An evaluation of the quality of care midwives provide during the postpartum period in northern Botswana

Abstract

Objective: To assess the quality of care midwives provide to clients during the postpartum period. Design: A cross sectional descriptive qualitative and quantitative survey among 65 practising registered nurse midwives. They were interviewed and observed in health institutions while examining the mother and baby prior to discharge. A convenient non-probability sampling was used to identify and select respondents from 14 primary health care facilities in northern Botswana, who were actively involved in provision of maternal health services. Method: Direct personal interviews using semi-structured questionnaires consisting of open and closed ended questions and non-participatory observations were used to collect data from informants at their respective places of work. Results: Of the 65 midwives interviewed, a majority were females aged between 30-39 years. Age and length of service were not significant predictors for type of service provided. Most nurses provide quality care during immediate postpartum period. A majority of nurses have good knowledge and practice in management of postpartum activities but there are some areas that are not well done. Findings further show that 9% of clinic nurses have poor knowledge in management of post delivery severe anaemia. Almost all nurses have good knowledge in promotion of breastfeeding including its benefits to mother and baby. However, a majority of nurses have good knowledge in most postpartum activities but poor practice on the same area. Almost all nurses have good knowledge in management of breast engorgement, follow-up care, counselling on family planning and pelvic exercises but have poor practice on the same elements. Most nurses provide limited information to women on the importance of the 6-8 weeks assessment. Among all facilities, a majority had sufficient supply of equipment and consumables, but less than half had family planning packs. Most clinic nurses have poor practice on examination of the baby. Conclusion: Many nurses have good knowledge and practice, and provide quality care during immediate postpartum period but not all. The need to provide refresher courses on Safe Motherhood for all nurses involved in obstetric care to improve their skills in identified weak areas is obvious. With close supervision, in-service training and support, there is scope for improvement. With rapid trend of short hospital stay and the impact of HIV/AIDS, most mothers will most likely need follow-up care and advice on breast-feeding, safer sex, self and baby-care or other problems that may arise. This study therefore recommends the development of nursing standards, maternal health audits and re-introduction of domiciliary nursing along other strategies to improve the quality of care.