Silent voices of the midwives: factors that influence midwives’ achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry

Becker, Jan and Becker, Chase and Oprescu, Florin and Wu, Chiung-Jung (Jo) and Moir, James and Shimwela, Meshak and Gray, Marion (2022) Silent voices of the midwives: factors that influence midwives’ achievement of successful neonatal resuscitation in sub-Saharan Africa: a narrative inquiry. BMC Pregnancy and Childbirth, 22 (1):39. pp. 1-13.

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Background: In Tanzania, birth asphyxia is a leading cause of neonatal death. The aim of this study was to identify factors that influence successful neonatal resuscitation to inform clinical practice and reduce the incidence of very early neonatal death (death within 24 h of delivery). Methods: This was a qualitative narrative inquiry study utilizing the 32 consolidated criteria for reporting qualitative research (COREQ). Audio-recorded, semistructured, individual interviews with midwives were conducted. Thematic analysis was applied to identify themes. Results: Thematic analysis of the midwives’ responses revealed three factors that influence successful resuscitation: 1. Hands-on training ('HOT') with clinical support during live emergency neonatal resuscitation events, which decreases fear and enables the transfer of clinical skills; 2. Unequivocal commitment to the Golden Minute® and the mindset of the midwife; and. 3. Strategies that reduce barriers. Immediately after birth, live resuscitation can commence at the mother’s bedside, with actively guided clinical instruction. Confidence and mastery of resuscitation competencies are reinforced as the physiological changes in neonates are immediately visible with bag and mask ventilation. The proclivity to perform suction initially delays ventilation, and suction is rarely clinically indicated. Keeping skilled midwives in labor wards is important and impacts clinical practice. The midwives interviewed articulated a mindset of unequivocal commitment to the baby for one Golden Minute®. Heavy workload, frequent staff rotation and lack of clean working equipment were other barriers identified that are worthy of future research. Conclusions: Training in resuscitation skills in a simulated environment alone is not enough to change clinical practice. Active guidance of 'HOT' real-life emergency resuscitation events builds confidence, as the visible signs of successful resuscitation impact the midwife’s beliefs and behaviors. Furthermore, a focused commitment by midwives working together to reduce birth asphyxia-related deaths builds hope and collective self-efficacy.

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Item Type: Article (Commonwealth Reporting Category C)
Refereed: Yes
Item Status: Live Archive
Faculty/School / Institute/Centre: Current - Institute for Resilient Regions - Centre for Health Research (1 Apr 2020 -)
Faculty/School / Institute/Centre: Current – Faculty of Health, Engineering and Sciences - School of Health and Medical Sciences (1 Jan 2022 -)
Date Deposited: 17 Mar 2022 02:47
Last Modified: 05 May 2022 03:07
Uncontrolled Keywords: Clinical practice; Limited clinical resources; Midwives’ voices; Narrative inquiry; Neonatal resuscitation; Self-efficacy; Simulation; Stories; Sub-Saharan Africa; Very early neonatal death
Fields of Research (2008): 11 Medical and Health Sciences > 1110 Nursing > 111006 Midwifery
Fields of Research (2020): 42 HEALTH SCIENCES > 4204 Midwifery > 420401 Clinical midwifery
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