health care logistics and supplies, and administrative support from local health authorities created an enabling environment for the midwives. Community engagement through volunteers helped build rapport with residents and allowed patients to navigate health services. Deploying midwives as a response to climate‐induced natural disaster was successful in establishing quality SRHR services. Future recommendations include systematically deploying midwives in health centers closest to the communities in locations vulnerable to climate change as part of routine health service delivery. This innovative approach clearly demonstrated that utilization of midwives during and after natural disasters could build community and health system resilience to climate change.

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“…Providing midwives with refresher training and opportunities for clinical simulation of emergencies and rare cases can be an effective technique to enhance skill performance ( 22 ). Moreover, supportive supervision of midwives also plays a pivotal role in improving the quality of care ( 23 ). One study with village midwives in Sudan found that consistent and sufficient supervision in conjunction with follow-up improved their skills and knowledge ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“Midwives are heroes of the country”: qualitative evaluation of a midwifery education program in South Sudan

Perera,

Isa,

Sebushishe

et al. 2023

Front. Glob. Womens Health

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BackgroundCountries affected by armed conflict have higher maternal mortality than stable settings. South Sudan has one of the highest maternal mortality ratios in the world, with an estimated 789 maternal deaths per 100,000 live births. Long-term socio-political instability has contributed to significant challenges in its health system. To reduce maternal and newborn morbidity and mortality, South Sudan must increase the number of skilled midwives.MethodsA cross-sectional mixed methods study was conducted in 2022 to assess the midwifery education program at three schools receiving support from International Medical Corps in South Sudan, including in-depth interviews with 15 midwifery school graduates currently working as midwives, their supervisors, 16 school faculty (in dyads), and two Ministry of Health officials; and nine focus group discussions with women clients of graduate midwives.ResultsParticipants identified strengths of the schools, including being well equipped with trained and competent teaching staff, competency-based curriculum, including practical training which prepared graduate midwives to apply their skills in practice. Weaknesses of the program included its dependence on donor funding, inadequate mentorship and number of tutors, and insufficient practice for some services due to low client load at clinical sites. Additionally, participants identified challenges affecting midwives' ability to provide good quality care, including lack of equipment and supplies, low client load, low salaries, and insecurity due to conflict. Nevertheless, women in the community appreciated the immense work that midwives do. Midwives were respected by the community at large, and graduates expressed pride and satisfaction in their job, as well as the positive impact they have had in providing critical services to communities.DiscussionOverall, the quality of the midwifery education program appears to be strong, however gaps in the program and the provision of quality care remain. The findings highlight the need to ensure sustained funding for midwifery education, as well as health system strengthening to ensure midwives can practice their skills. Continued investment in midwifery education and training is critical to reduce high maternal mortality and morbidity in South Sudan.

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Enhancing quality midwifery care in humanitarian and fragile settings: a systematic review of interventions, support systems and enabling environments

Cited by 22 publications

References 49 publications

Midwives’ perceptions regarding clinical support by nursing managers in a Tshwane hospital

Midwives’ perceptions regarding clinical support by nursing managers in a Tshwane hospital

Responding to Humanitarian Crises: Midwifery Care in Bangladesh

“Midwives are heroes of the country”: qualitative evaluation of a midwifery education program in South Sudan

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