Exploring women's experience of fundal pressure during the second stage of labour

Background and Aim: Despite the use of fundal pressure globally, there is a scarcity of information available on how women experience the application of uterine fundal pressure (UFP) during the second stage of labour. The aim of study was to explore the experiences of women concerning UFP application during the second stage of labour. Understanding women’s perception about UFP is important in informing the generation of new ideas to improve on the application of UFP for better outcomes. Methods: This was a qualitative, interpretive, and phenomenological analysis designed to explore the experiences of women regarding the application of UFP during the second stage of labour. Hermeneutics was applied to interpret the participants’ descriptions of their experiences as they tried to make sense of their exposure to UFP; bearing this in mind, the participants’ own interpretation was not distorted. The researcher immersed herself in each transcript, in order to make sense of each participant’s experiences and to gain a sense of what the participant had experienced during UFP application. Each interview was transcribed and analysed independently; and the convergences and divergences of themes were identified without losing the original meaning of each participant’s description before moving on to the subsequent interviews. The target population was women who had had UFP during second stage of labour. A purposive sampling method was used to select three women who were admitted to the DVDHMOU during the research period and who met the inclusion criteria. Information was collected through individual face-to-face interviews and semi-structured interview guide. The principal question was framed as: “Can you please share with me how you felt when the midwives pushed on your tummy to get the baby out”? An audio tape was used to record the interviews, and a notepad was used to make notes of gestures such smiles or other facial expressions. After each interview, the recorded interview was transferred onto a laptop and a file was opened for the interviewee, identified by a pseudonym. The interviews were transcribed verbatim as Word documents. Trustworthiness was maintained by applying the principles of credibility, transferability, dependability and conformability. Ethical approval was granted by the Ethical Committee of the University of Fort Hare. Permission to conduct the study was sought from the Eastern Cape Research Committee and Buffalo City Metropolitan Health District. Informed consent was obtained from the participants prior to data collection. Each interview was analysed separately after completion. Data was analysed using thematic content analysis applicable to interpretative phenomenological analysis (IPA) studies using six steps: reading and re-reading; initial noting; developing emergent themes; searching for connections across the emergent themes; moving to the next case; and lastly, looking for patterns across cases. Findings: The findings of this study indicated that the informants had feelings of fear, loneliness, worry and tearfulness; but also happiness associated with UFP during second stage of labour. They were also worried and expressed fear and anxiety concerning their infants; and their ability to give birth increased as they get tired in the process of pushing during UFP application. However, seeing their infants for the first time took most of the worries away, and all informants expressed relief when the birthing process was over. They also felt that their birthing experience was a very painful event; and were left alone, and they had not been given anything to drink or eat during labour. Midwives threatened them that their inability to pushing appropriately, could cause the death of their infants, leaving them with feelings of guilt and despair when their babies did not cry directly after birth. The findings demonstrated that midwives did not properly inform women what to expect during the second stage of their labour, whilst the midwives expected birthing mothers to know what was happening to them and how to react. Women in labour therefore depended almost entirely on information received from family members, and went into labour with preconceived ideas about labour pain. Although women do experience pain during the second stage of labour, the application UFP increased their pain. Four main themes emerged from the analysis, which are: perceived severity of UFP pain,emotional/physical reaction to UFP pain, perceptions of UFP and perception of midwives care and treatment. Conclusion: The uterine fundal pressure is not a pleasant experience for the women in the second stage of labour. Labouring women experienced pain, fear, and anxiety. However, they felt a sense of happiness after delivery. Before the application of UFP during the second stage of labour, midwives should explain to women the process of UFP application and what they can expect to happen; and where possible, and after explaining the procedure, midwives should get written permission before they apply the intervention during labour

A comparative analysis of teenagers and older pregnant women concerning maternal and neonatal adverse outcomes in Raymond Mhlaba sub-District, South Africa

