Maternal, neonatal and infant mortality is still high globally, but worse in low-resourced countries such as Kenya. Progress in reducing maternal mortality in Kenya is slow, with an estimated maternal mortality ratio of 400 deaths per 100,000 live births. Similarly, the infant mortality rate is tabulated at 39 deaths per 1000 live births. Given the high prevalence of maternal and newborn mortality and morbidity in low-income countries such as Kenya, it is vital to maximize nurses’ and midwives’ capacity to contribute to the reduction of this burden of disease during the perinatal period. As the main healthcare providers in rural Kenyan facilities, nurses and midwives are best positioned to provide effective maternal, newborn, and infant health (MNH) services. They provide both health promotion and disease prevention care throughout pregnancy, labor and delivery, and the early postpartum period. One way of achieving this is through effective postpartum care, a period of perinatal care that is plagued with high rates of pregnancy-related complications. A significant amount of research has been conducted on improving MNH in developing and low- to middle-income countries. However, there is a paucity of literature examining the experiences of nurses and midwives providing postpartum care in these settings. As is evident in the existing literature, nurses’ and midwives’ experiences and perspectives have not been explored to the fullest. This study, therefore, was guided by critical theory and Foucault’s concepts of knowledge and power. Using focused ethnography (FE) as the research methodology, the study had four specific objectives: 1) To describe how the sociopolitical and cultural contexts of healthcare influence the provision of postpartum care by nurses and midwives; 2) To identify the facilitators influencing nurses’ and midwives’ ability to competently provide postpartum care; 3) To identify the barriers to nurses’ and midwives’ ability to competently provide postpartum care; and 4) To explicate nurses’ and midwives’ current knowledge regarding best practices in postpartum care. As consistent with FE methods, this study employed individual in-depth interviews and focus groups to obtain data. Thematic analysis based on Braun and Clarke (2006) was used to analyze data. Credibility, transferability, dependability, and confirmability were used to ensure the trustworthiness of the research process. The analysis of data generated six themes: 1) Provider-Client Relationships; 2) Fostering a Healthy Work Environment; 3) Barriers to Postpartum Care; 4) Transcending Adversity; 5) Social Support Systems; and 6) Policies and Infrastructure Influencing Postpartum Care. The study findings demonstrated that nurses and midwives providing postpartum care in rural Kenya are the backbone of the healthcare system and greatly influence the health outcomes of the people they serve. Facilitators and barriers to the nurses’ and midwives’ work while providing postpartum care in this complex environment were identified. In this study, I have shown how gender, class, and power relations may be influencing the perinatal care that the nurses and midwives provide to postpartum women. The study also shines a light on how maternal and infant health may be influenced by power, politics, and policies. Therefore, I propose that use of an intersectionality lens to examine the experiences of nurses and midwives providing perinatal healthcare in rural Kenya could illuminate power dynamics within the healthcare sector. This study recommends relevant education, healthcare policies, and practice guidelines that support building the capacity of nurses and midwives through an inclusive, structured process, creating a robust environment in leadership, education, research, and nursing/midwifery practice.

Thesis (Ph.D.)--University of Alberta, 2009. / A thesis submitted to the Faculty of Graduate Studies and Research in partial fulfillment of the requirements for the degree of Doctor of Philosophy, Faculty of Nursing. Title from pdf file main screen (viewed on October 10, 2009). Includes bibliographical references.