Midwives And Mothers Perception Of Midwives Service Scheme

Midwives And Mothers Perception Of Midwives Service Scheme

Pregnancy and childbirth are normal physiological processes that bring joyful experiences to individuals and families. However, in many parts of the world, pregnancy constitutes a perilous journey, a risky and potentially fatal experience for millions of women especially in developing countries. Over 289,000 women die annually from complications during pregnancy, childbirth, or postpartum period (World Fact book, 2014 andWHO, UNICEF, UNFPA & The World Bank 2014). About 70% of these deaths are largely treatable or at least preventable (UNICEF, 2010) and nearly all these deaths (over 90%) occur in developingcountries where fertility rates are higher and a woman’s life time risk of dying during pregnancy and childbirth is over 400 times higher than in developed countries (Audu, Takai, &Bukar, 2010). Midwives And Mothers Perception Of Midwives Service Scheme Essay


The situation in Nigeria is especially grave as maternal mortality rateas high as630 per 100,000 live births is still recorded (World Health Organization, UNICEF & The World Bank, 2014), thus including Nigeria among the nations with the highest number of maternal deaths (WHO, 2010, National Primary Healthcare Development Agency (NPHCDA) 2009). Nigeria makes up only 1% of the total world population but accounts for about 10% of the global estimate for maternal mortality (FMOH & NPHCDA, 2010). The new-born and under-five mortality rates follow the same trend with an estimated infant mortality rate of 74/1,000 (Index Mundi, 2014).This ugly trend has been traced to deliveries being attended to by unskilled birth attendants (N&MCN Newsletter 2011 & NPHCDA, 2009). It is against this backdrop that the Midwives Service Scheme [MSS] was initiated in 2003 by the Nursing and Midwifery Council of Nigeria (N&MCN) though originally as a mandatory service. Midwives And Mothers Perception Of Midwives Service Scheme Essay

Global research has concluded that midwifery care has a pivotal role in the reduction of preventable maternal and newborn mortality and morbidity [1]. The increased access to skilled
attendance at birth in the low and middle income countries (LMICs) that contribute to 99% of
the global maternal mortality rate, has not, however, resulted in expected reductions in mortality [2]. This can be explained by a lack of quality maternity care [3, 4]. The evidence indicates
that strengthening midwifery is key to improving quality of care and achieving international
efforts; yet implementation of educated, trained, regulated and licensed midwives remains
inconsistent, resulting in a critical obstacle to progress [5].
The “three delays” model [1994] identified barriers to accessing care from the perspective of
childbearing women; (1) delay in the decision to seek care; (2) delay in arriving at a health facility and (3) delay in the provision of adequate care at the facility [6]. The perspective of the
women who provide that care, however, has remained virtually absent from the discourse [7]. Midwives And Mothers Perception Of Midwives Service Scheme Essay
To initiate the discussions on the possible barriers experienced by midwifery personnel in providing care, the World Health Organization (WHO), in collaboration with the International
Confederation of Midwives (ICM) and the White Ribbon Alliance (WRA), convened a session
at the 2013 Women Deliver Conference to determine if providers of midwifery care felt empowered, respected and safe [8, 9]. The research presented by delegates from Nepal, Papua Guinea
and Afghanistan and the ensuing multi-country discussions, highlighted the shortcomings in
the education, training, licensure and regulation of professionals, while also detailing the significant personal challenges that women who provide midwifery care face [10]. This includes: social
inequality, inadequate pay to meet the basic cost of living, unsafe working conditions and physical and sexual abuse [9]. The negative impact of these realities on quality of care was described
through the concepts of burn out and moral distress. Burn out is defined as the expenditure of
energy, effort and time on work without adequate time or environment to recover physically
and emotionally [11]. Moral distress is defined as the experience of being seriously compromised as a moral agent by being unable to practice in accordance with accepted professional values and standards. This is associated with frustration, anger, guilt, anxiety, perceived lack of
control, feeling belittled or unintelligent, and negative physical symptoms [12]. Midwives And Mothers Perception Of Midwives Service Scheme Essay
Analysis of the findings from the Women Deliver session enabled categorisation of the multiple issues faced by the women who provide midwifery care into social, economic and professional barriers, and resulted in the development of an analytical framework (Fig 1). This
framework presents burn out and moral distress as a consequence of interactions between all
three barriers.
It has recently been recognised that the complexity of access to quality of care goes beyond a
health and development issue and requires a broader human rights approach [13], thinking
beyond the practicalities of health systems to include human relationships, desires and values,
roles and norms, and power structures [14]. Maternal and newborn mortality reduction is
described as being hampered by gender inequality on two fronts—the gender discrimination
experienced by the woman who provides the care and the additional gender inequality experienced by the childbearing woman Midwives And Mothers Perception Of Midwives Service Scheme Essay

