Experiences of midwives who are faced with newborns affected by birth asphyxia in rural birth settings, southern Ghana

  • Author / Creator
    Ani-Amponsah, Mary
  • Background: The increasing trend in global neonatal deaths over the past decade has engaged global, regional, and national communities in seeking sustainable approaches to improve neonatal health outcomes. The major causes of these deaths are preterm birth complications, intra-partum related complications (including birth asphyxia), and sepsis. Understanding the dynamic contextual factors underlying these neonatal deaths are important to inform priorities for improving newborn health outcomes in the new Sustainable Development Goal [SDG] 2015-2030 era. Birth asphyxia, a preventable respiratory emergency that leaves survivors with irreversible neuro-muscular deficits, is associated with the quality of antenatal and intra-partum care. The worst affected are people who reside in rural communities within Sub-Saharan Africa where inequitable health coverage predominantly influences survival. In low-and-middle income countries [LMICs], very little information exists on care experiences of midwives regarding birth asphyxia. However, midwives have developed rich experiences in maternal and newborn health as frontline health workers. Predominant factors related to the occurrence of birth asphyxia include lack of access to basic and comprehensive emergency obstetric and newborn care, shortage of skilled staff, lack of basic life-saving devices, care provider inadequacies and poor referral systems. Aim: To understand, unveil the meanings and articulate the experiences of midwives who are faced with newborns affected by birth asphyxia in rural birth settings within southern Ghana. Methodology: Interpretive phenomenology that incorporates Heideggerian philosophy was used to explore, unveil the meanings and articulate the experiences of midwives who faced newborns with asphyxia at birth. Thirteen midwives were purposively sampled from rural birth settings in Southern Ghana (Shai-Osudoku District). Data were generated through audio-recorded conversations (voice text) with the midwives, field notes, and reflective journal. Emerging themes were synthesized from the oral data, verbal transcripts, field notes, reflective journal and commentaries from two second readers to produce detailed understandings of the midwives’ experiences. Emerging themes produced a rich understanding of midwives’ embodied experiences as they faced newborns with birth asphyxia. Findings: Rural midwifery practice in Ghana is grounded in harmonious communal relationships within restricted health care spaces where silent suffering occur. Midwives experience emotional drowning and adopt spirituality as coping mechanism when faced with birth-asphyxiated newborns. Midwives encounter moral distress and situation-helplessness within hegemonic power structures. Newly qualified midwives practice without mentorship in unsafe clinical spaces where ethical questions emerge as family members assist in resuscitative procedures. Conclusion: New knowledge serves as basis for scaling up practices, directing capacity building strategies, developing policies and implementing research-informed interventions to support midwifery practice, prevent birth asphyxia and improve newborn health outcomes in rural Ghana

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  • Graduation date
    Fall 2016
  • Type of Item
  • Degree
    Doctor of Philosophy
  • DOI
  • License
    This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
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  • Institution
    University of Alberta
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  • Department
  • Supervisor / co-supervisor and their department(s)
  • Examining committee members and their departments
    • Prof. Solina Richter (Nursing)
    • Prof. Lynne Ray (Nursing)
    • Dr. Sebalda Charles Leshabari (Nursing) - External Examiner
    • Dr. Patience Aniteye (Nursing) - External Evaluator
    • Prof. Nicole Pitre (Nursing)
    • Prof. Sherrill Conroy (Nursing)
    • Prof. Diane Kunyk (Nursing) - Chair of Committee