Midwives’ experiences and perceptions of the implementation of maternal care guidelines regarding screening and management of hypertensive disorders in pregnancy in Polokwane Municipality, Limpopo

Abstract

Midwives play a crucial role in ensuring high quality maternity care through evidence-based guidelines. Their practice is grounded in the utilisation of evidence-based guidelines, which serve as a foundation for their decision-making process, ensuring timely and effective interventions. However, despite the availability of these guidelines, approximately 830 women globally die every day due to preventable causes related to pregnancy and childbirth, of which 119 out of 100,000 women in South Africa. Existing literature indicates that hypertensive disorders of pregnancy, such as preeclampsia and eclampsia, are the leading causes of maternal mortality. The incidences are not declining and continue to be associated with unfavourable pregnancy outcomes. There is a paucity of literature focusing on midwives’ experiences and perceptions of the implementation of these guidelines. Therefore, this study aimed to assess midwives’ experiences and perceptions of the implementation of maternal care guidelines regarding screening and managing hypertensive disorders in pregnancy in Polokwane Municipality, Capricorn District, Limpopo Province. The Promoting Action on Research Implementation in Health Services (PARIHS) theoretical framework underpinned this qualitative, exploratory-descriptive, and contextual study. The setting was primary healthcare clinics, a community health centre, and district hospitals in Polokwane Local Municipality, Capricorn District, Limpopo Province, South Africa. Participants were purposively selected midwives working in the study setting, with a minimum of one year of experience, having managed hypertensive disorders during pregnancy. A qualitative study design was adopted, with an exploratory, descriptive, and contextual approach. A total of 23 face-to-face, semi-structured, individual interviews were conducted. Data was transcribed verbatim using TurboScribe AI. Data analysis was conducted by the researcher and an independent coder, following Braun and Clarke’s six-phase approach to thematic analysis. Three primary themes emerged: midwives expressed caring in their practices, enhanced by the guidelines. However, they also described experiencing obstacles that hamper the implementation of maternal care guidelines during the screening and management of hypertensive disorders in pregnancy. They highlighted that women are not taking ownership of and involvement in their care due to personal challenges. An independent coder was employed to ensure trustworthiness and enhanced research quality. The study adhered to ethical principles guided by the Belmont Report: credibility, confirmability, and dependability. The researcher formulated seven recommendations based on the thematic findings.Thesis (MCur) -- Faculty of Health Sciences, School of Clinical Care & Medicinal Sciences, 202