Implementing essential steps to manage obstetric emergencies in South Africa: midwives’ perspectives

Abstract

Background/Aims South Africa, and in particular the KwaZulu Natal province, failed to meet the millennium development goal of reducing maternal mortality rates by 2015. The new sustainable development goals provide another opportunity to achieve a maternal mortality rate of less than 70 maternal deaths per 100 000 live births by 2030. Despite implementation of the ‘essential steps in managing obstetric emergencies’ in KwaZulu Natal, the maternal mortality rate remains high. This study analysed midwives’ views of implementing the essential steps in managing obstetric emergencies guidelines in contributing to reducing the maternal mortality rate. Methods A total of 14 purposively chosen midwives trained in the essential steps in managing obstetric emergencies from all levels of hospitals and community health clinics in two of 11 randomly chosen districts in KwaZulu Natal, South Africa, participated in a qualitative, unstructured interview. The interview focused on barriers and challenges to the effective implementation of the guidelines. The data were thematically analysed and presented as themes and subthemes. Results Effective implementation of the guidelines was obstructed by a lack of resources. The lack of staff, including those able to train others in the guidelines and doctors at the hospitals, as well as there being no obstetrician at community health centres, and the shortage of advanced midwives across facilities and wards impacted implementation of the guidelines. The lack of drugs, equipment and materials, such as manikin to simulate ‘fire drill’ training across facilities, contributed to ineffective management of emergencies. The participants believed that further efforts are required through collaborative teams to enhance implementation of the guidelines to achieve the sustainable development goals target before 2030. Conclusions Implementation of the essential steps in managing obstetric emergencies to reduce maternal mortality requires immediate, significant effort on the part of the Department of Health in KwaZulu Natal.