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Midwifery Dissertation Topics

Published by Owen Ingram at January 3rd, 2023 , Revised On August 16, 2023

There have been midwives around for decades now. The role of midwives has not changed much with the advent of modern medicine, but their core function remains the same – to provide care and comfort to pregnant women during childbirth.

It is possible to be a midwife in the healthcare industry, but it is not always a rewarding or challenging career. Here are five things you didn’t know about midwifery nursing to help you decide if it could be the right career choice for you.

The profession of midwifery involves caring for women and newborns during pregnancy, childbirth, and the first few days following birth. Registered nurses are trained with four additional years of education along with major research on methods involve in midwifery and writing on midwifery dissertation topics, while midwives provide natural health care for mothers and children.

As a midwife, your role is to promote healthy pregnancies and births while respecting women’s rights and dignity. Midwives provide care to patients at every stage of life, from preconception to postpartum, family planning to home delivery to breastfeeding support.

Important Links: Child Health Nursing Dissertation Topics , Adult Nursing Topics , Critical Care Nursing Dissertation Topics . These links will help you to get a broad experience or knowledge about the latest trends and practices in academics.

Midwifery Is A Good Fit for the Following:

● Those who want to work with women, especially those at risk of giving birth in a                    hospital setting. ● Those who enjoy helping people and solving problems. ● Those who like to be creative and solve complex problems. ● Those who want to help others and make a difference in their lives.

Midwifery is a career with many benefits for both the midwife and the baby. They are well-trained and experienced in caring for pregnant women and newborns and often have access to the exceptional care that other nurses may not have.

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Midwifery Dissertation Topics With Research Aim

Topic:1 adolescence care.

Research Aim: Focus on comprehensive medical, psychological, physical, and mental health assessments to provide a better quality of care to patients.

Topic:2 Alcohol Abuse

Reseasrch Aim: Closely studying different addictions and their treatments to break the habit of drug consumption among individuals.

Topic:3 Birth Planning

Research Aim: Comprehensive birth planning between parents discussing the possible consequences of before, between, and after labour.

Topic:4 Community midwifery

Research Aim: Studying different characters in community midwifery and the midwife’s role in providing care for the infant during the early days of the child’s birth.

Topic:5 Contraception

Research Aim: Understand the simplicity of contraception to prevent pregnancy by stopping egg production that results in the fertilization of egg and sperm in the later stages.

Topic:6 Electronic fetal monitoring

Research Aim: In-depth study of electronic fetal monitoring to track the health of your baby during the womb, record construction per minute, and make a count of your baby’s heart rate.

Topic:7 Family planning

Research Aim: Importance to follow the basic rhythm methods for the couple to prevent pregnancy and use protection during the vaginal sex to plan a family without fertility treatments.

Topic:8 Foetal and newborn care

Research Aim: Expansion of the maternal-fetal and newborn care services to improve the nutritional quality of infants after delivery during their postnatal care time.

Topic:9 Foetal well being

Carefully tracking indications for the rise in heart rate of the fetal by weekly checkups to assess the overall well-being of the fetal.

Topic:10 Gender-based violence

Research Aim: Studying the consequences of male desire for a child that results in gender-based violence, harming the child’s physical and mental health.

Topic:11 Health promotion

Research Aim: Working on practices that help in controlling the amount of pollution of people, taking care of their overall health, and improving quality of life through adapting best health practices.

Topic:12 High-risk pregnancy

Research Aim: Calculating the ordinary risks of a high-risk pregnancy and how it affects a pregnant body resulting in a baby with poor health or any by-birth diseases, increasing the chance for complications.

Topic:13 HIV infection

Research Aim: Common causes of HIV infection and their long-term consequences on the body’s immune system. An in-depth study into the acquired immunodeficiency and the results leading to this.

Topic:14 Human Rights

Creating reports on human rights and their link with the freedom of thought, conscience, religion, belief, and other factors.

Topic:15 Infection prevention and control

Research Aim: Practices for infection prevention and control using efficient approaches for patients and health workers to avoid harmful substances in the environment.

Topic:16 Infertility and pregnancy

Research Aim: Evaluating the percentage of infertility and pregnancy, especially those facing no prior births, and who have high chances of infertility and pregnancy complications.

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Midwives are nurses who provide continuous support to the mother before, during, and after labour. Midwives also help with newborn care and educate parents on how to care for their children.

How Much Do Midwives Make?

The salary of a midwife varies depending on the type of work, location, and experience of the midwife. Midwives generally earn $132,950 per year. The average annual salary for entry-level midwives is $102,390.

The minimum requirement for becoming a midwifery nurse is a bachelor’s degree in nursing, with the option of pursuing a master’s degree.

An accredited educational exam can also lead to certification as a nurse-midwife (CNM). The American College of Nurse-Midwives (ACNM) enables you to practice independently as a midwife.

