The general health status of pregnant women depends largely on the quality of the antenatal services available to them. The provision of good antenatal services ensures early detection and prompt management of any complication or disease that may adversely affect pregnancy outcome. In order to ensure high quality care, antenatal services need to be evaluated at regular intervals, both from provider and client perspective, to ensure their effectiveness in improving the health status of pregnant women. The midwife, as the first contact person for most pregnant women attending antenatal clinics in South Africa, has the potential to play a major role in improving the health status of these women. However, for the midwife to be effective in achieving this, antenatal services need to be effectively utilized by women. One of the factors that affect utilization of any service is client satisfaction with the service being rendered. This study, therefore, explores the perceptions that pregnant women have of the care that they receive from midwives at the selected antenatal clinics. The objectives of the study are to: {u100083} Explore and describe the perceptions and experiences of pregnant women attending antenatal clinic regarding the care they receive from midwives. {u100083} Make recommendations to assist registered midwives in optimizing the accompaniment of women during the antenatal period. A qualitative, descriptive, exploratory and contextual design was used for the study. The sample was chosen from the target population by means of purposive sampling and data was collected through unstructured interviews with the participants. Before data collection, permission was obtained from the Eastern Cape Department of Health and the Nursing Service Manager of the Gateway clinic, in the district hospital where the research was conducted. The Nursing Service Manager was acting as a Medical Superintendent at the time of the study. Written, informed consent was obtained from all participants before conducting interviews. Trustworthiness was ensured by means of Guba’s model throughout the study, and the aspects of truth value, applicability, consistency and neutrality were considered. Tesch’s eight steps of data analysis were used to analyze the data collected, and four main themes were identified namely: • Women perceive midwives as considerate and knowledgeable • Women perceive midwives as lazy and rude • Women experience mixed emotions about the care they receive from midwives • Though their experiences, women identified certain needs in the services and care they received at the clinic. Conclusions were drawn and recommendations for midwifery practice made based on the results of the study, with the aim of improving antenatal services rendered to pregnant women.

The Department of Health in South Africa, as in many countries, has developed a policy guideline and recommendations for feeding of infants of HIV positive mothers. This is aimed at providing midwives with detailed and sound information about HIV and infant feeding practices based on current understanding of HIV and exclusive breastfeeding for the first six months of the infant’s life. The policy states that breastfeeding is a significant and preventable mode of HIV transmission to infants and there is an urgent need to educate, counsel and support women and families, so that they can make decisions about how best to feed infants in the context of HIV (http://www.doh.gov.za/aids/doc/feeding/html.2005-03-07). Speaking to midwives from the Provincial Hospitals in the Nelson Mandela Metropole, the researcher became aware of the midwives’ often-expressed unhappiness about the new policy from the Department of Health on exclusive breastfeeding. Midwives complained about the dilemma with which they are faced regarding infant feeding practices. They could not understand the advocacy of exclusive breastfeeding, when breastfeeding is recognised as one of the modes of Mother-to-Child Transmission (MTCT) of HIV. The aim of the study was to help, support and encourage midwives to implement the policy of exclusive breastfeeding. The objectives of the study were to: • Explore and describe the experiences and perceptions of midwives related to promoting exclusive breastfeeding in HIV positive first-time mothers. • Make recommendations to the Department of Health regarding the support and help that can be given to midwives to encourage their implementation of the exclusive breastfeeding policy. The researcher made use of a qualitative, phenomenological, descriptive, explorative and contextual design. Permission for conducting the research was iv obtained from relevant authorities, and participants were asked to sign a consent form before the researcher proceeded with the study. Collection of data was done by means of unstructured interviews using an audiotape recorder. Once data was saturated, the interviews were transcribed verbatim and analysed, using the steps described by Tesch’s (1990 in Creswell, 1994: 153) method of descriptive analysis. Field notes were also taken to record non-verbal communication during the interviews. In order to ensure trustworthiness of the study, the ethical principles of Guba’s model (in Krefting, 1991:215), namely truth-value, applicability, consistency and neutrality were used. The services of an independent coder were utilised and a consensus meeting was held between the researcher and the independent coder in order to discuss the identified themes. Prior to the consensus meeting, the independent coder was provided with interview transcripts and a protocol to guide the data analysis. Following the data analysis, a literature control was undertaken to highlight the similarities and differences found in the data analysis. Three themes with sub-themes were identified. The participants expressed positive views on the policy of exclusive breastfeeding in HIV positive first-time mothers. They were satisfied with the policy and viewed the policy of exclusive breastfeeding as an effective contribution to feeding options of babies born of HIV positive first-time mothers. However, the participants identified several factors hindering the effective implementation of the policy of exclusive breastfeeding in HIV positive first-time mothers. Factors identified were staffshortages, lack of cooperation among staff members regarding promotion of exclusive breastfeeding, lack of information regarding the CD4 count of patients on admission in the ward, cultural beliefs, lack of training among staff members and inadequate counseling facilities to ensure privacy and confidentiality for mothers. Participants also experienced a variety of emotions related to exclusive breastfeeding such as happiness, confidence, helplessness, frustration, worry and concern, stress and exhaustion. Based on the findings of the study, guidelines were developed and recommendations made concerning nursing practice, nursing education and nursing research.

