Background: According to a Cochrane review, continuous support during childbirth increases the mother’s chances of a vaginal birth without identified adverse effects. However, this evidence-based practice is not universally implemented. The objective of the study was to identify challenges encountered in implementing continuous support during childbirth in public hospitals in the North West Province of South Africa. Method: An explorative, descriptive and contextual qualitative approach was used. The data were collected during 2013 by conducting focus group interviews with 33 registered midwives who had worked in maternity units in three selected public hospitals in the North West Province for at least two years. Results: Midwives identified challenges that negatively impacted the implementation of continuous support during childbirth at organisational and interpersonal levels. At the organisational level, challenges included human resources, policies and guidelines as well as the architectural outlay of the maternity units. The personal challenges related to communication and attitudes of nurses, patients and their families. Conclusions: Organisational and personal challenges had a negative impact on the provision of continuous care during childbirth.
The need to improve health services to HIV-positive women requires a specific focus on limiting mother-to-child transmission. Vertical transmission most often takes place during the intrapartum period; hence, it is essential to alert midwives to what constitutes safe or risky intrapartum practices. Midwives in the southern region of the North West Province of South Africa were surveyed for their knowledge of safe intrapartum practices that can limit vertical transmission of HIV, consequently indicating which intrapartum practices prevail in the region. We used a quantitative survey design and collected data by means of a questionnaire and checklist. A purposeful availability sample of 31 midwives who work in all four hospitals in the province was used and a random sample of 401 obstetric records was audited. Data were analysed by means of frequency analysis, effect sizes and cross-reference. A slight majority of the midwives had sufficient knowledge to distinguish between risky and safe practices. However, safe intrapartum practices are not always carried out and this raises concerns. Accordingly, we formulate general recommendations for nursing education, future research, and midwifery practice. In particular we suggest ways the national Guidelines for Maternity Care in South Africa may be adapted and better implemented to enhance safe intrapartum practices to limit vertical transmission of HIV.
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