Midwives’ views on delivery method decision making in private sector labour wards of Namibia

Mlambo, Sarah (2018-03)

Thesis (MCur)--Stellenbosch University, 2018.

Thesis

ENGLISH SUMMARY: Background: The views of midwives regarding decision making in the Namibian private sector hospital labour wards are investigated in this study. The high prevalence of caesarean sections in the Namibian private sector has been the motivation to attempt to understand this phenomenon. Midwives are an integral part in the care of women as prioritised patients, before, during and after childbirth. The objectives of the study included the midwives’ views on how women in the labour wards decide on a birthing method, whether the Robson classification for doing caesarean section was being applied in their workplaces, and what their perceived role as advocates entails during the women’s decision making of her birthing mode. Methods: The study used a qualitative design with an exploratory approach. Purposive sampling was applied in the selection of research participants. Permission was granted by the Health Research Ethics Committee of Stellenbosch University and the management of the two hospitals selected for the study. Seven individual interviews for allowing the phenomenon to be explored in-depth were conducted in two private hospitals in Windhoek. Data analysis was done using the six steps by Creswell. Results: The seven midwives who participated in this study reported that the decisions in the labour wards are affected by a myriad of factors. These include the relationship the midwife has with the doctor, the patient and the institution; trust among and between health professionals, and the availability of adequate antenatal information for the women to make informed decisions about the mode of birth. The following themes and subthemes (in brackets) emerged from the study: midwife (dependent, interdependent and independent role functions); doctor (dependent, interdependent and independent role functions; instrumental and expressive roles; motivations for caesarean sections); patient (antenatal care and expectations of pain management in labour; presence of support or birthing partner); and hospital (policies and guidelines; Robson classification). The study found that women are not well informed about the choices they have for childbirth, about the advantages and disadvantages of the chosen mode of delivery, as well as what to expect during the active stages of labour. The notion that some decisions are influenced by convenience also emerged in this study. Midwives’ roles in the Namibian private sector context were found to include decreased independent and increased interdependent functions due to the enlarged role of the private doctor as the primary care-giver, as well as expectations of the institution and the doctor. Conclusion: Decision making in the labour wards is important, as it determines the birthing method outcome for every woman in the labour ward. Health information during antenatal care needs to be improved to empower women with knowledge, for them to make informed decisions regarding the mode of delivery. The views of midwives emphasised the advocacy role on the part of the midwife, who needs to be more assertive in this role to benefit women in labour. Further studies need to be done in the same context and public hospital settings, to compare the views of women on decision making in the labour wards.

AFRIKAANSE OPSOMMING: Agtergrond: Hierdie studie ondersoek die opinies van vroedvroue aangaande besluitneming in die kraamsale van Nambiese privaatsektor hospitale. Die motivering om hierdie verskynsel te probeer verstaan is na gelang van die hoë voorkoms van keisersnitte. Vroedvroue vorm ‘n integrale deel van die sorg van vroue wat geprioritiseer word as pasiënte voor, gedurende en na geboorte. Die doelwitte van die studie was om vas te stel wat vroedvroue se opinies is oor hoe vroue in die kraamsale besluit op ‘n geboortemetode; of die Robson klassifikasie vir keisersnit-oorweging toegepas word in hulle werksplekke; en wat hul waargenome rol is as advokaat vir vroue gedurende die geboortemetode besluitnemingsproses. Metodes: ‘n Kwalitatiewe ontwerp met ‘n verkennende benadering is gebruik in die studie. Deelnemers is geselekteer deur middel van doelgerigte steekproefneming. Die Universiteit van Stellenbosch se Etiese Komitee vir Gesondheidsnavorsing en bestuur van die twee privaat hospitale het toestemming vir die studie verleen. Individuele onderhoude was gevoer in twee privaat hospitale in Windhoek (Hospitaal A en Hospitaal B) om sodoende die verskynsel in diepte te ondersoek. Sewe individuele onderhoude was gevoer in twee privaat hospitale in Windhoek (Hospitaal A en Hospitaal B) om sodoende die verskynsel in diepte te ondersoek. Creswell se ses stappe is gebruik vir die data analise. Resultate: Die sewe vroedvroue wat deelgeneem het aan die studie het rapporteer dat daar verskeie faktore is wat besluitneming in ‘n kraamsaal beinvloed. Dit sluit in die verhouding wat die vroedvrou het met die dokter, die pasiënt en die hospitaal; vertroue tussen gesondheidsorgwerkers; die beskikbaarheid van voldoende voorgeboorte inligting aan die vroue om sodoende ingeligte besluite te maak rakende geboortemetodes. Die volgende tema’s en sub-tema’s (in hakies) het uit die studie na vore gekom: vroedvrou (afhanklike, interafhanklike en onafhanklike rolfunksies); geneesheer (afhanklike, interafhanklike en onafhanklike rolfunksies; instrumentele en ekspressiewe rolle; motiverings vir keisersnit); pasiënt (voorgeboortesorg en verwagtinge rakende pynbeheer tydens geboorte; huidige ondersteuning of geboortevennoot); en hospitaal (beleide en riglyne; Robson klassifikasie). Die studie het bevind dat vroue nie voldoende ingelig is oor die beskikbare keuses wat hulle het ten opsigte van geboorte, asook die voordele en nadele van die gekose geboortemetode, en wat om te verwag tydens die aktiewe fase van geboorte nie. Dit het ook tydens die studie na vore gekom dat gerieflikheid sommige besluite beïnvloed. Daar is bevind dat vroedvrourolle in die Namibiese privaatsektorkonteks verminderde onafhanklike en vergrote interafhanklike funksionering behels as gevolg van die vergrote rol van die privaat geneesheer as primere gesondheidsorgverskaffer, sowel as die verwagtinge van die instelling en die geneesheer. Afsluiting: Besluitneming in die kraamsaal is belangrik omdat dit die geboorte metode en uitkoms van elke vrou in die kraamsaal bepaal. Voorgeboorte gesondheidsvoorligting moet verbeter word om sodoende elke vrou te bemagtig met die nodige kennis om ingeligte besluite rondom geboorte metodes te maak. Die sieninge van vroedvroue beklemtoon hul rol as advokate wat meer assertief moet wees om vroue in kraam te bevoordeel. Verdure studies moet gedoen word in dieselfde en publieke hospitaal omgewings om sodoende die sieninge van vroue rakende besluitneming in kraamsale te ondersoek.

Please refer to this item in SUNScholar by using the following persistent URL: http://hdl.handle.net/10019.1/103563
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