Teenage pregnancy has become a common global public health issue, associated with increased risk of obstetric complications and adverse neonatal outcomes. Teenagers are more prone to obstetric complications compared to older women. This study examined the maternal and neonatal adverse outcomes among teenagers, and compared them with older pregnant women. This study extracted maternal and neonatal adverse outcomes from 196 medical records of women delivered at Fort Beaufort Hospital from April 2017 to March 2018. Teenagers developed anaemia (13%) and pre-eclampsia (2.1%) during pregnancy as compared to older pregnant women. Most of the women delivered through normal vertex, although the teenagers had the highest percentage of caesarean section (27%) compared to the older women. Few proportions of women developed complications during delivery, however, obstructed labour (14.7%), prolonged labour (11.5%), foetal distress (14.8%) was more prevalent in teenagers. Most neonates were delivered at preterm birth and were alive across all age groups. However, few of the preterm births (23.2%) and very premature neonates (7.4%) occurred among the teenager mothers compared to older women. Few neonates had an Apgar score of less than 7in 1 minute across all age groups. The risk of obstructed labour, prolonged labour, and foetal distress was predominant among teenagers compared to the older women. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. The findings of this study revealed that the teenagers start booking at the second trimester, which may impose the risk of complications if not observed at an early stage. There was high incidence of vaginal deliveries, preterm babies and low Apgar score among teenagers compared to the older women. Programmes to support early antenatal bookings for teenagers are important to address adverse maternal complications associated with late antenatal bookings. Keywords: Teenage pregnancy, Maternal and neonatal adverse outcomes, Older pregnant women, South Africa La grossesse chez les adolescentes est devenue un problème de santé publique mondial courant, associé à un risque accru de complications obstétricales et d'issues néonatales défavorables. Les adolescentes sont plus sujettes aux complications obstétricales que les femmes plus âgées. Cette étude a examiné les résultats indésirables maternels et néonatals chez les adolescents et les a comparés à ceux des femmes enceintes plus âgées. Cette étude a extrait les résultats indésirables maternels et néonatals de 196 dossiers médicaux de femmes accouchées à l'hôpital de Fort Beaufort d'avril 2017 à mars 2018. Les adolescentes ont développé une anémie (13%) et une pré-éclampsie (2,1%) pendant la grossesse par rapport aux femmes enceintes plus âgées. La plupart des femmes ont accouché par un sommet normal, bien que les adolescentes aient eu le pourcentage le plus élevé de césarienne (27%) par rapport aux femmes plus âgées. Peu de proportions de femmes ont développé des complications lors de l'accouchement, cependant, le travail dystocique (14,7%), le travail prolongé (11,5%) et la détresse fœtale (14,8%) étaient plus fréquents chez lesadolescentes. La plupart des nouveau-nés ont été nés prématurément et étaient vivants dans tous les groupes d'âge. Cependant, peu de naissances prématurées (23,2%) et de nouveau-nés très prématurés (7,4%) sont survenues parmi les mères adolescentes par rapport aux femmes plus âgées. Peu de nouveau-nés avaient un score Apgar inférieur à 7 en 1 minute dans tous les groupes d'âge. Le risque de dystocie, de travail prolongé et de détresse fœtale était prédominant chez les adolescents par rapport aux femmes plus âgées. Il y avait une incidence élevée d'accouchements vaginaux, de bébés prématurés et un faible score d'Apgar chez les adolescents par rapport aux femmes plus âgées. Les résultats de cette étude ont révélé que les adolescents commencent à réserver au deuxième trimestre, ce qui peut entraîner un risque de complications s'il n'est pas observé à un stade précoce. Il y avait une incidence élevée d'accouchements vaginaux, de bébés prématurés et un faible score d'Apgar chez les adolescents par rapport aux femmes plus âgées. Les programmes visant à soutenir les réservations prénatales précoces pour les adolescents sont importants pour lutter contre les complications maternelles indésirables associées aux réservations prénatales tardives. Mots-clés: Grossesse chez les adolescentes, Résultats indésirables maternels et néonatals, Femmes enceintes âgées, Afrique du Su

Development of a strategy to promote prenatal physical activity participation among women in Buffalo City Municipality, South Africa

