Barriers and Facilitators associated with partograph completion by midwives in a referral hospital in Botswana

Abstract

The partograph (or partogram) is a tool commonly used to monitor maternal and foetal wellbeing during labour and is recommended by the World Health Organization (WHO). A significant number of maternal, perinatal, and neonatal mortalities are caused by obstructed and prolonged labour, resulting from poor labour monitoring practices such as lack of proper partograph completion and timely interventions. Studies have shown that when the partograph is completed correctly, early diagnosis of complications and timeous interventions will be possible, resulting in the prevention of a significant number of mortalities. The reduction of maternal, perinatal, and neonatal mortalities is vital because the world regards them as serious birth challenges that need to be addressed aggressively. Despite the monitoring and evaluation project named Maternal and Mortality Reduction Initiative (MMRI) that the Botswana Ministry of Health and Wellness embarked on in 2013, partograph completion was still low. The low percentage of partograph completion led to the researcher’s assumption that partograph completion was still a challenge. This assumption prompted the need to explore the barriers and facilitators associated with partograph completion by the midwives working in the selected referral hospital. Aim of the study The study aimed to explore and describe barriers and facilitators associated with partograph completion by midwives in the selected referral hospital in Botswana. Research design and methods A constructivist approach was used to do a qualitative, explorative, and descriptive research study. The study population was midwives working in the labour ward of a referral hospital in Botswana. From the study population, ten participants were initially sampled by purposive sampling. The researcher interviewed the ten participants and added two more as determined by data saturation. Data was collected through individual interviews using semi-structured open-ended questions. Interviews were recorded using an audiorecorder and later transcribed verbatim. A thematic approach was used to analyse the data. Relevant literature was integrated during results discussion. Trustworthiness and ethical principles were adhered to throughout the study. Findings The results addressed the two main themes namely barriers and facilitators to partograph completion. The health care system barriers that emerged included the health care provider barriers, the health care facility barriers, and the health care system barriers. The identified facilitators to partograph completion were the human resource-related, the midwife related, support related, and the partograph related facilitators. The themes were sectioned into different categories and sub-categories for an extensive discussion. The third theme that emerged addressed recommendations relevant to the two main themes. The participants recommended that the identified barriers should be addressed, and the perceived facilitators should be strengthened, as ways to improve the partograph completion. Conclusion The findings of the study revealed the barriers to partograph completion and facilitators to partograph completion as perceived by the midwives. Recommendations to convert the barriers into facilitators were made. Key terms /concepts Barriers; Facilitators; Midwife; Partograph; Referral hospital