Supporting Midwives to Improve the Care of Women and Babies

When pregnant, this vulnerability is accentuated, women often having to navigate unsatisfactory health systems and unsupportive community influences to receive optimum maternity care. In parallel to these challenges, midwives strive to provide the best possible care, but often whilst working in difficult working environments which are under-resourced. In order for women to receive the best possible care, midwives need to be adequately trained in evidence-based practice.  This is the basis of the work being carried out at the Centre for Global Women’s Health (WHO Collaborating Centre), at the University of Manchester (UoM).

Aimed at improving the health of women and children in low and middle income countries, the Centre has an established relationship with the Lugina Africa Midwives Research Network (LAMRN), which comprises 6 countries in Sub-Saharan Africa (Kenya, Tanzania, Uganda, Malawi, Zambia and Zimbabwe). The development of this Network has been possible through multi-country partnership funding and two additional funded projects from the Tropical Health Education Trust (THET).

Over the last 5 years, the UoM team have led capacity building projects in the LAMRN countries which have involved training midwives in evidence-based practice, research methodology and clinical audit. To date we have trained over 300 midwives.

When we started this project, midwifery-led research, in the ECSA region, was in its infancy resulting in poor availability of data and a lack of information to deal with complex health issues. Midwives wishing to develop their academic skills had been obliged to migrate to developed countries which offer postgraduate courses unavailable within their region. Whilst midwives were aware of evidence based practice this needed further development and dissemination across wider practice areas. Furthermore, whilst midwives had contributed to the research of other disciplines, few were independent researchers.

We aimed to improve and increase midwifery research generated in sub-Saharan Africa and strengthen evidence-based practice. To do this we had a number of activities including training workshops, conferences, learning and sharing events, on-line discussion boards, ‘buddying’ between UK and Africa members and mentoring of research projects. All our activities were based on the principles of evidence based practice and support by national and international guidelines (World Health Organization).

The project has been extremely successful in developing a group of midwives who now share a passion for research and evidence based practice. The Delphi technique was used to identify locally relevant research priorities and questions and these informed the completion of 27 projects. Involving all LAMRN participants in the identification of research priorities also contributed to creating a strong sense of local ownership for the research activities. The participatory teaching style and mentoring through an actual research project exposed participants to the reality of conducting research. Midwives reported a rich learning experience in comparison with more traditional didactic teaching methods.

LAMRN midwives demonstrated increased capability and confidence to engage in research through completion and presentation of research projects and in mentoring others to do research. This is reflected by over 20 peer reviewed publications and over 50 presentations.  Most midwives developed their research skills, as demonstrated in the evaluation survey conducted by independent evaluators (Capacity Development International), with 100% of participants indicating either significant improvement (64%) or some improvement (36%) in skills relating to research identification and methodologies. Similar results were shown related to improvement in skills relating to conducting research (62% significant improvement and 36% some improvement).

Our latest THET-supported projects aim to increase skills in clinical audit to improve outcomes for mothers and babies. We can demonstrate a number of positive outcomes as a direct result of these projects:

Zimbabwe: 

Mpilo- Respectful care improved in all areas, but the biggest improvement reported was a reduction in physical abuse in labour from 23.9% (baseline) to 6.8% (re-audit).

Harare – Wound care post caesarean section. Baseline audit figures revealed 22% of wounds assessed on exposure and subsequently. At re-audit 100% of wounds were assessed, meeting the audit standard.

Kenya:

Kenyatta – Postpartum haemorrhage – There was a 74% increase in women being given information about what was being done to her, and a 33% increase in 2 wide bore catheters being inserted.

Zambia:

Mansa – A re-audit of care was conducted and there was marked improvement in adherence to the set standards in trying to reduce factors contributing to intrapartum fresh stillbirths

Uganda:

Jinja Hospital:  Criterion audit demonstrated a 70% increase in observing vaginal blood loss within 1 hour of birth following staff education sessions.

The latest capacity building project is focussing on promoting south-south support. To this end, the previously trained Ugandan team of midwives are now supporting the clinical audit training of midwives in Tanzania. This will strengthen capacity building and will optimise the sustainability of clinical audit within the region.