Thesis (MPH.) -- University of Limpopo, 2016. / Introduction and purpose: Midwives are the backbone of maternal and child health—the output of their action affect quality of life of mother and child. The purpose of the study was to describe the challenges encountered by one-year diploma student midwives while acquiring clinical skills at selected hospitals in Limpopo Province. Research design and method: A quantitative, descriptive cross-sectional research method was used in this study. The study population comprised all one-year diploma student midwives in selected hospitals in Limpopo Province, namely, Dilokong Hospital, Jane Furse Memorial Hospital, Mokopane Hospital, Philadelphia Hospital, Siloam Hospital and St Rita’s Hospital. The whole study population was used as the total population was small. Data were collected using a self-administered questionnaire. Informed consent was received from the participants as was ethical approval from the relevant authorities. Data were analyzed using SPSS version 22 with the aid of a statistician. Descriptive statistics were used to analyze and describe the data. Data were presented in tables and bar graphs.Findings: Respondents in this study indicated that they encountered the following challenges during their acquisition of clinical skills at the selected hospitals in the Limpopo Province: inadequate resources; inadequate mentoring. Male participants reported feelings of being more competent than their female counterparts. There was no relationship between acquisition of skills and marital status, and no correlation between age and acquisition of skills.

Submitted in fulfilment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, 2014. / Introduction High maternal, perinatal and under-five morbidity and mortality are some of the formidable development challenges in Africa. The World Health Organisation (WHO) estimates that worldwide, as many as 1500 women die every day due to complications related to pregnancy or childbirth (WHO 2010). The partograph or partogram, an inexpensive tool, was designed by WHO to be used by midwives for decision-making during labour. Many studies conducted in and out of Africa reflect sub-optimal use of the partograph. Aim of the study The aim of the study was to describe the utilisation of the partograph by registered midwives working in the maternity sections of public hospitals in the uMgungundlovu District in the province of KwaZulu-Natal. Methodology A quantitative descriptive cross-sectional study was used to describe the use of the partograph in the selected hospitals, and carried out in two phases. In phase one, 197 participants completed a questionnaire. In phase two, retrospective audits on 310 completed maternity records were done. The collected data was analysed using SPSS version 20 and presented in frequency tables, cross-tabulations and graphs. Results The results revealed that there were certain parameters that were given more focus when it came to correct and consistent recording, such as contractions (80.0%) and cervical dilatation (89%) whilst others were poorly done, such as the duration of labour (13.5%), pain relief (23.5%) and unrecorded partographs from the primary health care clinics and community health centres (80.8%).

