Midwives’ Knowledge and Practice of Midwifery-Led Care Model in Embu County.

Abstract

Globally, there is great threat to midwifery practice that compromises maternal and neonatal health outcomes. This is due to limited autonomy of midwives in various health institutions. This threat is not different in Embu county and Kenya at large despite the rich evidence that midwife-led care is the most crucial factor in attaining improved maternal and neonatal health outcomes. There is no reliable literature on knowledge and practice of midwifery led care model in Embu county. This poses the need to evaluate knowledge and practice of midwifery- led care model among midwives in Embu county. Therefore, the study objective was to determine the midwives’ knowledge and practice of midwifery-led care model in Embu county. The study sites were Siakago and Runyenjes level four hospitals. A survey study design was adopted. Target population comprised midwives offering maternal and child health care services in the two hospitals. A sample size of 60 midwives was used in the study with response rate of 92.0 %. Questionnaires, interviews, observation checklists and secondary sources were used to collect data. Pretesting was done at Ishiara level four hospital. Quantitative data were analysed using Statistical Package for Social Science (SPSS) software for windows version 28.0. Descriptive statistics to include frequencies and percentages were used in data analysis. Chi-square test and regression analysis, were used to draw inferences. Qualitative data were analysed by content analysis through grouping data into themes according to the study objectives. Results were presented in form of narratives and tables. Permission to undertake the study was obtained from Chuka University Ethics and Research Committee. A research permit was obtained from the National Commission for Science, Technology and Innovation (NACOSTI). Relevant authorities in Embu county health department, Siakago, Runyenjes and Ishiara level four hospitals were informed for study authorisation. All the relevant ethical considerations were adhered to during the study. The study revealed that a high percentage 76.4% of midwives had poor knowledge on midwifery led care model. There was a very high percentage 90.6% of midwives who had not heard about midwifery led care model before. Majority of the midwives 93.8% were not aware of benefits of reflexology, dimming of lights and music refreshments during labour. Among the midwives, 81.9 % demonstrated poor practice of midwifery-led care model. Care given to low risk mothers 87.3% was a shared responsibility by midwives, doctors and other health professionals. There were no midwifery led care units where midwives are solely in charge of maternal and neonatal care 85.4%. Variety of mechanical pain relief options such as labour in water, visualization and other hypnobirthing 100% were not practiced. The null hypothesis was rejected; therefore, there was statistically significant relationship at 0.05 level of significance with 1 degree of freedom between midwives’ knowledge and practice of midwifery-led care model. Using pearson and spearman’s rho correlations, the relationship between knowledge and practice was statistically significant at the 0.01 level (2-tailed). After running a linear regression model, midwives’ knowledge level was found to affect their midwifery practice (95% CI 0.846 – 1.011), P=000. The study concluded that there were gaps in knowledge and practice of midwife- led care model in Embu county. The study recommended an intervention for educating midwives about midwifery led care model and subsequent introduction of the model in this county aiming to strengthen midwifery for improved maternal and neonatal health outcomes in Embu County.