Research has proven that prenatal physical activity practice is associated with multiple health benefits; however, most women in South Africa rarely participate in prenatal physical activity. In contrast to more developed countries, there is dearth of research focusing specifically on prenatal physical activity and exercise among South African women. Nevertheless, in order to effectively, and strategically promote such prenatal activity, such information is important to plan for an intervention strategy. The main aim of this study was to assess the level, patterns, and associated factors of prenatal physical activity; beliefs, knowledge, attitudes, perceived benefits, and sources of information women received during pregnancy; and, furthermore, to develop an effective and relevant intervention strategy to facilitate the participation in this particular activity in Buffalo City Municipality, Eastern Cape, South Africa. Methods The study was a mixed-method, cross-sectional study design with both quantitative and qualitative data collection and analyses. The sequential explanatory design was adopted to merge and mix different datasets to be collected and analysed. The quantitative data involved a convenient sample of 1082 pregnant women in 12 randomly selected primary healthcare clinics offering antenatal health services in Buffalo City, Eastern Cape. The Pregnancy Physical Activity Questionnaire was interviewer-administered to women at each antenatal health clinic on pre-specified days, in a designated room allocated to the primary researcher by the health facility manager. The descriptive statistics were frequency distribution, percentages, mean and standard deviation. Furthermore, the bivariate and multivariate analyses were performed on two categories of participants, namely inactive or active, to determine the factors affecting prenatal physical activity behaviour. Furthermore, multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels, and the associations between prenatal physical activity levels and socio-demographic, lifestyle, and obstetrics characteristics were determined using a chi-squared analyses. The significance level was set at p = 0.05. In addition, a qualitative descriptive approach was applied, using semi-structured face-to-face interviews with 15 purposively selected pregnant women, as well as 17 midwives offering antenatal health-care services to pregnant women in the 12 selected healthcare clinics. Qualitative data were analysed using a thematic content analysis. To develop the physical activity strategy for the promotion of prenatal physical activity practice, three frameworks were applied, namely the Strength, Weakness, Opportunity and Threat (SWOT), the Political, Economic Growth, Socio-Cultural, Technological, Laws and Environmental (PESTLE), and, lastly, the Build, Overcome, Explore and Minimise (BOEM) analytical frameworks. To facilitate the validation of the strategy, the findings were additionally analysed, after which, appropriate intervention strategies promoting prenatal physical activity were developed by again using the SWOT and PESTLE analytical strategic frameworks. This process involved a purposive sampling of seven experts with knowledge of and a proven academic and scholarly background in prenatal physical activity and maternal health. Next, the developed physical activity strategy was presented to various stakeholders, which included six primary healthcare managers, two midwives, and pregnant women purposively selected in each of the 12 chosen antenatal health clinics for the validation process. The stakeholders discussed, deliberated on, and provided comments and opinions of the feasibility and implementation of the developed prenatal physical activity for promotion of physical activity practices in the Eastern Cape Province. Results The findings of this particular study demonstrated low levels of prenatal physical activity among pregnant women, and, further indicated that the most preferred form of activity was light-intensity and household activities. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate–vigorous physical activity was 151.6 min (95% CI: 147.2– 156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8–67.0), and 47.6% (95% CI: 46.3–48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16–0.76), semi-urban residence (AOR = 0.8; CI: 0.55–1.03), lower educational level (AOR = 0.5; CI: 0.20–0.71), unemployment (AOR = 0.5; CI: 0.29–0.77) and nulliparity (AOR = 0.6; CI: 0.28–1.31) were negatively associated with prenatal physical activity, while prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06–3.31) compared to other trimesters. In addition, the pregnant women were aware of the safety (88.2%) and benefits of physical activity for both mother and baby (79.6%), improved labour and delivery (93.1%), promote energy (89.0%), and should be discontinued when tired (76.6%). However, they also held the contradictory belief that pregnancy is “a time to rest” (56.5%). Furthermore, the most common sources of information about prenatal physical activity were the media, television, the radio and Internet-based websites (70.2%). Most women affirmed that prenatal physical activity reduced infant weight (61.4%), lessen moodiness (90.4), decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). The majority of women indicated that prenatal physical activity improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%). The results from the quantitative data revealed that the major modifiable barriers to prenatal physical activity were tiredness (73.3%), lack of advice from healthcare professionals (nurses/midwives) (64.7%), low energy (64.5%), and non-accessibility to physical activity facilities (63.0%). The results were confirmed in the qualitative data, based on the Ecological Model, in which women also mentioned tiredness, work and household responsibilities, a lack of motivation, and the lack of physical activity advice and information on the relevant recommendations and guidelines. Overall, 62.4% women had high knowledge regarding prenatal physical activity; and half of the women showed a positive attitude toward it (50.1%). Whilst participants had knowledge of other types of antenatal exercises, 80.9% of the women had no knowledge of swimming exercise. Negative attitudes towards physical activity included the feeling of tiredness (67.7%), lack of interest (64.8%), and inadequate information on physical activity (59.5%). In addition, the study highlighted that midwives rarely educate and counsel pregnant women about prenatal physical activity during scheduled antenatal visits, which was attributed largely to the shortage of midwives handling many responsibilities at clinics. Nevertheless, the midwives did express a willingness to provide effective physical activity education and counselling on prenatal physical activity, if supported by relevant training and workshops. Furthermore, they further recommended the use of the Mom Connect application, which is a technological device designed by the National Department of Health, to distribute relevant information about maternal and child health. The prenatal physical activity strategies developed to address the above-mentioned and other barriers associated with prenatal physical activity include the use of scientific and technological innovations to provide basic information on prenatal physical activity to pregnant women by means of Mom Connect, and, by collaborating with the various cellphone and network companies in South Africa. Another strategy was to integrate prenatal physical activity training into the curricula of the existing higher institutions of learning that provide teaching of maternal health in the Eastern Cape Province. Additional strategies included the documentation and subsequent clarification of misconceptions about the safety concerns often associated with prenatal physical activity by making the documents accessible to all women at the clinics in the form of a small pamphlet or booklet. Lastly, stakeholders suggested that the government offer periodic prenatal physical activity campaigns, which should be presented in local community town halls and clinics and by other stakeholders to address the current lack of awareness and effectively eliminate misrepresentations and falsehoods around the safety of prenatal physical activity within geographical setting of the Eastern Cape Province. Conclusion Despite the advantages of prenatal physical activity practices, most pregnant women in South Africa do not participate in moderate-intensity physical activity. Notably, while women perceive prenatal physical activity as beneficial to both mother and baby, such theoretical knowledge is not easily translatable into practice. The predominant sources of information on prenatal physical activity are the television, the radio, and other media, which may be potentially misleading or contradictory to evidence-based physical activity practice. Furthermore, tiredness, a lack of time, work and household responsibilities, and a lack of motivation were major modifiable barriers to prenatal physical activity by the women. In addition, pregnant women rarely receive information on prenatal physical activity. Consequently, to address the needs of the pregnant women as highlighted in this study, a prenatal physical activity intervention strategy was developed and validated by key stakeholders to promote prenatal physical activity and exercise practice among women, taken in account the local context.Thesis (PhD) -- Faculty of Health Sciences, 202

