Labour has been characterized as the most dangerous journey a woman undertakes. The reason being, that although it is a natural process, many labouring women suffer complications during labour and childbirth including prolonged or obstructed labour. These complications can result in maternal and infant morbidity and mortality. The partograph is a monitoring tool that can provide a continuous pictorial overview and is essential to monitor and manage labour. It is recommended by the WHO for use universally by midwives while monitoring labour. However partographs are poorly utilized and most parameters on the partograph are not monitored and findings after reviewing a labouring woman are not documented on the partograph. It is unclear how midwives working in Namibian Health services experience and utilize the partograph during the monitoring of a woman in labour. These may be the factors that hinder the effective utilization of the partograph. The objective of this study was to explore and describe the experiences of midwives regarding the utilization of the partograph for monitoring a labouring woman in a Namibian regional hospital in order to develop guidelines based on the findings to improve the use of the partograph by midwives in order to improve the management of labour. The research design was qualitative, descriptive, explorative and contextual in nature. The research population consisted of midwives working in a regional hospital in Namibia. A purposive and convenient sampling method was used to select participants. Specific inclusion criteria were met and consent was obtained from the participants and from the Regional Health Directorate Management of the hospital where the research was conducted. Interviews were conducted by an independent interviewer within the Department of Health to ensure an unbiased viewpoint. Data were collected by means of semi-structured in depth interviews with a guide, using an audio tape recorder. Field notes were used to record non- verbal communication. As soon as data were saturated, the interviews were stopped. They were then transcribed, verbatim and analysed using the Tesch’s approach as described in (Creswell, 2009:186). The service of an independent coder was utilized to ensure trustworthiness. Trustworthiness was further ensured by using the strategies suggested by Lincoln and Guba’s model, namely credibility, transferability, dependability and confirmability. Ethical considerations were honoured throughout by adhering to ethical principles during the study. These included ensuring that the participants` rights were respected, they were not harmed and fairness were ensured. On completion of the data analysis a literature control was conducted and existing literature was compared to the findings in order to identify similarities and differences and to verify whether the literature supported the findings. Four main themes that emerged during data analysis are:  Theme 1.Midwives found it a positive experience to use the partograph when caring for a woman in labour.  Theme 2. When a midwife experienced problems in using the partograph, it may lead to detrimental outcomes.  Theme 3. Utilizing the partograph evoked differing emotions in midwives.  Theme 4. Midwives` knowledge and skills in the utilization of the partograph should be updated regularly. By describing the lived experienced of midwives in the maternity ward on the use of the partograph, the midwives had a positive attitude to using the partograph, but they also found it difficult to utilize the instrument as was directed by the (WHO) due to challenges experienced such as: unrealistic staff/patient ratio, shortage of staff, time consuming, insufficient knowledge and skills among midwives and lack of appropriate equipment. There is a specific need to prevent further negative emotions by addressing the challenges experienced. Based on the findings, guidelines for partograph utilization which aimed at improving the midwifery care were developed. Recommendations were made regarding midwifery education, clinical midwifery care and midwifery research.

