The Impact and Experience of Introducing Professional Midwives into Rural Government Hospitals in Bangladesh, a Mixed-Methods Study

Anderson, Rondi (2022) The Impact and Experience of Introducing Professional Midwives into Rural Government Hospitals in Bangladesh, a Mixed-Methods Study. PhD thesis, Lancaster University.

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Abstract

The aims of this research were 1) to determine if introducing international standard midwives in rural sub-district hospitals in Bangladesh, both with and without mentoring, improved the availability and quality of maternal and newborn health care; and 2) to explore the experiences of the midwives, and the maternity staff and managers that they joined, following their introduction. Key objectives were to examine the enabling environment and document barriers and facilitators to midwifery-led care. This was a mixed-methods study that examined differences between hospitals grouped into three categories—without midwives, with midwives, and with midwives and mentorship. The quantitative component consisted of observations of facility readiness and clinical care to assess whether newly introduced evidence-based maternity care practices recommended by the World Health Organization were being implemented. In addition, maternity staff and midwives completed a written survey on their knowledge, perceptions and utilization of the new care practices. Qualitative focus groups and interviews were used to gain an understanding of the perceptions, attitudes and experiences among maternity staff and managers toward the midwives and the improved care practices. There were 641 clinical observations, 237 completed surveys, 18 interviews and five focus groups. A continuum was identified reflecting that the facilities without midwives were the least comfortable with and likely to implement the quality maternity care practices, and those with midwives and mentoring were the most likely to. In addition, perceptions toward midwives’ capabilities, both among midwives themselves and among the other maternity staff they worked with, improved with mentoring. The introduction of professional midwives was found to improve the quality of maternal health care in settings already staffed with doctors and nurses. The addition of mentors to support midwives potentiated the effect. Mentors strengthened capacity regarding new clinical practices, created enabling environments, and facilitated supportive transitions between the existing and new maternity staff.