Midwifery is practiced throughout the world according to the norms, traditions and cultural practices entrenched
in each country, in the same way that midwifery standards and their training curriculum vary from country to
country [1]. Even though the International Confederation of Midwives (ICM) regulates midwife training and
practice, yet informally trained midwives are often not covered by such regulations [1]. Early in the 21st century,
the scope of midwifery did not just include the care of obstetric needs of women but also taking care of their
gynecological needs throughout their life. Globally, two approaches to licensed midwifery practice are consis-
tently found: nurse-midwives and direct-entry midwives. The latter, which is the more common approach, enters
health care practice directly as midwives rather than through any other health profession, while the former in-
volves post-nursing education. Countries such as Canada, Ghana, Kenya, the United Kingdom, and the United
States train both types of midwives. However other countries like Cameroon, Uzbekistan, Nigeria and Sierra
Leone license only nurse-midwives, whereas Côte d’Ivoire, Vietnam, and Ethiopia encourage only direct-entry
midwifery. Direct-entry midwives in the United States are designated certified midwife (CM) or certified pro-
fessional midwife (CPM), if certified by the American Midwifery Certification Board or the North American
Registry of Midwives, respectively. Conversely, nurse-midwives are trained as nurses first and then move on to
acquire midwifery training as a postgraduate component either at the certificate or master’s level. Irrespective of
the type of midwife, they all attend to births either in women’s homes, or maternity/hospital settings [1] and they
have a big role to play in the maternal mortality ratio reduction in developing countries such as Nigeria. Midwives And Mothers Perception Of Midwives Service Scheme Essay
There is a general belief that maternal mortality ratio in Nigeria remains at an embarrassing high level and is
deemed to be one of the highest in the developing world [2]. A woman’s chance of dying due to complications
around pregnancy and birth in Nigeria is 1/15, compared to 1/5000 in developed nations. It is estimated that
more than 53,000 women and 250,000 newborns die each year due to preventable causes [3]. Furthermore, the
average maternal mortality ratio in northern Nigeria has been 2400 (range: 1060 – 4477) per 100,000 live births
[4]-[7], while similar data in the southern parts of the country were considerably lower; and within the range of
450 and 750/100,000 live births [8] [9]. Maternal mortality has continued to be one of the most serious chal-
lenges in Nigeria, and until recently; despite several efforts (policies, initiatives and instruments etc.) the country
has achieved only marginal progress with this most basic indicator of health and development.
The direct consequence of this reality (poor maternal and neonatal indices) was the establishment of Mid-
wives Service Scheme (MSS) which focus was to ensure the availability of skilled birth attendants to reduce
maternal, infant and child mortality. The Midwives Service Scheme is a Millennium Development Goal (MDG)
supported project being jointly carried out by the Nigeria Governments at federal, state and local government
levels. Under the scheme, midwives are deployed to health facilities in rural communities to enhance skilled at-
tendance at birth and hopefully aid reduction in maternal, newborn and child mortality and morbidity. The
scheme seeks to mobilise midwives, especially newly qualified midwives, to health facilities in rural communi-
ties to undertake a one year community service. The MSS is therefore set to address the human resource need
for skilled attendance at the primary level of care as the majority of Nigeria’s obstetric population reside in the
rural area [10]. This review briefly explores the contributions of the MSS towards improving maternal and neo-
natal indices in Nigeria.
2. Main Content
The midwives service scheme has five key components including [3]: 1) community participation which recog-
nizes the role of the community in the success of the scheme, and involves local ward development committees
(WDC) across all 652 primary health care (PHC) facilities, 2) deploying skilled birth attendants in rural com- Midwives And Mothers Perception Of Midwives Service Scheme Essay

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