Many midwives throughout the world experienced high stress levels when they deal with emergency childbirths. Midwifery professionals experience certain unique stressors, such as midwives being responsible for the care of women when they are giving birth. Complications of childbirth may occur during labour leading to the life of the baby and the mother being threatened. Situations such as this leave midwives experiencing high levels of stress for which they often do not have effective coping mechanisms. When the stress is not managed, it may lead to burnout. When burnout occurs the midwives present with physical and psychological symptoms of stress, grief for the loss and lack of motivation, which results in staff turnover and a fear of working in a maternity ward. Consequently, patient care may be compromised as some midwives became apathetic and develop unacceptable attitudes toward their patients. Such behavior led to poor work performances, maternity services that are not woman-friendly and women seeing the maternity ward as a place where they are treated in rude and unfriendly manner which increased the chances of adverse childbirth outcomes. The aim of the study was to explore and describe the experiences of midwives who have to cope with stress associated with emergency childbirths. This information was used to develop the guidelines to help midwives to cope with the high stress associated with emergency childbirths. The researcher used a phenomenological, qualitative approach. The study was explorative, as little was known on this topic in the Namibian context and it was also descriptive and contextual. Purposive and convenient sampling was used to select the research sample. The research population was all the midwives working in the maternity ward of a Namibian regional hospital, who met the inclusion criteria. Data gathering was done using semi-structured interviews. Once data saturation occurred, interviewing stopped. The interviews were audio-taped and transcribed verbatim. Tesch’s eight steps of data analysis were followed to create meaning from the data collected. An independent coder assisted with the coding process to ensure the trustworthiness of the findings. Literature control was done after data collection to support and strengthen the study’s findings. Trustworthiness, as suggested by using Lincoln & Guba’s model of trustworthiness, included truth-value/credibility, applicability/transferability, consistency/dependability and neutrality/conformability was implemented. Ethical principles of beneficence, non-maleficence, autonomy and justice were ensured by obtaining permission to conduct the research from relevant authorities and from University structures, obtaining consent from the participants before the interviews, voluntary participation and right to withdraw from the study, privacy, confidentiality and dissemination of the results. Three main themes and sub-themes were identified namely: Midwives experienced significant stressors associated with emergency childbirth situations. Midwives experienced mixed emotions about dealing with emergency childbirth situations Midwives shared their views regarding their support needs associated with emergency childbirth situations. Recommendations for nursing education, clinical midwifery and for further research were made. Four guidelines were developed based on the study findings as well as literature related to these findings, to help the midwives to cope with high stress levels associated with emergency childbirths.

Labour is a vital period for the labouring mothers, as it should bring with it the fulfilment of an expectation of having the baby that has been awaited. The health of the foetus which is to be born and that of the labouring mother are inextricably linked with each other which is why the labouring mother needs to be assessed and monitored carefully. The cardio-tocograph, which is a globally accepted method of diagnosis and assessment of the foetal status during labour is preferred to be used in monitoring labouring mothers, especially high- risk patients. Despite the evidence and information regarding the effectiveness of the use of the cardio-tocograph, midwives are still found not to be using it correctly, the reasons given that the women not always co-operate; do not keep the electrode and belt in place or cite the discomfort they experience from contraction. The objectives of this study were to: explore and describe the perceptions and current practice of Namibian midwives regarding the use of the cardio-tocograph as an informative labour- monitoring tool. Explore and describe how midwives working in labour wards in Namibia perceive informing laboring women of the use of the cardio-tocograph as an informative labour- monitoring tool and based on the results, develop an instruction guide for midwives working in the labour ward in intermediate hospital in Namibia that would serve as a guide on how to teach labouring women about the use of the cardio-tocograph as a labour- monitoring tool and enhance positive labor and delivery outcomes The study was conducted between May and June 2016, using a qualitative, explorative, descriptive and contextual design, following the necessary university approval and approval from other relevant authorities. The research population was midwives who work in labour wards at a public hospital in Namibia. Semi-structured interviews were used to collect data from purposively sampled participants using set criteria. A voice recorder was used to capture the interview with the permission of the participants. Seventeen midwives were interviewed of whom two were used for the pilot study. Data saturation determined the sufficient sample size. The collected data was analyzed using Tesch’s spiral method of data analysis with the assistance of an independent coder From the research findings, it emerged that midwives had varying perceptions regarding the use of the CTG machine. Midwives still perceive CTG interpretation as a challenge as a labour -monitoring tool and expressed a need for updates. Furthermore, midwives expressed the fact that they had limited communication with labouring women regarding the use of CTG. Based on the research findings and guided by Health Belief Model principles, three main guidelines were developed for midwives working in the labour ward in a public hospital in Namibia. These guidelines will serve as a tool to assist midwives in their teaching of labouring women about the use of the cardio-tocograph as a labour- monitoring tool, and the role to be played by labouring women during that monitoring period. Furthermore, recommendations for clinical nursing practice, nursing education and nursing research were developed. The researcher used literature control to ensure validation and integrity of the study. Trustworthiness, which was used to ensure rigour of the study, was guided by the principles of truth-value, transferability, dependability and confirmability. Ethical considerations were guided by the Belmont report adopting the principles of beneficence, respect for human dignity, justice and non-maleficence.