Submitted in fulfillment of the requirements for the Degree in Masters of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2016. / Introduction Registered midwives are expected to practice their duties within the parameters of their scope of practice. Pregnant women have certain expectations about the midwife and their skills. If such expectations are not met, substandard care occurs. Such substandard care has a negative impact for both the pregnant woman and the Department of Health. Aim of the study The aim of this study was to explore and describe the experiences of midwives working in maternity units, concerning midwifery practice breakdown in maternity units at a public hospital in KZN. Methodology A qualitative research study that was exploratory, descriptive and contextual in nature was conducted. Semi-structured interviews were conducted with 13 midwives. Data was transcribed verbatim then organised into codes. Results The study revealed that the majority of the participants faced practice breakdown almost daily and most of the midwifery practice breakdowns start during antenatal care visits. Midwives who attended to pregnant women during antenatal care did not follow set protocols and guidelines and this resulted in complications during delivery. Most midwives were emotionally stressed and did not wish to continue practicing midwifery. Midwives were of the opinion that the management did not care about their challenges and did nothing to resolve the challenges. / M

The World Health Organization (WHO) recommends that of all the live births per year no more than 10-15% of these should be delivered by caesarean section. Despite this recommendation there has been a global increase in the percentage of caesarean section deliveries over the past few decades. In South Africa the percentage is as high as 70% in certain health care institutions which is of concern to midwives. Caesarean section deliveries are needed when the life of the baby, mother or both are at stake. However, this method of delivery bears more disadvantages than advantages to the baby and mother. Despite these disadvantages, some women request a caesarean section in their birth plans while others are influenced by health professionals to request a caesarean section. Therefore, there is a need for labouring women to be guided where possible to have vaginal birth because of its many advantages. This study sought to explore and describe the perceptions of the midwives regarding their role in facilitating the choice of delivery mode for labouring women in public hospitals and midwifery obstetric units (MOUs) of the Nelson Mandela Bay and Sarah Baartman districts. Based on the results of the study, guidelines for midwives in this role were developed. Maputle’sWoman-Centred Childbirth Model (2010) was used as the theoretical lens through which this study was viewed. The researcher selected a quantitative survey design using an explorative, descriptive and contextual research approach. The population consisted of midwives who were working in labour wards at public hospitals and midwife-led MOUs. A non-probability convenience sample was used to collect data using a structured, self-administered questionnaire. The reliability and validity of the data collection instrument were ensured by using various means including a pre-test and an expert panel. Altogether, 300 questionnaires were distributed and 288 were returned. This number excluded the pilot study. Data was collected over a period of three months using the assistance of two fieldworkers. Data was captured and analysed under the supervision of the statistician and supervisors. Analysis was done by means of descriptive analyses that involved the production of frequencies and presented using charts, figures and tables. The major findings of the study are: -The midwives perceived themselves as the main facilitators of a suitable decision by the labouring woman for a safe delivery method - The midwives emphasised the importance of the delivery position preferred by the labouring woman -The midwives indicated that a collaboration between doctors, senior midwives, midwives and midwives in management positions could assist with a decision for a suitable delivery mode option. -The midwives agreed that the culture of the labouring woman should be considered when deciding on a delivery mode and therefore midwifery curriculum should include lessons about cultural diversity. Three principal guidelines were developed, namely: 1. Create an environment that promotes acceptance of a woman’s choice of a delivery mode. 2. Create an environment promoting a collaborative health care relationship 3. Create an environment that is sensitive to cultural needs in the maternity unit Ethical considerations in this study were upheld by maintaining the principles of beneficence, maleficence, autonomy and justice.

