Background
Methods
Study design
Participants
Inclusion criteria and exclusion criteria
Ethical considerations
Sample size and participants
Data collection
Data analysis
Reflexivity
Rigor
Results
Average range of ages | Educational background | Experience managing neonatal resuscitation | Years in labor ward |
---|---|---|---|
28–54 | • 2-9 years training on average • Master’s of Midwifery and Women’s Health; 9 years training • 6 Registered nurse/midwife (RNM); 4 years training • 7 Enrolled nurse/midwife (ENM); 2 years training | • 100-2500 neonatal resuscitations performed by each participant • 825 neonatal resuscitations carried out by each midwife on average | • 13.5 years on average • Range 4-25 years |
Themes
Theme 1: hands-on training (“HOT”) with clinical support (mentorship) during actual emergency neonatal resuscitation events decreases fear and enables clinical skills transfer
“I think demonstration, demonstration. If every shift, before starting the activities of the day, practiced resuscitation first, before every shift. You come in the morning, after cleaning and preparing the equipment, and you start with resuscitation.The main problem of the labor ward – ‘resuscitation’. If everyone knows how to resuscitate, death will be rare” (Mkunga_06)
“As a midwife, it's easy to help others if we are sitting in a meeting, a regular meeting. For the meeting on wellness, we talk about how to care for the patient in the ward. Regular and monthly meetings of the staff of the labor ward are held, reminding the midwife of her roles, how to help the mother, how to help the baby so that they begin and end labor safely with their baby.” Mkunga_06
“Live practice is better, without using a doll. A doll is easy. We take this, ‘Ah, this doll!’ But when you see a live baby, a real baby … Because the dummy doesn’t give confidence. It teaches a skill” (Mkunga_08)
“Sometimes they are scared. Yeah. I’m afraid. When you call, ‘you have to do Helping Babies Breathe - HBB!’ I’m running. I run away when I hear that” (Mkunga_08)
“I’ve now seen how a baby changes, and I am much more successful … use air and the baby gets pink. The success makes me believe in HBB.Before we used to use penguins, and the baby would die of birth asphyxia.We didn’t see the change.A pink baby gives me hope and a sign of my success” (Mkunga_08)
Theme 2: unequivocal commitment to the Golden Minute© and work mindset of the midwife
“If you do [midwifery] like ‘a job,’ you are not going to work properly, because you are working because of money, not because you are assisting the helpless mothers. And this is not from the heart. You are not going to be a good midwife if you do it like that” (Mkunga_03)
“I think a midwife needs heart, needs heart, because if you have no heart and no real, real internal calling to be a midwife, it is hard to work. We must try to work hard, hard, hard and save all those mothers” (Mkunga_02)
“That’s why when you have a patient, you know the type of baby that might be delivered, so you prepare. The mother needs a caesarean, you prepare for a caesarean, communicate it to the theatre, to the doctor. If you follow our midwife skills, then fresh stillbirth will be history. But fresh stillbirth will not be history because of neglect” (Mkunga_06)
“And no delay because the mtoto (‘mtoto’ means ‘baby’ in Swahili) is there, the champion is there, the neonatologist is there, and the equipment is there. You are supposed to stay with the bag and mask and penguin beside your bed” (Mkunga_01).
“What’s the baby need? Who is the mother who has come into the labor ward? What are the needs of this mother? Don’t know. Observe the mother. What’s their need? If you know their need, help accordingly. If this mother needs some help with the fetal heart now, warn the fetal heart specialists. If you need to take vital signs now, take vital signs. If this mother needs to be re-examined, perform the re-examination. Now this mother is in the second stage, what’s the need? Prepare, they will be fine” (Mkunga_06)
“But the place for HBB is too small, you see. Sometimes you put almost 10 babies there, and in the same place, we have to do HBB, so it is not suitable. It is not enough.I think that place can cause cross-infection because you find one baby sucking on another baby, sucking on its hand, on the clothes of the other baby. I don’t like that place. Better with the mother” (Mkunga_05)
“Sometimes you deliver a baby who needs resuscitation, and you have no equipment for resuscitation nearby, so you must run to find the equipment, and the resuscitation needs to be performed in the golden minute, one minute to help the baby to breathe. So, it can take more than one minute before you can help the baby, and this is very, very discouraging to me” (Mkunga_2)
Theme 3: strategies to reduce barriers to successful resuscitation, especially unnecessary suctioning as the first response
“Establishing a lot of champions on each shift who can insist on ‘don’t suck; air first, don’t suck; air first’ and you can promote air. The air you introduce to the baby can be very good” (Mkunga_01)
“The penguin. Put it aside … Ambu bag, Ambu bag, Ambu bag, air, air, air—yes, good” (Mkunga_08).
“And you cannot, with a penguin, suck up the lungs. No. A baby just needs air, to breathe as a human being. If the baby is breathing, I think you will save the baby. Let’s just try. Removing penguins from the labor ward can help the baby to begin breathing. Maybe because they need air. Human beings, what do they need? ‘Air’” (Mkunga_06)
“If I don’t get enough resources, I feel bad because my work will be hindered. I will not be able to perform my work well. So, when I have enough resources, I can perform my work effectively” (Mkunga_03)
“The midwife in the labor ward is not a permanent nurse at the site. They’ll come, you train the midwife to understand the labor ward, then three months later they go to another unit, and another midwife comes who is not as skillful” (Mkunga_06)