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- Möller, Ann-Beth, et al.
(author)
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Are midwives ready to provide quality evidence-based care after pre-service training? Curricula assessment in four countries-Benin, Malawi, Tanzania, and Uganda.
- 2022
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In: PLOS global public health. - : Public Library of Science (PLoS). - 2767-3375. ; 2:9
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Journal article (peer-reviewed)abstract
- This research sought to map midwifery pre-service training curricula as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity in sub-Saharan Africa (ALERT) project conducted in Benin, Malawi, Tanzania, and Uganda. We conducted the review in two phases. In the first phase, online interviews were performed with the lead project midwives in all four study countries to get an overview of midwifery care providers' pre-service training courses, registration, and licensing requirements. We performed a mapping review of midwifery care providers' pre-service training curricula from different training institutions in the four study countries during the second phase. Curricula were reviewed and mapped against the International Confederation of Midwives (ICM) Essential Competencies framework to assess whether these curricula included the minimum essential training components described in the ICM framework. We identified 10 different professional titles for midwifery care providers. The number of years spent in pre-service training varied from one and a half to four years. Ten pre-service curricula were obtained and the assessment revealed that none of the curricula included all ICM competencies. Main gaps identified in all curricula related to women-centred care, inclusion of women in decision making, provision of care to women with unintended or mistimed pregnancy, fundamental human rights of individuals and evidence-based learning. This review suggests that there are skills, knowledge and behaviour gaps in pre-service training curricula for midwifery care providers when mapped to the ICM Essential Competencies framework. These gaps are similar among the different training courses in participating countries. The review also draws attention to the plethora of professional titles and different pre-service training curricula within countries. Trial registration: PACTR202006793783148-June 17th, 2020.
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| 2. |
- Möller, Ann-Beth, et al.
(author)
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Midwifery care providers' childbirth and immediate newborn care competencies: A cross-sectional study in Benin, Malawi, Tanzania and Uganda.
- 2023
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In: PLOS global public health. - 2767-3375. ; 3:6
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Journal article (peer-reviewed)abstract
- Evidence-based quality care is essential for reducing sub-Saharan Africa's high burden of maternal and newborn mortality and morbidity. Provision of quality care results from interaction between several components of the health system including competent midwifery care providers and the working environment. We assessed midwifery care providers' ability to provide quality intrapartum and newborn care and selected aspects of the working environment as part of the Action Leveraging Evidence to Reduce perinatal morTality and morbidity (ALERT) project in Benin, Malawi, Tanzania, and Uganda. We used a self-administered questionnaire to assess provider knowledge and their working environment and skills drills simulations to assess skills and behaviours. All midwifery care providers including doctors providing midwifery care in the maternity units were invited to take part in the knowledge assessment and one third of the midwifery care providers who took part in the knowledge assessment were randomly selected and invited to take part in the skills and behaviour simulation assessment. Descriptive statistics of interest were calculated. A total of 302 participants took part in the knowledge assessment and 113 skills drills simulations were conducted. The assessments revealed knowledge gaps in frequency of fetal heart rate monitoring and timing of umbilical cord clamping. Over half of the participants scored poorly on aspects related to routine admission tasks, clinical history-taking and rapid and initial assessment of the newborn, while higher scores were achieved in active management of the third stage of labour. The assessment also identified a lack of involvement of women in clinical decision-making. Inadequate competency level of the midwifery care providers may be due to gaps in pre-service training but possibly related to the structural and operational facility characteristics including continuing professional development. Investment and action on these findings are needed when developing and designing pre-service and in-service training. Trial registration: PACTR202006793783148-June 17th, 2020.
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| 3. |
- Portz, Suniva, et al.
(author)
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Midwives and obstetricians’ attitudes towards VBAC: Development and validation of the HCAV-scale
- 2021
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In: Sexual and Reproductive Healthcare. - : Elsevier BV. - 1877-5756. ; 27
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Journal article (peer-reviewed)abstract
- Objective: To develop a scale that measures attitudes towards vaginal birth after caesarean (VBAC) among clinicians. Methods: A cross sectional survey among midwives (n = 58) and obstetricians (n = 51). A 23-item “Hannover Clinicians’ Attitudes towards VBAC scale” (HCAV–scale) was developed. Indicators of reliability and validity were assessed, including item-to-total correlation, Cronbach alpha coefficient and factor analysis. Results: The response rate was 35.3% (n = 109). The HCAV–scale showed high construct validity and high internal consistency. The Cronbach alpha coefficient of the 23 items was 0.87 (n = 89), indicating good internal consistency of the items. Exploratory factor analysis resulted in factor loadings between 0.34 and 0.70; all 23 items loaded above 0.3 on one factor, providing evidence that the scale can be conceptualized as one dimensional. Conclusions: The HCAV–scale is a reliable and valid tool to assess clinicians’ favourable attitudes towards VBAC. The scale can be used to assess how attitudes of clinicians might contribute to institutional variations in VBAC rates, and has the potential to enhance inter-professional understanding and collaboration around VBAC and quality of care for childbearing people with a previous caesarean.
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