Midwives’ use of symphysis fundal height measurement to monitor foetal growth in eThekwini district, Kwazulu-Natal

Abstract

Introduction and background: Ending preventable death of new-borns and children under 5 years of age by 2030 is one of the Sustainable Development Goals. Assessment of foetal growth by symphysis fundal height (SFH) measurement is one of the aims of antenatal care (ANC) and is used as the screening tool of choice for foetal growth assessment to identify small and large for gestational age foetuses at increased risk of perinatal morbidity and mortality. Correct estimation of gestational age allows for proper scheduling of ANC visits, informs decision-making at different stages of pregnancy, and is key to correct interpretation of foetal growth. It is a simple and inexpensive clinical activity, widely used during ANC in both high- and low-income settings worldwide, particularly in low- and middle-income countries including South Africa, where access to ultrasound machines and trained ultra-sonographers is limited. The effectiveness of SFH use is largely dependent on accuracy of measurements and the findings being accurately plotted onto the foetal growth chart to allow for accurate interpretation. An error in measurement, plotting and/or interpretation of SFH can result in inaccurate estimation of gestational age and growth monitoring which then becomes difficult and inaccurate, all of which can result in inappropriate interventions such as premature induction of labour or prolonged pregnancies. Aims of the study: The aim of the study was to explore and describe midwives’ use of SFH measurement to monitor foetal growth in ANC clinics located within the primary health care (PHC) clinics under eThekwini Municipality administration in KwaZuluNatal. Research objectives: The objectives of the study were to: explore the current practices of the midwives in the use of SFH management to monitor foetal growth during pregnancy; determine the perspectives of midwives regarding the use of SFH management to monitor foetal growth during pregnancy; explore the challenges if any that were experienced by the midwives in the use of SFH management to monitor foetal growth during pregnancy; and, describe how correct use of SFH measurements to monitor foetal growth during pregnancy can be enhanced. Method: A qualitative descriptive design using the theory of planned behaviour as a framework to guide the study was employed. Data was collected through semi-structured interviews with 20 registered midwives working at ANC clinics and a retrospective record review of 60 maternity case records for pregnant women attending ANC. Data from the interviews were thematically analysed following the six steps of qualitative data analysis, and document analysis used content analysis. Findings: The study findings revealed that in the majority of cases the SFH measurements were done as expected. Nevertheless, situations also prevailed where this was not correctly done, meaning SFH measurements were either incompletely done, incorrectly done or missing. In most cases these were blamed on several challenges experienced by the midwives working in the ANC clinics which included shortage of human and material resources, overcrowded ANC/PNC clinics, time constraints and limited skills. The perceptions of midwives and the culture that prevailed in the ANC clinics influenced how the midwives used the SFH measurement to monitor foetal growth. Conclusion and recommendations: Evidence of good practices from some participants and record reviews support the researcher’s conclusion that although gaps exists in the use of SFH measurements to monitor foetal growths, these gaps could be corrected by addressing all prevailing challenges. A number of these challenges could be overcome with both policy formulation and/or review, particularly with regards to provision of material and human resources; improvement of clinical practice during service delivery, paying particular attention to constructive feedback to staff regarding their performance; and/or aligning the nursing education curriculum more closely to clinical practice.