A model for midwives towards the facilitation of childbirth choices among women in selected public healthcare facilities in Namibia
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Date
2022
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Publisher
University of Namibia
Abstract
The facilitation of childbirth-choices is the epitome in rendering patient centred care to ensure that women make informed decisions regarding their care. The rights of women in ensuring decision making and affording women choices regarding childbirth types is critical for the emotional wellbeing of the women and positive birth experiences. In the public healthcare institutions in Namibia, women have no choices but rather have assumed choices and as such they receive no or little information on childbirth types. The objectives of the study were encapsulated in four phases which were: identification and analysis of concepts (Phase one); define, classify and conceptualise concepts as a basis of model development [Phase two]; developing, describing and evaluating the model (Phase three), and developing and describing the guidelines for the model (Phase four). A mixed method approach with a convergent parallel design was used in the study. In Phase one of the study a scoping review was adopted to identify the best practices in the facilitation of childbirth-choices, whereas the qualitative approach with purposive sampling was adopted for the experiences of midwives and women. In addition, a quantitative approach with stratification was applied to identify the different childbirth types in the selected healthcare facilities. Ethical clearance was accorded by the University of Namibia Research Ethics Committee, Ministry of Health and Social Services, the selected healthcare facilities and the sampled research participants. Four participating hospitals, 1446 maternal files, 10 midwives, 12 women and 30 articles formed the sample for the study. Qualitative data were analysed through the six steps proposed by Creswell, and quantitative data were analysed through Statistical Package for the Social Sciences (version 26). The study results were merged (Phase one and two) and they corroborated well together in the discussion of the facilitation of childbirth-choices. In the study, the results showed that facilitation is a process to be done timely and women need to be accorded some reasonable time to decide. In the scoping review, results showed that the facilitation of childbirth-choices should include shared decision making, patient centred care, the implementation of protocols and guidelines at all levels, informed consent or choice and the giving of unbiased information. The experiences of midwives in this study echoed barriers in the facilitation of childbirth choices as they expressed the shortages of staff, timing of information, information sharing as well as cultural influences. Furthermore, midwives shared a lack of provision for childbirth choices as the rights of women were not observed and a lack of women centred care despite protocols and guidelines hence, they are not adhered to. In addition, women in this study iii affirmed that they have inadequate information of the childbirth types and they were unsure and or surprised that they had choices, and lacked shared decision making and childbirth choices. The women also indicated that the timing of the information was late or impromptu, thereby making informed decisions difficult. Moreover, antenatal attendance in this study was 96.7%, with childbirth distribution showcasing vaginal birth 76% and caesarean section 24%. Of the 24% of caesarean sections performed, 10.44% was attributed to repeat caesarean section and 4.77% to foetal distress. In conclusion, a model was developed and described (Phase three) based on the study findings to help in the facilitation of childbirth-choices among women. The developed model was evaluated following the considerations by Fawcett. Guidelines to operationalise the model (Phase four) were developed guided by the study results and best practices. Facilitation is of paramount importance in ensuring that women are involved in the decision making when they have accurate information and with that, they will be able to make informed choices. The right to information and the autonomy of women should not be infringed as this yields positive childbirth experiences. Midwives have the mandate to treat each woman individually hence woman centred care will be attained. Further studies need to be conducted in the private sector as well.
Description
A dissertation submitted in fulfilment of the requirements for the Degree of Doctor of Philosophy (Nursing Science)
Keywords
Facilitation, Childbirth-choices, Woman centred care, Decision making