Development of a strategy to promote prenatal physical activity participation among women in Buffalo City Municipality, South Africa

Research has proven that prenatal physical activity practice is associated with multiple health benefits; however, most women in South Africa rarely participate in prenatal physical activity. In contrast to more developed countries, there is dearth of research focusing specifically on prenatal physical activity and exercise among South African women. Nevertheless, in order to effectively, and strategically promote such prenatal activity, such information is important to plan for an intervention strategy. The main aim of this study was to assess the level, patterns, and associated factors of prenatal physical activity; beliefs, knowledge, attitudes, perceived benefits, and sources of information women received during pregnancy; and, furthermore, to develop an effective and relevant intervention strategy to facilitate the participation in this particular activity in Buffalo City Municipality, Eastern Cape, South Africa. Methods The study was a mixed-method, cross-sectional study design with both quantitative and qualitative data collection and analyses. The sequential explanatory design was adopted to merge and mix different datasets to be collected and analysed. The quantitative data involved a convenient sample of 1082 pregnant women in 12 randomly selected primary healthcare clinics offering antenatal health services in Buffalo City, Eastern Cape. The Pregnancy Physical Activity Questionnaire was interviewer-administered to women at each antenatal health clinic on pre-specified days, in a designated room allocated to the primary researcher by the health facility manager. The descriptive statistics were frequency distribution, percentages, mean and standard deviation. Furthermore, the bivariate and multivariate analyses were performed on two categories of participants, namely inactive or active, to determine the factors affecting prenatal physical activity behaviour. Furthermore, multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels, and the associations between prenatal physical activity levels and socio-demographic, lifestyle, and obstetrics characteristics were determined using a chi-squared analyses. The significance level was set at p = 0.05. In addition, a qualitative descriptive approach was applied, using semi-structured face-to-face interviews with 15 purposively selected pregnant women, as well as 17 midwives offering antenatal health-care services to pregnant women in the 12 selected healthcare clinics. Qualitative data were analysed using a thematic content analysis. To develop the physical activity strategy for the promotion of prenatal physical activity practice, three frameworks were applied, namely the Strength, Weakness, Opportunity and Threat (SWOT), the Political, Economic Growth, Socio-Cultural, Technological, Laws and Environmental (PESTLE), and, lastly, the Build, Overcome, Explore and Minimise (BOEM) analytical frameworks. To facilitate the validation of the strategy, the findings were additionally analysed, after which, appropriate intervention strategies promoting prenatal physical activity were developed by again using the SWOT and PESTLE analytical strategic frameworks. This process involved a purposive sampling of seven experts with knowledge of and a proven academic and scholarly background in prenatal physical activity and maternal health. Next, the developed physical activity strategy was presented to various stakeholders, which included six primary healthcare managers, two midwives, and pregnant women purposively selected in each of the 12 chosen antenatal health clinics for the validation process. The stakeholders discussed, deliberated on, and provided comments and opinions of the feasibility and implementation of the developed prenatal physical activity for promotion of physical activity practices in the Eastern Cape Province. Results The findings of this particular study demonstrated low levels of prenatal physical activity among pregnant women, and, further indicated that the most preferred form of activity was light-intensity and household activities. Only 278 of the women (25.7%) met recommendations for prenatal activity (≥150 min moderate intensity exercise per week). The average time spent in moderate–vigorous physical activity was 151.6 min (95% CI: 147.2– 156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8–67.0), and 47.6% (95% CI: 46.3–48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Lower age (<19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16–0.76), semi-urban residence (AOR = 0.8; CI: 0.55–1.03), lower educational level (AOR = 0.5; CI: 0.20–0.71), unemployment (AOR = 0.5; CI: 0.29–0.77) and nulliparity (AOR = 0.6; CI: 0.28–1.31) were negatively associated with prenatal physical activity, while prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06–3.31) compared to other trimesters. In addition, the pregnant women were aware of the safety (88.2%) and benefits of