Exploring midwifery competence and confidence based on midwives' experiences and stakeholders' insights in Kenya: A descriptive phenomenological approach

Abstract

Abstract Background Midwives who are educated and regulated to international standards can provide ninety percent of the needed essential care for women and newborns and reduce preventable maternal and child mortalities. However, inadequacies in midwifery care, especially in low- and middle-income countries, leads to lack of competence and confidence among midwives to achieve their potential. The study objective was to explore midwives’ experiences and stakeholder insights into midwives’ competence and confidence in the four International Confederation of Midwives (ICM) domains; general competence, pre-pregnancy and antenatal care, labour and childbirth, and ongoing care of the woman and the baby. Methods A descriptive phenomenological study was utilised to explore these experiences. Ten midwives were purposively selected from subcounty, county and tertiary referral hospitals. Further, stakeholders (nine County Chief Nursing Officers and one Chief Executive Officer from the tertiary hospital in Kenya) were included. Interview guide questions were developed following the findings of the midwives’ self-perceived competence and confidence. All interviews were recorded, translated, and transcribed verbatim. Thematic analysis was done using the Colaizzi framework. Atlas. ti 9 software was utilised to assist with the coding categorisation and creating the themes. Findings Four themes emerged from the analysis. They included qualification categories, clinical practice experience, clinical practice environment and the need to optimise midwifery. In addition, multidisciplinary support and standardisation of midwifery practice were identified as key to promote the confidence and competence of midwives. Conclusions Midwives had disparities in competence and confidence during clinical practice, based on their different qualifications. A supportive environment emerged as necessary in enabling appropriate clinical experience, confidence, and competence. Standardisation of midwifery qualification promotes competence, which promotes the confidence of midwives in the clinical environment.