An exploration of midwives and clients experiences of emergency caesarian section at Bwaila Maternity Unit
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Date
2012-08-01
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Abstract
Worldwide 35.7 % of women suffer from major complications post caesarian section (Mukherjee, 2006). These include but are not limited to pelvic infection, generalized sepsis, deep vein thrombosis, and minor complications such as fever, urinary tract infections, and wound sepsis. Major complications are almost double in emergency caesarian sections compared to those in elective caesarian section. There is evidence that preoperative care rendered to mothers before emergency caesarean section helps to reduce complications postoperatively. A study was conducted at Bwaila maternity unit to determine midwives’ and clients’ experiences of preoperative care before emergency caesarean section. The objectives of the study were: to establish midwives’ perception of the components of standard preoperative care of clients undergoing emergency caesarian section; to assess midwives’ actions on components of standard preoperative care for emergency caesarian section; to determine clients’ perception of the preoperative teaching rendered to them prior to undergoing emergency caesarian section; to determine clients’ reaction to preoperative care they received prior to undergoing emergency caesarian section. to determine if there was an association between preoperative emergency care rendered and the incidence of postoperative complications. The study used a combination of retrospective and prospective designs using quantitative methodologies. A sample size of 87 clients and 28 midwives was obtained through convenient sampling. Data was collected using structured questionnaires and structured interview guides and a checklist was used to collect data from client chart review. The data obtained was analyzed using the statistical package for social science (SPSS Version 16.0). Data has been summarized using frequency tables, and bar charts and tables have been used to present the results. The Chi-Square test was used to determine the significant statistical association between the preoperative care rendered to the clients and the incidence of postoperative complications. Independent-samples t-test was used to examine statistically significant differences between the complications expressed by clients and those documented in the clients’ charts. Imogene King’s middle range theory of Goal Attainment guided this study. Chi-Square test showed a statistically significant association between preoperative teaching offered to the clients on deep breathing and coughing exercises, and the incidence of postoperative complications (P<0.05). Complications expressed by the clients (mean = 0.84, S.D. = 1.7) scored statistically significantly higher (p<0.05) than those documented in the clients’ charts. Although results showed that midwives were able to mention most of the components of basic preoperative care for clients undergoing emergency caesarean section, only 25% mentioned that they would check vital signs prior to emergency caesarean section, 28.6% mentioned that they would allow the client to ask questions, and 25% mentioned that they would answer client’s questions. Gaps were also noted between the mentioned components of care and those documented in the clients’ charts the least documented being vital signs (19.5%), psychological reassurance of the client (3.4%) and preoperative teaching of the client (1.1%). The main contributing factors were poor deployment of midwives to this hospital; lack of preoperative care guidelines; and lack of in-service training for the midwives in perioperative care.