A Study to Assess the Barriers and Strategies to provide Maternal and Neonatal Care in Labour Room among Midwives

Midwives make a vital contribution to the quality and safety of sexual, reproductive, maternal, newborn and adolescent health services. Despite their critical importance in healthcare outcomes, midwives working conditions are globally challenging. 1

 The main challenges faced by midwives for providing quality maternal and neonatal care includes inadequate infrastructure (lack of bed and physical space), shortage of midwifery staff, logistical challenges, lack of motivation, limited in service training opportunities, work demand, the overload of bureaucratic activities, conflicts with the health team members, and limited autonomy.2

Midwives thriving in the profession due to their ability to use resilience strategies that help them to cope with the difficulties in the profession. Midwives employ adaptation strategies to cope with the barriers and the effects of those barriers in their working lives. An important coping strategy that is commonly adopted by midwives is trying to control themselves in their work environment and able to work effectively. 3  Globally, the midwives face challenges in their day-to -day practice which include feelings of demoralization, shortage of resources, shortage of personnel, societal challenges and personal struggles. To improve this situation, measures should be taken such as supportive leadership, reduction of workload, increasing availability of equipment and increasing knowledge of reproductive health in society. 4The direct and indirect barriers that midwives face in their workplace have negative consequences on their ability to provide quality maternal and neonatal care, however, they still carry on with their duties. The midwives use various strategies such as assertiveness, self-affirmation, social and professional support from work colleagues and supervisors help midwives cope with the barriers in their job environment.3

2.MATERIALS AND METHODS

Study Designs and Participants:    

Qualitative study was used in this study. Convenient sample of 30 were selected from Midwives working in Pondicherry Institute of Medical Sciences, Puducherry for the study. Midwives who are having atleast one year of experience in OBG unit at PIMS are included in the study. Midwives who are on long leave are excluded from the study.  

Source of Data Collection: Midwives working at Pondicherry Institute of Medical Sciences, Puducherry.

Socio-Demographic Variables:

Socio- Demographic Variables includes Age, Marital status, Education, work experience and Monthly income.

DATA COLLECTION PROCESS

•      Ethical clearance from Institutional Ethics Committee and administrative permission from concerned authorities were obtained before data collection. The study was conducted for a period of 4 weeks from 25.11.2024 to 20.12.2024 at Pondicherry Institute of Medical Sciences among midwives.

•      Participants who fulfilled the inclusion criteria were selected for the study using convenient sampling techniques.

•      The nature and purpose of the study was explained to the study participants, and informed consent was obtained from the selected participants. The data was collected by focus group discussion followed by individual in-depth interview using interview probes to assess the barriers and strategies to provide maternal and neonatal care in labour room among midwives working at PIMS.

•      A total of five focus group discussions were conducted in three rounds, with a group of six midwives, each lasting 30-40 minutes, until the data saturation was achieved.

•      The investigator was the moderator for the discussion and the discussion was audio recorded by investigator. Individual in-depth interviews were conducted face-to-face with 6-7 midwives per day, each lasting approximately 30 to 40 minutes and were audio recorded by the investigator.

Inclusion criteria

•      Midwives who are having atleast one year of experience in OBG unit at PIMS. 

Exclusion criteria

•      Midwives who are on long leave.

Statistical Analysis: Data collection was analyzed using descriptive statistics and Thematic analysis. The Descriptive statistics includes Frequency and Percentage were employed in the study to describe demographic variables, to find out association Fisher exact test was used.

3.RESULTS

 

 

Figure 1: Fishbone diagram expliciting Barriers and Strategies to provide Maternal and Neonatal care

NS - Not Statistically significant (p>0.05)

BS - Borderline significant (p=0.050)                             

S - Statistically significant at (p<0.05)

The Fisher exact test showed that there was no statistically significant association between strategies of midwives except self-initiatives and willingness to adapt which shows borderline significant (p value 0.052) and floating of staff which shows significant association with total years of experience        (p <0.001).

4. DISCUSSION

In the present study the results are classified under five main themes regarding barriers which includes personal barriers, physical barriers, emotional barriers, professional barriers and workplace barriers and four main themes regarding strategies which includes motivational strategies, empowerment strategies, resilience strategies and workplace strategies.

