Guidelines to facilitate collaboration between midwives and traditional birth attendants in KwaZulu-Natal

Abstract

Introduction: Perinatal deaths are untimely deaths and are a major public health concern in many developing countries. They have enormous economic, social and health implications for families and society. Over 300 000 women die annually due to pregnancy-related and childbirth complications in sub-Saharan African countries including South Africa, and about 2.6 million babies are stillborn, particularly during the third trimester, with the majority of these deaths occurring in low-socioeconomic communities. Midwives, with their training, and traditional birth attendants (TBAs), with their cultural experience, play a pivotal role in maternal and newborn health, especially in the rural communities where they both bring their expertise to the care of women and newborn babies. There is evidence that in most stettings these two groups coexist but work independently with no form of formal collaboration. Collaboration between these two groups could bridge the gap between formal and traditional health systems and ensure that women and babies receive quality healthcare support throughout pregnancy, labour and post-delivery. Therefore, strengthening collaboration between midwives and TBAs is crucial to reduce maternal and neonatal mortality rates and improve overall health outcomes especially in the rural settings where the services of both TBAs and midwives coexist. AIM: This study aimed to develop practice guidelines to facilitate collaboration between midwives and TBAs in KwaZulu-Natal. Method: A qualitative research design using explorative, descriptive, case study approaches was employed at uThukela District Municipality in KwaZulu-Natal, South Africa, guided by the structural functionalism theory of Talcott Parsons following the adaptation, goal attainment, integration, and latency process. The sample comprised 38 midwives and 18 women who were purposively sampled and 10 TBAs who were sampled using the snowball method. Data were collected between April and August 2023 following ethics approval (IREC 307/220) from the Durban University of Techology. Data were collected using interviews and focus group discussions and thematically analysed guided by the six steps of qualitative data analysis as described by Creswell and Creswell (2023). v Findings: The study findings confirmed that midwifery and TBA sevices coexisted in uThukela District and that women were utilising services from both groups during pregnancy, childbirth and the postnatal period. The study also confirmed that there was no existing collaboration between the midwives and TBAs in this district thus resulting in no formal communication between the two groups regarding the care of women and children. This had negative implications for the care of women and children, particularly regarding the continuity of care. However, midwives and TBAs expressed a willingness to collaborate because of their shared goal of reducing maternal and neonatal mortality rates in the district. The women also expressed their support for collaboration between the midwives and TBAs which they stated would address a number of challenges that they face as they sought healthcare from the two groups. Recommendations: The study makes several recommendations mostly related to policy formulation/revision to incoperate TBAs, training and inservice education, midwifery, and TBA practices, as well as further research. Most importantly, guidelines to facilitate collaboration between the TBAs and midwives were developed as part of the study. Conclusion: The findings from the study highlight the negative influences of lack of collaboration on the management of women and children and several benefits that could be achieved through collaboration. Benefits include establishing a shared vision, team work, benchmarking and sharing of good practices, all of which could have positive outcomes on the care of women and children. This could also aid in achievement of Sustainable Development Goals of the country especially goal number number 3 related to ensuring healthy lives and promoting the well-being of mothers and children. These guidelines are expected to assist in bridging the gap between midwives and TBAs, fostering a collaborative environment that leverages the strengths of both groups. Furthermore, the guidelines aim to foster community unity by involving various stakeholders, ultimately enhancing maternal and neonatal healthcare outcomes