Midwifery Practice Guidelines to Promote Quality Care of Preterm Babies in Resource-Limited Obstetric Units of Limpopo Province, South Africa

Abstract

Preterm birth is an unresolved health issue; globally it is the largest contributor to mortality among children under 5 years of age. Worldwide, approximately 9.6% of all births are preterm which the World Health Organization (WHO) recognizes as one of the top ten causes of neonatal deaths. The alarming rates of preterm births and deaths may be directly linked to the shortage of resources and an inadequate database of midwifery care guidelines for midwives in South Africa resulting in poor maternal care in public health. This study sought to develop midwifery practice guidelines to promote quality care of preterm babies in resource-limited obstetric units of the Limpopo Province of South Africa. The convergent parallel mixed method was used, explorative, descriptive and contextual qualitative design were run concurrently with the descriptive quantitative approach. For the qualitative design, non-probability purposive sampling was used to select midwives and managers from Limpopo Province. In-depth one-to-one interviews were conducted with 11 midwives and 4 managers. Tesch’s eight steps of open-coding was used to analyze qualitative data. Trustworthiness was ensured through credibility, confirmability, dependability and transferability. For the quantitative approach, 31 midwives and 24 managers completed the Likert scale questionnaire. The non-probability method was employed to select midwives and managers to make up a sample size of 55 participants. Reliability and validity of the instrument was ensured through extensive literature review and a pilot study. Data were analyzed with the IBM Statistical Package for the Social Sciences (SPSS) version 23.0. Both quantitative and qualitative data analysis yielded three themes as follows: the role of midwives in reduction of preterm births and deaths in obstetric units; challenges faced by midwives whilst executing their role during preconception, antenatal, labour and v puerperium period; support needed by midwives during provision of maternal and neonatal care to reduce preterm births and deaths. In the discussion of the findings, qualitative findings were supported by quantitative findings. The WHO model (PICOS & GRADES) was adapted in the development of the guidelines. The group then validated the guidelines using a closed-ended checklist to verify whether the guidelines were congruent with practice. The results were analyzed through simple descriptive statistics where the data were summarized using frequency