A comparison between four midwife obstretic units in the Pretoria region

Abstract

Introduction Midwifery obstetric units (MOUs) have been established in South Africa in response to the health needs of pregnant women. Although various types of MOUs currently exist, the function of the MOU and the quality of midwifery care rendered, have never been documented. This study aims to describe and compare four different types of MOUs in the Pretoria region. This will contribute towards providing and evidence base, needed for effective policy-making. The researcher believes that MOUs should play an important role in the reduction of maternal morbidity and mortality. Methods and procedures A comparative and descriptive design was used to reach the aim of the study. Both qualitative and quantitative methods were used, to contribute to a comprehensive picture of the functioning of MOUs and midwifery care rendered. Three objectives were set at the onset of the study. Objective one was to describe and compare the function of the MOUs with regard to: specific criteria: the number of admissions, the number of referrals, the number of deliveries, birth mass of babies delivered, number of perinatal deaths before admission and after delivery, neonate deaths, episiotomies rate, oxytocin use, pain relief rate, apgar score at 5 minutes of <8, neonatal referral rate, pregnancy complications (e.g. postpartum haemorrhage, retained placenta, birth trauma), management of third stage of labour, fetal monitoring type (doptone, Pinard stethoscope), referral criteria of each institution, indication for referral, and compliance to management protocol. Objective two was to describe and compare staffing and work load, which include the number of staff per shift in the labour ward, number of deliveries per shift, level of training, number of midwives with PEP training, number of advanced midwives, and availability job description of staff in labour ward. Objective three dealt with the description and comparison of the quality of care, with specific regard to the quality of the partogram and patient satisfaction. Triangulation of data collection methods were used to ensure trustworthiness of data. To attain the objectives, stated above, the data collection methods included: monthly statistical forms for objective one, structured individual interview with unit managers and job analysis of all categories of staff in the MOU, for objective two and for objective three a structured individual interview with patients was used to determine patient's satisfaction, and an audit of the partogram, to determine quality of care. A sample of four MOUs in the Pretoria region was purposively selected, because of their unique characteristics, resembling four different types of MOUs. To achieve objective one, statistics were obtained for a twelve-month period. To attain objective two a convenient sample of unit managers of the four MOUs were used. To attain objective three, a simple random sampling was used, to select patients' records (n=50) from each MOU, a total of (n=200) 200 records were selected. Convenient sampling was done for the interviews with patients, (n= 120) and again, a further interview was held with patients who bypassed the MOUs, of a period of 2 months. The content validity of the statistical form was based on the current format used in the MOUs and according to the "Guidelines for Maternity Care in South Africa" (Department of Health). The interview guide, used for interviews with the unit managers, was structured according to the study objectives. The interview guide, used to interview the patients, was based on an instrument developed by Steyn (1998), to assess patient's satisfaction in antenatal care, and adapted for the purpose of the study. All the methods used for data collection was tested during a pilot study. Descriptive and inferential statistics, as well as Tesch's approach towards the analysis of qualitative data, was used to examine differences between the four MOUs. Within the scope of this study, the researcher does not intend to generalize the findings. Conclusion The uniqueness of the study lies in the relevance of MOUs in the provision of maternity care, as one of the priorities of National Health. Up to date, little scientific knowledge is available on the functioning of the MOUs, In the Pretoria region. This study provides valuable information for the functioning of MOUs to effectively manage resources, and improve the quality of maternal care. It may further assist midwifery educators, to embark on hands-on, training on site, approach on the management criteria of each institution, indication for referral, and compliance to management of women in labour.