The challenge of preparing and enabling ‘skilled attendants’ to promote safer childbirth

Maclean, Gaynor D.

doi:10.1016/s0266-6138(03)00036-6

Cited by 25 publications

(19 citation statements)

References 10 publications

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“…This process requires both a skilled attendant and an enabling environment. An enabling environment has been described as one that provides supportive regulation, policies and infrastructure, communication, referral, logistics, and supplies, inputs that are necessary for a skilled attendant to provide care (Maclean 2003). A joint statement from the World Health Organization, the International Confederation of Midwives, and the International Federation of Gynecology and Obstetrics defines a skilled birth attendant as an "accredited health professional such as a midwife, doctor or nurse that is trained to proficiency and has the necessary skills to manage a normal pregnancy, childbirth and provide postnatal care as well as the skills to detect, manage and refer any complications in the mother and neonate" (WHO 2004).…”

Section: Introductionmentioning

confidence: 99%

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Munabi‐Babigumira

Glenton

Lewin

et al. 2017

Cochrane Database of Systematic Reviews

160

163

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BackgroundIn many low- and middle-income countries women are encouraged to give birth in clinics and hospitals so that they can receive care from skilled birth attendants. A skilled birth attendant (SBA) is a health worker such as a midwife, doctor, or nurse who is trained to manage normal pregnancy and childbirth. (S)he is also trained to identify, manage, and refer any health problems that arise for mother and baby. The skills, attitudes and behaviour of SBAs, and the extent to which they work in an enabling working environment, impact on the quality of care provided. If any of these factors are missing, mothers and babies are likely to receive suboptimal care.ObjectivesTo explore the views, experiences, and behaviours of skilled birth attendants and those who support them; to identify factors that influence the delivery of intrapartum and postnatal care in low- and middle-income countries; and to explore the extent to which these factors were reflected in intervention studies.Search methodsOur search strategies specified key and free text terms related to the perinatal period, and the health provider, and included methodological filters for qualitative evidence syntheses and for low- and middle-income countries. We searched MEDLINE, OvidSP (searched 21 November 2016), Embase, OvidSP (searched 28 November 2016), PsycINFO, OvidSP (searched 30 November 2016), POPLINE, K4Health (searched 30 November 2016), CINAHL, EBSCOhost (searched 30 November 2016), ProQuest Dissertations and Theses (searched 15 August 2013), Web of Science (searched 1 December 2016), World Health Organization Reproductive Health Library (searched 16 August 2013), and World Health Organization Global Health Library for WHO databases (searched 1 December 2016).Selection criteriaWe included qualitative studies that focused on the views, experiences, and behaviours of SBAs and those who work with them as part of the team. We included studies from all levels of health care in low- and middle-income countries.Data collection and analysisOne review author extracted data and assessed study quality, and another review author checked the data. We synthesised data using the best fit framework synthesis approach and assessed confidence in the evidence using the GRADE-CERQual (Confidence in the Evidence from Reviews of Qualitative research) approach. We used a matrix approach to explore whether the factors identified by health workers in our synthesis as important for providing maternity care were reflected in the interventions evaluated in the studies in a related intervention review.Main resultsWe included 31 studies that explored the views and experiences of different types of SBAs, including doctors, midwives, nurses, auxiliary nurses and their managers. The included studies took place in Africa, Asia, and Latin America.Our synthesis pointed to a number of factors affecting SBAs’ provision of quality care. The following factors were based on evidence assessed as of moderate to high confidence. Skilled birth attendants reported that they were not always...