physical activity for both mother and baby (79.6%), improved labour and delivery (93.1%), promote energy (89.0%), and should be discontinued when tired (76.6%). However, they also held the contradictory belief that pregnancy is “a time to rest” (56.5%). Furthermore, the most common sources of information about prenatal physical activity were the media, television, the radio and Internet-based websites (70.2%). Most women affirmed that prenatal physical activity reduced infant weight (61.4%), lessen moodiness (90.4), decreased risk of gestational diabetes mellitus (92.9%), pregnancy-induced hypertension (92.5%), and complications at birth (97.8%), while common negative perceptions included musculoskeletal discomfort (82.7%), and back pain (85.7%). The majority of women indicated that prenatal physical activity improved self-image (95.7%), sleep patterns (94.2%), and respiratory function (95.8%). The results from the quantitative data revealed that the major modifiable barriers to prenatal physical activity were tiredness (73.3%), lack of advice from healthcare professionals (nurses/midwives) (64.7%), low energy (64.5%), and non-accessibility to physical activity facilities (63.0%). The results were confirmed in the qualitative data, based on the Ecological Model, in which women also mentioned tiredness, work and household responsibilities, a lack of motivation, and the lack of physical activity advice and information on the relevant recommendations and guidelines. Overall, 62.4% women had high knowledge regarding prenatal physical activity; and half of the women showed a positive attitude toward it (50.1%). Whilst participants had knowledge of other types of antenatal exercises, 80.9% of the women had no knowledge of swimming exercise. Negative attitudes towards physical activity included the feeling of tiredness (67.7%), lack of interest (64.8%), and inadequate information on physical activity (59.5%). In addition, the study highlighted that midwives rarely educate and counsel pregnant women about prenatal physical activity during scheduled antenatal visits, which was attributed largely to the shortage of midwives handling many responsibilities at clinics. Nevertheless, the midwives did express a willingness to provide effective physical activity education and counselling on prenatal physical activity, if supported by relevant training and workshops. Furthermore, they further recommended the use of the Mom Connect application, which is a technological device designed by the National Department of Health, to distribute relevant information about maternal and child health. The prenatal physical activity strategies developed to address the above-mentioned and other barriers associated with prenatal physical activity include the use of scientific and technological innovations to provide basic information on prenatal physical activity to pregnant women by means of Mom Connect, and, by collaborating with the various cellphone and network companies in South Africa. Another strategy was to integrate prenatal physical activity training into the curricula of the existing higher institutions of learning that provide teaching of maternal health in the Eastern Cape Province. Additional strategies included the documentation and subsequent clarification of misconceptions about the safety concerns often associated with prenatal physical activity by making the documents accessible to all women at the clinics in the form of a small pamphlet or booklet. Lastly, stakeholders suggested that the government offer periodic prenatal physical activity campaigns, which should be presented in local community town halls and clinics and by other stakeholders to address the current lack of awareness and effectively eliminate misrepresentations and falsehoods around the safety of prenatal physical activity within geographical setting of the Eastern Cape Province. Conclusion Despite the advantages of prenatal physical activity practices, most pregnant women in South Africa do not participate in moderate-intensity physical activity. Notably, while women perceive prenatal physical activity as beneficial to both mother and baby, such theoretical knowledge is not easily translatable into practice. The predominant sources of information on prenatal physical activity are the television, the radio, and other media, which may be potentially misleading or contradictory to evidence-based physical activity practice. Furthermore, tiredness, a lack of time, work and household responsibilities, and a lack of motivation were major modifiable barriers to prenatal physical activity by the women. In addition, pregnant women rarely receive information on prenatal physical activity. Consequently, to address the needs of the pregnant women as highlighted in this study, a prenatal physical activity intervention strategy was developed and validated by key stakeholders to promote prenatal physical activity and exercise practice among women, taken in account the local context.Thesis (PhD) -- Faculty of Health Sciences, 202