Thesis ( Ph.D. ( Nursing)) -- University of Limpopo, 2016 / The purpose of this study was to develop an evidence-based model for enhancing optimal midwifery practice environment in maternity units of public hospitals, Limpopo Province. A mixed method sequential explanatory design was adopted. The study was conducted in four phases, namely: quantitative, qualitative, model development and validation of the model. Self-developed 4-point Likert scale questionnaires consisting of 81 item questions for learner midwives and 89 item questions for midwifery practitioners were administered. The questionnaires were pre-tested prior to being administered to the respondents of the main study. The sample size of midwifery practioners was 174 and that of the learner midwives was 163. Data collected from respondents were analyzed quantitatively using descriptive and inferential statistics. Tables, pie and bar graphs were drawn to present the results. The results from the quantitative phase were utilized to formulate the interview guides that were used to explore the experiences of midwifery practitioners, experiences of learner midwives and perceptions of puerperal mothers. Phenomenological semi-structured individual interviews were conducted for midwifery practitioners (n=20), 3 Focus group discussions of learner midwives (n=18) and 3 focus group discussions of puerperal mothers (n=18) were held until data reached saturation. Data were analyzed qualitatively using Tesch’s open-coding method. Themes and sub-themes were coded manually. Results that emerged from the corroboration, comparison and integration of quantitative and qualitative results revealed the existence a sub-optimal midwifery practice environment, sub-optimal midwifery experiential learning environment and provision of sub-optimal midwifery interventions in the public hospitals of Limpopo province. Development of an evidence-based model emanated from the findings of numeric quantitative data and qualitative narratives. The evidence-based information from the existing situation as seen from the world of participants brought about a gap of optimal midwifery practice environment. The ideal situation was designed in a way of addressing the gaps identified. Experts were given the validation tool to assess whether the model was clear, simple, understood and that it can be utilized by any discipline in future.

M.Cur. (Maternal and Child Nursing Science) / The implementation of the PMTCT programme was conceptualised in 2000. The aim of this study was to determine the views of midwives regarding the implementation of the PMTCT programmes in the public health centres in Soweto. Data was collected from midwives involved in the implementation of PMTCT in antenatal clinics by means of semi-structural interviews. Of the 20 midwives (N=20) interviewed, only five (5) midwives attended formal training. The discussion of the views of midwives regarding the implementation of PMTCT centered around the lack of formal training, lack of resources, lack of infrastructure, negative attitude of the community, lack of budgeting, lack of support by colleagues and poor management support, language barriers in communication and religious beliefs. This study found that midwives need to go for formal training on PMTCT programmes and that more research need to be done in this field. Moreover, the findings from this study have implications for clinical practice. In addition, guidelines were formulated to help midwives and other health care practitioners to implement the PMTCT programmes in antenatal care.

The aim of this study was to investigate whether patients were satisfied with midwifery services rendered at the two Community Health Centres in the Eastern Cape Province.The study sites were Empilweni Gompo and Nontyatyambo Community Health Centres. Descriptive quantitative study design was employed, using a questionnaire with closed and open ended questions as the data collecting tool. Likert Scale was used to measure the following variables: quality care variables to measure level of satisfaction with midwifery services rendered and to determine positive and negative perceptions regarding quality of care received during antenatal, labour and postnatal period. Non-random convenience sampling of sixty pregnant women, thirty from each Community Health Centre, with two or more antenatal subsequent visits and forty postpartum women, twenty from each health facility, six hours after delivery if there were no complications. Out of 60 participants interviewed n=60 (100 percent) agreed that individual counseling and importance of HIV testing was explained.The majority of participants n=53(88 percent) disagreed that they were educated about focused antenatal visits. Out of 60 participants interviewed n=41(68 percent) agreed that delivery plan formed part of their ANC visits and n=18 (30 percent) disagreed. Of the 60 participants interviewed n=11(18 percent) agreed that they were told that they had the right to choose labour companions and n=48 (80 percent) disagreed.Out of 60 participants interviewed n=23 (38 percent) stated that they waited a long period of time without being attended to by midwives. In general, the study revealed high satisfaction level with intrapartum and postnatal care due to functional accessibility of both Community Health Centres. Both health centres delivered normal healthy babies and mothers. However, the participants were dissatisfied with antenatal care rendered at the two facilities. The researcher’s recommendations were based on the closing of gaps that were identified with regard to the implementation of Basic Antenatal Care; birth companions: health education deficiency; community involvement and participation.

Department of Advanced Nursing Science / MCur