Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Feb 25:26:1546.
doi: 10.4102/hsag.v26i0.1546. eCollection 2021.

Midwives' perceived role in up referral of high-risk pregnancies in primary healthcare settings, eThekwini district, South Africa

Siyabonga W Ximba  1 , Olivia B Baloyi  1 , Mary Ann Jarvis  1
Affiliations

Midwives' perceived role in up referral of high-risk pregnancies in primary healthcare settings, eThekwini district, South Africa

Siyabonga W Ximba et al. Health SA. .

Abstract

Background: South African maternal and neonatal mortality rates remain unnecessarily high, which are considered avoidable through timeous identification, treatment and referral. An efficient referral process of high-risk pregnant women is dependent on the midwives' ability to respond with relevance to the maternal and neonatal healthcare needs. The attainment of improved maternal and neonatal outcomes commences at the primary healthcare level, with the midwife, recognised as the first person responsible and accountable for pregnant women's healthcare.

Aim: To explore midwives' perceptions of their role in the referral of high-risk pregnant women from primary health care clinics to expert-centred sites.

Methods: A qualitative, exploratory, descriptive in nature approach, underpinned by a social constructivism paradigm, guided the methodology. Purposive sampling was used to select both the primary health care clinics in the feeder zone and the registered midwives working in these clinics. Data were collected through four focus group discussions and analysed using content analysis. The principles of trustworthiness were observed.

Setting: Department of Health primary health care clinics in the eThekwini district, South Africa.

Results: The midwives understood their role in the up referral of high-risk pregnant women but experienced many interruptions in its execution. Four categories emerged from the data, namely, enhanced by team support in the clinics, restrictions in transfer to expert-centred sites, impeding social determinants and midwifery competence facilitates referral process.

Conclusion: Global initiatives cannot guarantee maternal and neonatal health because of the challenges experienced by the midwives in the execution of their roles as they interface with the healthcare team.

Keywords: South Africa; eThekwini; high-risk pregnancy midwives; primary healthcare; up referral.

PubMed Disclaimer

Conflict of interest statement

The authors have declared that no competing interest exists.

References

    1. Austin, A., Gulema, H., Belizan, M., Colaci, D.S., Kendall, T., Tebeka, M. et al. ., 2015, ‘Barriers to providing quality emergency obstetric care in Addis Ababa, Ethiopia: Healthcare providers’ perspectives on training, referrals and supervision, a mixed methods study’, BMC Pregnancy and Childbirth 15(1), 1–10. 10.1186/s12884-015-0493-4 - DOI - PMC - PubMed
    1. Beek, K., McFadden, A. & Dawson, A., 2019, ‘The role and scope of practice of midwives in humanitarian settings: A systematic review and content analysis’, Human Resources for Health 17(1), 5. 10.1186/s12960-018-0341-5 - DOI - PMC - PubMed
    1. Biswas, A., Anderson, R., Doraiswamy, S., Abdullah, A.S., Purno, N., Rahman, F. et al. ., 2018, ‘Timely referral saves the lives of mothers and newborns: Midwifery led continuum of care in marginalized teagarden communities – A qualitative case study in Bangladesh’, F1000Research, 7, 365. 10.12688/f1000research.13605.1 - DOI - PMC - PubMed
    1. Bomela, N.J., 2020, ‘Maternal mortality by socio-demographic characteristics and cause of death in South Africa: 2007–2015’, BMC Public Health 20(1), 157. 10.1186/s12889-020-8179-x - DOI - PMC - PubMed
    1. Donabedian, A., 2005, ‘Evaluating the quality of medical care’, The Milbank Quarterly 83(4), 691–729. 10.1111/j.1468-0009.2005.00397.x - DOI - PMC - PubMed

LinkOut - more resources