Perceptions of women of reproductive age towards maternal death in Qaukeni sub-District, Eastern Cape Province, South Africa: A qualitative study

Maternal mortality is a global problem, particularly in developing countries. This study explored perceptions, knowledge and attitudes of women of reproductive age concerning maternal deaths in Qaukeni Sub-District, Eastern Cape Province, South Africa. This was a community-based qualitative study using using in-depth interviews among women of reproductive age. Data was analyzed using thematic analysis. The study found some of the mothers knew the causes, signs and symptoms of pregnancy as well as danger signs during pregnancy such as haemorrhage, sepsis, high blood pressure and complications of unsupervised home deliveries, while others had little knowledge about these signs and symptoms. The participants indicated that using herbal medications during pregnancy could result to serious complications and even maternal death. Women do not attend antenatal care because of the long distances, absence of clinics, shortage of nurses and doctors; thus, predisposing women to deliver at homeswith the assistance of traditional birth attendants, who had limited knowledge related to health issues and the Prevention of Motherto-Child-Transmission programme. The findings indicated that some women are knowledgeable about the causes of maternal deaths during pregnancy as well as the signs and symptoms of pregnancy. Health education during pregnancy and provision of better resources would help improve the maternal health of women in this rural setting. Keywords: Mothers, Maternal deaths, Perceptions, Knowledge and attitudes, South AfricaLa mortalité maternelle est un problème mondial, en particulier dans les pays en développement. Cette étude a exploré les perceptions, les connaissances et les attitudes des femmes en âge de procréer concernant les décès maternels dans le sous-district de Qaukeni, province du Cap oriental, Afrique du Sud. Il s'agissait d'une étude qualitative communautaire utilisant des entretiens approfondis auprès de femmes en âge de procréer. Les données ont été analysées à l'aide d'une analyse thématique. L'étude a révélé que certaines mères connaissaient les causes, les signes et les symptômes de la grossesse ainsi que les signes de danger pendant la grossesse tels que l'hémorragie, la septicémie, l'hypertension artérielle et les complications des accouchements à domicile non supervisés, tandis que d'autres avaient peu de connaissances sur ces signes et symptômes. Les participantes ont indiqué que l'utilisation de médicaments à base de plantes pendant la grossesse pouvait entraîner de graves complications et même la mort maternelle. Les femmes ne se rendent pas aux soins prénatals en raison des longues distances, de l’absence de dispensaires, du manque d’infirmières et de médecins; ainsi, prédisposant les femmes à accoucher à domicile avec l'aide des accoucheuses traditionnelles, qui avaient des connaissances limitées sur les problèmes de santé et le programme de prévention de la transmission mère-enfant. Les résultats indiquent que certaines femmes connaissent les causes des décès maternels pendant la grossesse ainsi que les signes et symptômes de la grossesse. L'éducation sanitaire pendant la grossesse et la fourniture de meilleures ressources contribueraient à améliorer la santé maternelle des femmes dans ce milieu rural. Mots-clés: Mères, décès maternels, perceptions, connaissances et attitudes, Afrique du Su

Development and Validation of Prenatal Physical Activity Intervention Strategy for Women in Buffalo City Municipality, South Africa

