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  • 1.
    Byrskog, Ulrika
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Akther, Hasne Ara
    Khatoon, Zohra
    Bogren, Malin
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Social, economic and professional barriers influencing midwives’ realities in Bangladesh: a qualitative study of midwifery educators preparing midwifery students for clinical reality2019In: Evidence Based Midwifery., ISSN 1479-4489, Vol. 17, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    Introduction

    Identifying existing barriers inhibiting the provision of quality care in Bangladesh can guide both the government, in fulfilling its commitment to establishing the midwifery profession, and midwifery educators, in preparing midwifery students for the reality of midwifery clinical work.

    Aim

    The aim of this study was to describe midwifery educators’ perceptions of midwives’ realities in Bangladesh, focusing on social, economic, and professional barriers preventing them from carrying out quality care.

    Methods

    Data were collected through focus group discussions with 17 midwifery educators and analysed using qualitative content analysis, guided by the analytical framework “What prevents quality midwifery care?”. Ethical clearance was obtained from Bangladesh’s Directorate General of Nursing and Midwifery.

    Results

    The results generated by the application of the framework included social barriers of gender structures in Bangladeshi society. This influenced entry into midwifery education, carrying out midwifery work safely, and the development of the profession. Economic barriers included challenges for Bangladesh as a low-income country with a large population, inadequate salaries, and staff shortages, adding extra strain to midwives’ working conditions. These social and economic barriers were further enhanced by professional barriers due to the midwifery profession not yet being fully established or acknowledged in the health system.

    Conclusions and implications

    The study presents novel country-specific perspectives but confirms the general underlying issues of gender inequality as a base for barriers preventing midwives from carrying out quality care, in line with the framework “What prevents quality midwifery care?”. Addressing these structures can facilitate more students to enter midwifery education, enable quality midwifery work free from discrimination, and provide sufficient working space and professional integrity. Leadership training is pivotal to increasing responsiveness to the needs of the new cadre of midwives. Midwifery educators should take the lead in sensitising clinical supervisors, mentors, and preceptors about midwives’ realities in Bangladesh.

  • 2.
    Erlandsson, Kerstin
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sayami, Jamuna Tamrakar
    National Centre for Health Professional Education, PO Box 2533, Maharajgunj, Kathmandu, Nepal.
    Sapkota, Sabitri
    Sunaulo Parivar Nepal, Baluwatar, PO Box 11254, Kathmandu, Nepal.
    Safety before comfort: a focused enquiry of Nepal skilled birth attendants’ concepts of respectful maternity care2014In: Evidence Based Midwifery., ISSN 1479-4489, Vol. 12, no 2, p. 59-64Article in journal (Refereed)
    Abstract [en]

    Background. Respectful maternity care is the universal right of childbearing women, but in Nepal there are no midwives to deliver this care and it is provided by skilled birth attendants (SBAs), who may be physicians, certified nurses, auxiliary nurse-midwives or degree-trained nurses. 

    Aim. To explore how this concept of respectful maternity care was perceived by SBAs in practice. 

    Design. Focus group discussions were used and the setting was two tertiary level maternity hospitals in Nepal. Ethical approval for the study was obtained from the Nepal Health Research Council. A total of 24 SBAs were recruited voluntarily from the maternity units. Data were analysed using a phenomenographic approach and interpretation was verified by the focus group facilitator and note-taker. 

    Findings. Five categories, divided into16 sub-categories, present the SBAs’ collective description of respectful care. 

    Conclusions. SBAs understood that respectful care at birth was important, but argued that ‘safety comes before comfort’. To achieve safe maternity care, the contribution of relatives is essential, in addition to the provision of medical care. 

    Implications. Family members need to accompany the woman and her newborn from admission to discharge to provide basic care and this needs to be reviewed. Professional midwives need to be trained, recruited, and deployed in areas where they are most needed and the government needs to regulate the profession and make it legal.

  • 3.
    Mattebo, Magdalena
    et al.
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing. Mälardalens högskola.
    Lindkvist, Madelene
    Pedersen, Christina
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Sayami, Jamuna
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    The influence of a patriarchal culture on women’s reproductive decision-making: exploring the perceptions of 15 Nepali healthcare providers2016In: Evidence Based Midwifery., ISSN 1479-4489, Vol. 14, no 3, p. 94-100Article in journal (Refereed)
  • 4. Sapkota, Sabitri
    et al.
    Tamrakar Sayami, Jamuna
    Devi Manadhar, Maiya
    Erlandsson, Kerstin
    Dalarna University, School of Education, Health and Social Studies, Caring Science/Nursing.
    Nepalese mothers' experiences of care in labour2014In: Evidence Based Midwifery., ISSN 1479-4489, Vol. 12, no 4, p. 127-132Article in journal (Refereed)
    Abstract [en]

    Background and aim: The government of Nepal aims to reach Millennium Development Goals (MDGs) 4 and 5 by focusing on the provision of Skilled Birth Attendants (SBAs). This is undertaken by providing two months additional training on complicated childbirth to physicians, certified nurses, auxiliary nurse midwives and degree trained nurses. However, SBA’s are under-utilised as only36% of all births are supported by SBAs whilst 72% of births take place at home. For the women in Nepal that do access main hospitals with highest level of maternity care, there are limited descriptions of their experiences of being cared for during birth. The aim of this study was to explore mothers’ experiences of the care received while giving birth in Nepal hospital settings.

    Methods: An interview study with 10 first time mothers voluntarily recruited from maternity units in two tertiary level hospitals was conducted over a 4 month period. Ethical approval was obtained from the Nepal Health Research Council. Data were analysed using content analysis.

    Results: The main category `Trust in care providers, both relatives and professionals, was fundamental for mothers to feel cared for’ captured the essence of the two categories `accountable caring´ and `the act of communication ´with, in total, nine sub-categories. Key conclusion: For women to experience “being cared for” when giving birth they need to be accompanied by relatives and they need to trust those relatives and health care providers. This study concludes by arguing that relatives are a valued addition to health care providers’ provision of clinical care during birth. Delivery of preparation for birth sessions for both mother and relatives are recommended. Mothers highlighted that more information and some preparation for birth might have reduced their fear.

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