How can Midwives and Doctors contribute to the Prevention of Postpartum Haemorrhage in a Hospital in Nigeria, West Africa?

This thesis reports How can Midwives and Obstetricians contribute to the Prevention of Postpartum Haemorrhage in a Hospital in Nigeria, West Africa? Its’ aim is to work together with midwives and obstetricians to identify steps and actions needed including identifying existing barriers to reduce postpartum haemorrhage. Postpartum haemorrhage is one of the major causes of maternal morbidity and mortality in Nigeria. Maternal mortality is very high in Nigeria with a global maternal mortality ratio estimate of 1,047 per 100,000 live births and varying maternal mortality ratio of 1,602 and 2,085 per 100,000 live births within Nigeria, as well as PPH incidence ranging from 6.0% to 18.5%. Prophylactic administration of uterotonic agents to mothers during the third stage of labour is effective for reducing postpartum haemorrhage. Despite the utilization of uterotonic agents in Nigeria, postpartum haemorrhage still occurs and even results in maternal deaths. There is little research about involvement and participation of midwives and obstetricians in the prevention of postpartum haemorrhage in Nigeria. This thesis fills the gap by investigating how working together with midwives and obstetricians can contribute to the prevention of PPH in a maternity unity in Nigeria. Action research was the approach taken to complete the study. A Cooperative inquiry framework was used to collect the data, which was then analysed using the Reflexive Thematic Analysis Technique. The data for this study emerged from seven cooperative inquiry meetings that involved nine group members, four midwives, four obstetricians and the initiating researcher. The study findings indicate the need to educate women and their families about ways to prevent anaemia which is a known risk factor for postpartum haemorrhage. The Participants in the study believed that high levels of anaemia in the pregnant women in their care for their maternity service was secondary to poor nutrition linked to poverty. An Action from the Group members was the need to educate and counsel women in their care on the intake of nutrition rich in iron to optimise their haemoglobin levels. Other Actions included educating women to work or engage in some form of trade so that they would have money and save money gradually. The Participants believed that by empowering women to make a change in their nutrition and prepare adequately financially for their pregnancy and childbirth would help prevent Postpartum Haemorrhage. A creative, new and unique action that emerged from one of the Cooperative inquiry group meetings included the development of a nutritional pictorial material with variety of food items to give women choice of food that they can eat, to optimize their haemoglobin levels and address cultural beliefs and practices on nutrition. Equally, new and unique was the education of women to do family planning that would enable them time to replenish lost stores of iron before entering into another pregnancy. Furthermore, advocacy meetings were held with other stakeholders, healthcare managers to look for tangible support that would assist midwives and obstetricians to enhance the provision of maternal services. There was emphasis on the need for respectful maternal care to attract women to continuously use the maternity for skilled care of their pregnancy and childbirth. The findings indicate that the prevention of postpartum haemorrhage is the responsibility of multiple stakeholders including the women of Nigeria.