 Elizabeth K et al., (2023), Malekzade N et al., (2023), Aksoy DS et al., (2021), Kaushik et al., (2021) and Peter AK et al., (2021) emphasized that work- life balance and health problems among midwives is reported as one of the significant barrier which affects the quality of maternal and neonatal care. Improving work-life balance and addressing health problems among midwives are critical not only for their personal well-being but also for sustaining high quality maternal and neonatal care. ^5-9

Milku ND et al., (2024), Hailu M et al., (2022), Mordal E et al., (2021) and Bogren M et al., (2020) emphasized that shortage of beds and inadequate equipment significantly hinder midwives ability to provide quality maternal and neonatal care. Improving infrastructure, ensuring regular supply of essential equipment, and planning for adequate bed spacing are necessary to support midwives and strengthen maternal health services.^10-13

Diaz EA et al., (2024) stated that inappropriate responses from team members and low self- esteem of midwives are significant challenges that negatively influence midwives ability to provide optimal maternal and neonatal care which was also stated in the findings of Asadi M et al., (2023), Yun L et al.,(2021) and Johnson RA et al., (2020). Strengthening interprofessional collaboration, promoting a culture of mutual respect and empowering midwives through capacity-building and mentorship are crucial.^14-17

Wang L et al., (2025), Naseem S et al., (2024), Sagherian K et al, (2023), Maghsoud F et al., (2022) and     Tullamora T et al., (2021) reinstated that work overload, staff shortage, inadequate leave and break impede midwives from delivering quality maternal and neonatal care. These factors contribute to high levels of stress, burnout, and decreased job satisfaction, ultimately compromising the quality of care delivered to mother and newborns. Appropriate staffing level, supportive supervision, regular rest breaks and policies that promote midwives physical and mental well-being are required to achieve sustainable improvements in maternal and neonatal health outcomes.^18-22

Mramel M et al., (2024), Alenezi I (2022), Tuominen AO et al., (2022) and Kaddourah B et al., (2018) had also stated in their findings that inadequate training, staff turnover, limited authority and floating of staff are the complex and interconnected barriers that midwives face in delivering high quality maternal and neonatal care. Regular in-service training, career advancement opportunities, leadership development and clear role definitions are targeted actions to provide quality maternal and neonatal care.^23-26

Zeng D et al., (2022), Weiseth A et al., (2022), Oluwatosin O et al., (2022), Ayalew F et al., (2019) and Mestdagh E et al., (2019) also had emphasized personal satisfaction, effective collaboration with team members and self-initiatives are critical strategy employed by midwives to enhance the quality of maternal and neonatal care.^27-31

Gakwerere M et al., (2024), Lima SM et al., (2024), Ibrahim R et al., (2024) and Wei H et al., (2024) also had emphasized Continuous learning, preceptorship and esprit de corps are the vital strategies repeatedly emphasized by many researchers that empower midwives to  deliver high- quality maternal and neonatal care. ^32-35

Shahmari M et al., (2025) emphasized that self-control, willingness to adapt, seeking help from team members and professional ethics are the strategies that enable midwives to manage stressful and resource-limited environments effectively, promote patient safety and uphold quality care standards & the same strategies were reported also by Ryan L et al., (2025), Baek H et al., (2023) and Yang Q et al., (2023).^36-39

White SA et al., (2024), Michl G et al., (2024) and Paul M et al., (2024) also identified same themes auditing, standard operating procedures, floating of staff and feedback are the strategies that empower midwives to navigate resource constraints and systemic challenges more effectively.^40-42

5. LIMITATIONS

• The study was limited to 30 midwives.
• The study was conducted in a selected tertiary care hospital.
• The study findings could not be generalized to all midwives.

6.RECOMMENDATIONS

• A similar study can be done for larger group of midwives for better generalization.
• A comparative study can be done to identify the strength & weakness of the midwives team in providing MCH care between government and private hospitals.
• A similar study can be conducted with different interview probes to assess barriers and strategies.

7. SUGGESTIONS

• Training and educational programs should be arranged to educate the midwives regarding strategies to overcome the barriers.
• Recreational activities can be organized for midwives to reduce workload.

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