The challenge of improving perinatal care in settings with limited resources. Observations of midwifery practices in Mozambique.

The aim of this study was to observe and analyse midwifery care routines related to asphyxia and hypothermia during the perinatal period and to investigate the effect of an in-service education program. A direct non-participant pre- and post-intervention observation study of midwifery a performance during childbirth was conducted at a labour ward in Maputo. The observed groups consisted of 702 and 616 midwifery-attended deliveries. Examination was also conducted of the partographs (702 vs. 616). The quality of midwifery care related to prevention and early detection of asphyxia and hypothermia was found to be inadequate and the intervention had no significant effect upon the midwives' performances. This could be attributed to the quality of the intervention itself or to failure of implementing managerial decisions such as transfer of partograph documentation from obstetricians to midwives. Change in professional performance does not automatically follow awareness of evidence-based midwifery practices, but requires behavioural change, which may be more difficult to achieve.

[1]  R. Black,et al.  Research Priorities for the Reduction of Perinatal and Neonatal Morbidity and Mortality in Developing Country Communities , 2002, Journal of Perinatology.

[2]  A. Nazir,et al.  Kangaroo mother care with limited resources. , 2000, Journal of tropical pediatrics.

[3]  K. Christensson,et al.  Midwifery Care Routines and Prevention of Heat Loss in the Newborn: A Study in Zambia , 1988 .

[4]  R. Pattinson,et al.  Intrapartum-related birth asphyxia in South Africa--lessons from the first national perinatal care survey. , 2002, South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde.

[5]  B. Bassaw,et al.  An audit of perinatal mortality. , 2001, The West Indian medical journal.

[6]  A. Costello,et al.  Stillbirths and neonatal encephalopathy in Kathmandu, Nepal: an estimate of the contribution of birth asphyxia to perinatal mortality in a low-income urban population. , 2000, Paediatric and perinatal epidemiology.

[7]  Rajesh Kumar,et al.  Body Temperatures of Home Delivered Newborns in North India , 1998, Tropical doctor.

[8]  B. Amadi,et al.  Randomised study of skin-to-skin versus incubator care for rewarming low-risk hypothermic neonates , 1998, The Lancet.

[9]  B. Ahlberg,et al.  Quality of maternity care for adolescent mothers in Mbabane, Swaziland. , 2002, International nursing review.

[10]  G. Maclean.  The challenge of preparing and enabling 'skilled attendants' to promote safer childbirth. , 2003, Midwifery.

[11]  S. Bergström,et al.  Reducing maternal mortality in Kigoma, Tanzania. , 1995, Health policy and planning.

[12]  K. Christensson,et al.  Mozambican Midwives' Views on Barriers to Quality Perinatal Care , 2006, Health care for women international.

[13]  R. H. Philpott.  Graphic records in labour. , 1972, British medical journal.

[14]  L. Ronfani,et al.  Comparison of two training strategies for essential newborn care in Brazil. , 2001, Bulletin of the World Health Organization.

[15]  V. Diwan,et al.  Routine care of women experiencing normal deliveries in Zambian maternity wards: a pilot study. , 1997, Midwifery.

[16]  Raj Kumar Gupta,et al.  Knowledge, attitude and practices about neonatal hypothermia among medical and paramedical staff , 2000, Indian journal of pediatrics.

[17]  H. Lagercrantz,et al.  [Temperature, metabolic adaptation and crying in healthy full-term newborn infants cared for skin-to-skin or in a crib]. , 1992, Jordemodern.

[18]  G. Tamburlini,et al.  Thermal control of the newborn: knowledge and practice of health professionals in seven countries , 1997, Acta paediatrica.

[19]  F. Barrett.  Creating appreciative learning cultures , 1995 .

[20]  K. Christensson,et al.  Evaluation of an adapted model of the World Health Organization partograph used by Angolan midwives in a peripheral delivery unit. , 2000, Midwifery.

[21]  K. Christensson,et al.  The effect of routine hospital care on the health of hypothermic newborn infants in Zambia. , 1995, Journal of tropical pediatrics.

[22]  H. Lagercrantz,et al.  Temperature, metabolic adaptation and crying in healthy full‐term newborns cared for skin‐to‐skin or in a cot , 1992, Acta paediatrica.