A MIXED-METHODS STUDY TO EXPLORE EVIDENCE-BASED INTRAPARTUM CARE IN MATERNITY SETTINGS IN BAHRAIN

UoM administered thesis: Phd

  • Authors:
  • Leena Khonji

Abstract

Background: The World Health Organization (WHO) acknowledges childbirth as a normal physiological process that does not require unnecessary interventions by maternity care providers. However, some maternity settings in Bahrain still continue to intervene during labour and childbirth while providing care to low-risk women. This approach contradicts the WHO’s initiatives in implementing Evidence-Based Practices (EBP) of intrapartum care. Aim: to gain an understanding of intrapartum practices in Bahrain. Methods and methodology: A convergent parallel mixed-methods design was used in the study, conducted in two maternity units of governmental and University-affiliated hospitals in Bahrain. Quantitative data were collected by auditing retrospective birth records and a questionnaire on the intrapartum care of 228 postpartum women. Qualitative data were collected using purposive and theoretical sampling guided by grounded theory through 20 semi-structured interviews with maternity care providers and women and six non-participant observations of care providers’ practices during labour. Descriptive and inferential statistical analyses were applied for quantitative data using IBM SPSS Statistics 23. Qualitative data were analysed by constant comparative analysis using Microsoft Word 2016. Findings: Integrated findings revealed that current intrapartum practices in the two maternity units in Bahrain contradicted the recommendations of EBP in certain aspects of intrapartum care. There was a routine use of continuous Electronic Fetal Monitoring (EFM) (93.4%), limited fluid intake during labour (77.2%), discouragement of mobility during labour (76.3%), routine vaginal examinations (65.8%) and lack of companionship presence at labour and birth (64.9%). Qualitative findings provided an in-depth understanding about the intrapartum practices in the two settings. The core category ‘women as recipient of care’ which includes three major categories ‘experiencing childbirth’, ‘knowing the context of childbirth care’ and ‘moving toward EBP’ emerged from qualitative data analysis. Qualitative findings explored the positive attitude of maternity care providers to some intrapartum practices such as the commitment to use the partograph, encouragement of skin-to-skin contact, provision of privacy and midwives’ empathetic support. The integrated study findings contributed to the development of a theoretical model: ‘Labouring women-from recipients to participants’, drawing a path to move current intrapartum care in Bahrain toward women’s active participation and involvement in care through adopting the recommendations of EBP. Conclusion: This study offers insights about how low-risk labouring women experience childbirth in maternity settings in Bahrain. Study findings suggest an urgent need to move intrapartum practices in Bahrain towards consistency with the WHO’s recommendations for safe childbirth care. Maternity care providers should pay attention to the practices used routinely during labour. Policymakers need to consider the development of a unit policy that acts as a reference for midwives, updating the existing guidelines to align with Evidence based recommendations for care during labour and birth.

Details

Original languageEnglish
Awarding Institution
Supervisors/Advisors
Award date31 Dec 2018