THE MIDWIFE-LED CONTINUITY OF CARE ON WOMEN AND BABIES DURING THE POSTNATAL PERIOD

1.1 Introduction

Midwife-led continuity of care has generally improved continuity of care over a period of time. However, the general literature on continuity notes that a lack of clarity in definition and measurement of different types of continuity has been one of the limitations in research in this field (Haggerty 2003). Continuity has been defined by Freeman 2007 as having three major types management, informational and relationship. Management continuity involves the communication of both facts and judgements across team, institutional and professional boundaries, and between professionals and patients. Informational continuity concerns the timely availability of relevant information. Relationship continuity means a therapeutic relationship of the service user with one or more health professionals over time (Saultz 2004; Saultz 2005).

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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1.2 Background of Study

The World Health Organisation (2014) asserted that about 99% of maternal deaths occur in lowresource settings and most of it can be prevented; and approximately 2.6 million babies from lowresource settings were stillborn in 2015 (Blencowe et al., 2016). It is estimated that in the occurrence of each maternal death there is between 50-100 severe maternal morbidity suffered by other women (Geller, et al., 2018; Miller, et al., 2016). However, a review by Sandall et al. (2015) revealed that continuity of care improve the health outcomes of women and their babies.

Midwifery practice is about strengthening family relationships, empowerment and normal birth (Killingley, 2016). This is done more effectively through patient centered care, and continuity of care agrees with the call for making care to be patient centered (Burau & Overgaard, 2015). In midwifery, it has been proven that continuity of care is safe and developed trust between midwife and woman which bring about empowerment and informed choice (Boyle et al., 2016). Based on the human right approach, the concern about women is not only on avoiding death and morbidity, but also promoting health and wellbeing with respect, dignity and rights (World Health Organization [WHO], 2016a), an issue of great concern to developing countries. Thus, midwifery continuity of care (MCC) models are highly recommended for maternal and neonatal health (National Maternity Review, 2016; WHO, 2016b).

Midwifery is a health care profession that offers care to childbearing woman during the periods of pregnancy, labour and post-partum. It provides care to newborn, primary care to healthy pregnant women, family planning and menopausal care (Oyetunde, 2014). In Nigeria the midwifery service is largely through a traditional midwifery practice by which midwives run a shift duty in rotation (Morning, evening and night duties) with some days given as off duty between every shift. Thus, a pregnant woman would be having contact with many different midwives through her pregnancy, delivery and post-partum care. Also, traditional birth attendants (TBAs) provide midwifery services, most commonly in rural areas (Oyetunde, 2014). However, in 2009 the Nigerian government introduces a Midwifery Service Scheme (MSS) in which the newly qualified, unemployed, and retired midwives are recruited and deployed to public primary health facilities especially in rural areas (Okeke et al., 2017).

Some models of midwife-led continuity of care provide continuity of care to a defined group of women through a team of midwives sharing a caseload, often called ’team’ midwifery. Thus, a woman will receive her care from a number of midwives in the team, the size of which can vary. Other models, often termed ’caseload midwifery’, aim to offer greater relationship continuity, by ensuring that childbearing women receive their ante, intra and postnatal care from one midwife or her/his practice partner (McCourt 2006). There is continuing debate about the risks, benefits, and costs of team and caseload models of midwife-led continuity of care (Ashcroft 2003; Benjamin 2001; Green 2000; Johnson 2005; Waldenstrom 1998).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to examine the Midwife-led Continuity of Care on Women and Babies during the Postnatal Period.

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1.3 Statement of Problems

Investigation revealed that whilst it is difficult to categorize maternity models of care exclusively due to the influence of generic policies and guidelines, it is assumed that the underpinning philosophy of a midwife-led model of care is normality and the natural ability of women to experience birth without routine intervention. Midwife-led continuity of care has been defined as care where “the midwife is the lead professional in the planning, organisation and delivery of care given to a woman from initial booking to the postnatal period” (RCOG 2001). Some antenatal and/or intrapartum and/or postpartum care may be provided in consultation with medical staff as appropriate. Within these models, midwives are, however, in partnership with the woman, the lead professional with responsibility for assessment of her needs, planning her care, referral to other professionals as appropriate, and for ensuring provision of maternity services.

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1.4 Aim and Objectives of Study

The aim of the study is to scrutinize the Midwife-led Continuity of Care on Women and Babies during the Postnatal Period. In achieving this aim, the following specific objectives were laid out as follows:

1. To examine the potentiality of midwives adherence to midwifery continuity of care on Women and Babies during the Postnatal Period.
2. To identify the factors militating the Midwife-led Continuity of Care on Women and Babies during the Postnatal Period.
3. To determine whether the midwives are having positive thinking and potentiality to adhere to Midwife-led Continuity of Care or not.
4. To compare the effects of midwife-led continuity of care with other models of care for childbearing women and their infants.

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1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• Does a midwife adhere to midwifery continuity of care on Women and Babies during the Postnatal Period?
• Does a midwife have positive thinking and potentiality to adhere to Midwife-led Continuity of Care?
• What are the factors militating the Midwife-led Continuity of Care on Women and Babies during the Postnatal Period?
• What are the effects of midwife-led continuity of care with other models of care for childbearing women and their infants?

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1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

Hypothesis One

• H0: There are no significant factors affecting the Midwife-led Continuity of Care on Women and Babies during the Postnatal Period
• H1: There are significant factors affecting the Midwife-led Continuity of Care on Women and Babies during the Postnatal Period

Hypothesis Two

• H0: There is no significant relationship between the effects of midwife-led continuity of care with other models of care for childbearing women and their infants
• H1: There is a significant relationship between the effects of midwife-led continuity of care with other models of care for childbearing women and their infants

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1.7 Significance of Study

The research work will provide information about continuity of care associated with reduced preterm birth, or miscarriage, and fewer interventions in pregnancy and delivery. The mother’s health and wellbeing is a crucial factor that is closely associated with newborn child’s good health and survival. Thus, MCC can be a means of improving children health. The findings on midwife-led continuity of care will improve satisfaction with care also in such settings. There are increased user expectations for qualitative and safe care in low-and middle-income countries, including respectful and sensitive care.

This study will be of immense benefit to researchers who intend to know more on this study and can also be used by non-researchers to build more on their research work. This study contributes to knowledge and could serve as a guide for other study.

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1.8 Scope of the Study

The study focuses on the Midwife-led Continuity of Care on Women and Babies during the Postnatal Period using Enugu State Primary Health Care Centre as a case study.

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1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

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1.10 Definition of Terms

Medication: A medication is a substance that is taken in to or placed on the body that does one of the following things: most medications are used to cure disease or condition. (For example, antibiotics are given to cure an infection. Medications are also given to treat a medical condition).

Prescription: A prescription is a health-care program implemented by a physician or other qualified health care practitioner in the form of instructions that govern the plan of care for an individual patient.

Symptom: A symptom is a departure from normal function or feeling which is apparent to a patient, reflecting the presence of an unusual state or of a disease. (For example: tiredness, cough or fever).

Administration: An administration is the act of giving a drug to somebody or a patient .