Women rarely participate in physical activity during pregnancy, despite scientific evidence emphasising its importance. This study sought to develop an intervention strategy to promote prenatal physical activity in Buffalo City Municipality, Eastern Cape Province, South Africa. A multi-stage approach was utilised. The Strength, Weakness, Opportunity and Threat (SWOT) approach was applied to the interfaced empirical findings on prenatal physical activity in the setting. Subsequently, the Build, Overcome, Explore and Minimise model was then used to develop strategies based on the SWOT findings. A checklist was administered to key stakeholders to validate the developed strategies. Key strategies to promote prenatal physical activity include the application of the Mom-Connect (a technological device already in use in South Africa to promote maternal health-related information for pregnant women) in collaboration with cellphone and network companies; the South African government to integrate prenatal physical activity and exercise training in the medical and health curricula to empower the healthcare providers with relevant knowledge and skills to support pregnant women in prenatal physical activity counselling; provision of increased workforce and the infrastructure necessary in antenatal sessions and antenatal physical exercise classes and counselling; the government, in partnership with various stakeholders, to provide periodical prenatal physical activity campaigns based in local, community town halls and clinics to address the lack of awareness, misrepresentations and concerns regarding the safety and benefits of physical activity during pregnancy. The effective implementation of this developed prenatal physical activity by policymakers and health professionals may help in the promotion of physical activity practices in the context of women in the setting

Physical Activity Advice and Counselling by Healthcare Providers: A Scoping Review

Background: Despite scientific evidence on prenatal physical activity and exercise, synthesized evidence is lacking on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers. The scoping review seeks to fill this gap by synthesizing available literature on the provision of prenatal physical activity and exercise advice and counselling by prenatal healthcare providers to women during antenatal visits. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) search framework for scoping reviews was applied to retrieve original research articles on the prenatal physical activity and exercise practices of healthcare providers with pregnant women, published between 2010–2020, and available in English. The search databases included Google Scholar, PubMed, Science Direct, Scopus, EMBASE, The Cumulative Index for Nursing and Allied Health Literature (CINAHL), BIOMED Central, Medline and African Journal Online. Studies that fulfilled the eligibility criteria were retrieved for analysis. Results: Out of the 82 articles that were retrieved for review, 13 met the eligibility criteria. Seven of the articles were quantitative, four qualitative, one mixed-method and one controlled, non-randomised study, respectively. Three themes emerged as major findings. Healthcare providers affirmed their responsibility in providing prenatal physical activity advice and counselling to pregnant women; however, they seldom or rarely performed this role. Major barriers to prenatal physical activity and exercise included insufficient time, lack of knowledge and skills, inadequate or insufficient training, and lack of resources. Conclusion: This review highlights salient features constraining the uptake of prenatal physical activity and exercise advice/counselling by prenatal healthcare providers in both community and clinical settings. Prenatal physical activity advice and counselling are key components to the promotion of physical activity adherence during and post-partum pregnancy; this requires adequate knowledge of physical activity prescriptions and recommendations, which are personalised and contextual to environment. Research is needed to examine the prenatal physical activity advice and counselling from prenatal healthcare providers on issues hindering effective delivery of the aforementioned in the context of promoting prenatal physical activity in clinical or community settings

Physical Activity Level during Pregnancy in South Africa: A Facility-Based Cross-Sectional Study

Physical activity participation during pregnancy confers many maternal and foetal health benefits to the woman and her infant and is recommended by various health bodies and institutions. However, in South Africa, scant information exists about the physical activity status and its determinants among pregnant women. The aim of this study was to assess the physical activity level and associated factors among pregnant women. This cross-sectional study enrolled 1082 pregnant women attending public health facilities in Buffalo City Municipality, Eastern Cape, South Africa. Information on socio-demographic and maternal characteristics were obtained, and the Pregnancy Physical Activity Questionnaire was used to assess physical activity during pregnancy. Multiple logistic regression analyses were used to assess associations between physical activity and the predictor variables during pregnancy. Adjusted odds ratios with 95% confidence interval were applied to estimate factors associated with physical activity levels. Statistical significance was set at p &lt; 0.05. Only 278 of the women (25.7%) met recommendations for prenatal activity (&ge;150 min moderate intensity exercise per week). The average time spent in moderate&ndash;vigorous physical activity was 151.6 min (95% CI: 147.2&ndash;156.0). Most of the women participated in light exercises with a mean of 65.9% (95% CI: 64.8&ndash;67.0), and 47.6% (95% CI: 46.3&ndash;48.9) participated in household activities. The majority of the women did not receive physical activity advice during prenatal care sessions (64.7%). Factors negatively associated with prenatal physical activity were lower age (&lt;19 years) (adjusted odd ratio (AOR) = 0.3; CI: 0.16&ndash;0.76), semi-urban residence (AOR = 0.8; CI: 0.55&ndash;1.03), lower educational level (AOR = 0.5; CI: 0.20&ndash;0.71), unemployment (AOR = 0.5; CI: 0.29&ndash;0.77) and nulliparity (AOR = 0.6; CI: 0.28&ndash;1.31). However, prenatal physical activity was positively associated with starting physical activity in the first trimester (AOR = 1.9; CI: 1.06&ndash;3.31) compared to other trimesters. The findings of this study demonstrated low levels of physical activity during pregnancy in South Africa. The majority of women did not meet the recommendation of 150 min of moderate intensity activity per week. Light intensity and household activities were the most preferred form of activity. The factors affecting physical activity of women in this present study include lower age, semi-urban setting, low educational level, unemployment and nulliparity. In order to increase activity levels, future work should seek to improve knowledge, access and support for physical activity in pregnant women in South Africa. This should include education and advocacy regarding physical activity for professionals involved in maternal health provision