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Section: Introductionmentioning

confidence: 99%

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Munabi‐Babigumira

Glenton

Lewin

et al. 2017

Cochrane Database of Systematic Reviews

160

163

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“…There is no regulatory framework guiding their practices or protecting them in case of liability, however, nor do the midwives have a certified registration. According to Maclean (2003) this is not uncommon in countries struggling with high maternal and perinatal mortality, but the lack of supportive frameworks may prevent development of professional practice during childbirth.…”

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confidence: 99%

Mozambican Midwives' Views on Barriers to Quality Perinatal Care

Pettersson

Johansson

Pelembe

et al. 2006

Health Care for Women International

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Our purpose in this study was to explore the midwives' perception of factors obstructing or facilitating their ability to provide quality perinatal care at a central labor ward in Maputo. In-depth interviews were undertaken with 16 midwives and were analyzed according to grounded theory technique. Barriers to provision of quality perinatal care were identified as follows: (i) the unsupportive environment, (ii) nonempowering and limited interaction with women in labor, (iii) a sense of professional inadequacy and inferiority, and (iv) nonappliance of best caring practices. A model based on the midwives' reflections on barriers to quality perinatal care and responses to these were developed. Actions aimed at overcoming the barriers were improvising and identifying areas in need of change. Identified evading actions were holding others accountable and yielding to dysfunction and structural control. In order to improve perinatal care, the midwives need to see themselves as change agents and not as victims of external and internal causal relationships over which they have no influence. It is moreover essential that the midwives chose actions aiming at overcoming barriers to quality perinatal care instead of choosing evading actions, which might jeopardize the health of the unborn and newborn infant. We suggest that local as well as national education programs need to correspond with existing reality, even if they provide knowledge that surpasses the present possibilities in practice. Quality of intrapartum and the immediate newborn care requires a supportive environment, however, which in the context of this study presented such serious obstacles that they need to be addressed on the national level. Structural and administrative changes are difficult to target as these depend on national organization of maternal health care (MHC) services and national health expenditures.

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“…For sustainability of the effect of this training program, we need a strong infra structure and effective midwives as highlighted by Maclean who showed the importance of the three "Es (education, environment and effectiveness)" of skilled attendance at birth: the education of the skilled attendant, the environment in which she practices and the effectiveness of the skilled attendant, as supported by O'Heir [23,24] who concluded that Midwifery education for safe motherhood was relevant and easy to use, but will not be applied because of weaknesses in the health system infrastructure.…”

Section: Item Applied Mean Differencementioning

confidence: 99%

Impact of Universal Precautions Training Program on Nurse Midwives Performance during Labor in Khartoum State—Sudan 2006-2009

Taha¹

2014

UCMS

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Abstract:Objective: evaluate the effect of training program on the nurse midwives performance during the process of labor to prevent HIV (Human immunodeficiency virus) transmission. Methods: the study utilized quazi-experimental design to elicit the effect of training program on the NMs (nurse/midwives) practices to prevent HIV transmission. An educational program drawn from six selected hospitals through stratified cluster random sampling method in universal precautions for nurse/ midwives was developed, implemented, and assessed (n = 180). Official permission was obtained from the institutions and consent from participants. The study was implemented in three phases, pre-training base line assessment using a structured interview questionnaire to assess the knowledge, attitudes and practices towards HIV infection and prevention. Observation check list to assess application of universal precautions during the process of labor (two paths pre and post intervention). Training program is offered to participants and they were re-evaluated after six months. Results: universal precautions application scores increased significantly after training from 40.9%-52.2% (P < 0.005). General NMs level of knowledge towards HIV infection and prevention were higher than 80% and 70%, respectively and their attitude level were higher than 60%. The study showed a high rate (> 80%) of needle stick injuries among nurse midwives which may prone them to HIV infection. Conclusion: training program is effective in increasing nurse midwives application of universal precautions. NMs were highly knowledgeable, and their attitudes were fairly appropriate. Recommendation resources needed for practice should always be made available, and creation of a body to supervise application of universal infection control precaution.

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The challenge of preparing and enabling ‘skilled attendants’ to promote safer childbirth

Cited by 25 publications

References 10 publications

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

Mozambican Midwives' Views on Barriers to Quality Perinatal Care

Impact of Universal Precautions Training Program on Nurse Midwives Performance during Labor in Khartoum State—Sudan 2006-2009

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