Barriers to Exclusive Breastfeeding for Mothers in Tswelopele Municipality, Free State Province, South Africa: A Qualitative Study

Despite the numerous advantages of exclusive breastfeeding (EBF), the practice remains infrequently adopted in certain countries and is also associated with context-specific obstacles. Consequently, this study explores the experiences and opinions of mothers about the barriers and support systems of exclusive breastfeeding (EBF), in a bid to promote this practice in the Tswelopele Municipality of the Free State Province of South Africa. In-depth individual, semi-structured interviews were conducted with 16 mothers, using an audio recorder after receiving their permission to record the interviews. The analysis of the collected data revealed that opinions clustered around four topics: mother-related barriers to EBF, baby-related barriers to EBF, support systems to enhance EBF, and complications caused by barriers to EBF. The findings from these themes and sub-themes imply that the maternal factor is strongly influenced by other factors regarding the success or failure of this practice. These include extreme breast discomfort, maternal illness, the fear that the mother’s milk supply is insufficient, a lack of understanding about EBF, and the influence of different cultural factors. When mothers encounter difficulties with breastfeeding, these challenges may impede their ability to practice EBF. In addition, while some participants were eager to breastfeed their babies and continued EBF for a period of six months, their infant’s health and behavioral issues prevented them from doing so. Some of these problems included infant sickness and crying. From the prenatal to the postnatal period, mothers and their families should have access to breastfeeding education and counseling, along with sufficient time to make informed infant nutrition decisions. During counseling sessions, conversations with these stakeholders should focus on fostering a realistic understanding regarding what to expect when breastfeeding for the very first time, debunking breastfeeding-related misconceptions, and addressing inaccurate information and concerns. In addition, health professionals must be empathic and respectful of the mother’s traditions and cultures and must also educate mothers and their families on the importance of EBF. Our list of themes and sub-themes could be utilized to enlighten exclusive breastfeeding challenges and potential mitigation efforts, not only in Tswelopele Municipality, South Africa but also in a number of other geographical contexts

Exploring women’s experience of uterine fundal pressure during second stage of labour at Midwives-led Obstetric Unit (MOU) in East London, South Africa

Uterine Fundal Pressure (UFP), an age-long birthing procedure is applied on the uppermost part of a woman’s abdomen in order to accelerate childbirth. This study explores the experiences of women during the application of uterine fundal pressure during the second stage of labour in a Midwives-led Obstetric Unit (MOU) in East London, Eastern Cape Province, South Africa. The study applied interpretive phenomenological analysis involving three purposively sampled women. A semi-structured in-depth interview schedule was used to gather information on the experiences of the women when UFP is applied during the second stage of labour. Thematic content analysis was applied to synthesise the data. The findings indicated that the informants had feelings of fear, loneliness, worry and tearfulness; but also experienced happiness and relief associated with UFP, especially afterseeing their new-borns for the first time thus marking the end of birthing process.The findings further showed that the midwives did not properly inform the pregnant women about what to expect during the second stage of their labour, but expected them to know what was happening to them during the UFP and how to react. The UFP is not a pleasant experience for the women during second stage of labour. Before its application, it is pertinent that midwives explain to the expectant mothers what the UFP process entails, the pain associated with the process; and where possible, a written informed consent should be obtained from the expectant mothers.Keywords: Kristeller manoeuvre, uterine fundal pressure, second stage of labour, women’s experiences