There are many pros and cons to working as a midwife. As a midwife, you have the following pros and cons:

• Midwives have the opportunity to help women during one of the most memorable moments in their lives.
• Midwives can positively impact the health of mothers and their children.
• Midwives can work in many hospitals, clinics, and homes.
• In midwifery, there are many opportunities for continuing education and professional development.
• You will often have to work nights and weekends, which can be mentally draining.
• You will have to travel a lot since most births occur in hospitals or centres in different areas.
• You will have to deal with stressors such as complex patients and uncooperative families.
• You will be dealing with a lot of pain, so you need to be able to handle it without medication or other treatment methods.

A career in midwifery is a great fit for those with a passion for health and wellness, an interest in helping people, and a desire to work in a supportive environment.

It is important to become involved in your local midwifery community if you are contemplating a career in midwifery – the best source of learning is your major research work, along with writing a lengthy thesis document on midwifery dissertation topics that will submit to your university to progress your midwifery career.

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How to find midwifery dissertation topics.

To find midwifery dissertation topics:

• Explore childbirth challenges or trends.
• Investigate maternal and infant health.
• Consider cultural or ethical aspects.
• Review recent research in midwifery.
• Focus on gaps in knowledge.
• Choose a topic that resonates with your passion and career goals.

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Dissertations on Midwifery

Midwifery is a health profession concerned with the care of mothers and all stages of pregnancy, childbirth, and early postnatal period. Those that practice midwifery are called midwives.

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Latest Midwifery Dissertations

Including full dissertations, proposals, individual dissertation chapters, and study guides for students working on their undergraduate or masters dissertation.

Midwife Experiences of Maternity Care for Asylum Seekers

Dissertation Examples

The purpose of this dissertation is to investigate midwives’ experiences of providing maternity care to women seeking asylum....

Last modified: 22nd Feb 2022

What Causes Fear of Childbirth and How Can Midwives Support Women?

Fear of childbirth may lie behind a woman’s request for elective caesarean section and may lead to unnecessary caesarean section without medical indication if FOC is untreated....

Utilisation, Expectations, Experiences and Perspectives of Birth Plans

The utilisation of birth plans in childbirth and the expectations, experiences and perspectives of both women and healthcare professionals....

Relationship Between Pregnancy, Childbirth and IPV

Chapter 1 Introduction The chapter introduces the social and health problem of intimate partner violence (hereafter referred to as IPV[1]), highlights gaps in the research on IPV around the t...

Last modified: 16th Dec 2019

Promoting Normality Through Midwifery Care: Water Births

Maria is a primigravida woman who wants to have a water birth but she is concerned about neonatal safety in the water, as she has heard and read different stories and opinions about it. She is willing...

Last modified: 13th Dec 2019

Postnatal Depression in Fathers

CHAPTER 1 LO1 1.1 Research specification Outline Introduction This project will explain postnatal depression in fathers highlighting some of the causes and symptoms that can lead to Post-Nat...

Antidepressants for Postnatal Depression

Antidepressants are they a safe and effective choice for the treatment of postnatal depression? This review assessed the evidence concerning the effectiveness and safety of antidepressants in the mana...

Last modified: 12th Dec 2019

Safer Pregnancies in the Philippines

Example Literature Reviews

Chapter 2 Related Literature This chapter include Foreign and Local Studies, and Foreign and Local Literature in which will relate our study. Local Literature According to the philstar, CEBU, Philippi...

Last modified: 9th Dec 2019

Reducing Pain, Infection and Promote Healing of the Sutured Perineum During the Postnatal Period

What measures can be taken to reduce pain, infection and promote healing of the sutured perineum during the postnatal period   Word count: Post-natal perineal trauma has been shown to be a source of...

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Best Midwifery Dissertation Topics Ideas & Examples

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List of Midwifery dissertations Topics and Some Tips for Selecting Better Dissertation Topics in Midwifery

Many students feel difficulty in pursuing their studies in midwifery, let alone making a selection of topics for the dissertation. If you are searching for examples of midwifery literature review topics, midwifery research topics, midwifery dissertation titles , midwifery dissertation topics, or midwifery research questions this post is for you.

Do you belong to the above group of students who are not only shy but are also confused about how to make a selection of dissertation topics in midwifery for the midwifery dissertation?

Let’s first define what midwifery means and what its importance is in our social and medical structure.

What is Midwifery?

Midwifery is a healthcare profession that provides care to childbearing women during pregnancy, labor, and birth and during the postpartum period. They take care of the newborn and the mother. They also provide primary care to women which includes primary care to women, gynecological examination of women, family planning, and menopausal care.

In the nursing profession, students may be asked to write a dissertation on any topic of midwifery.

Tips for Selecting Midwifery Dissertation Topics

Like any dissertation in which it is difficult to choose a topic and write it, midwifery dissertations also students face the same problem. So, it is not an exception. However, one must know the important areas for the selection of the topic for the dissertation. Therefore, prior to the final selection of the topic, there are some important tips that would help students in selecting   midwifery dissertation topics. These tips are as follows.

• The students must be sure that they are going to discuss one of the most important topics in the subject.
• The dissertation on midwifery must touch on some of the serious problems which are faced by mothers and newborns.
• The students must take care that their topic is specific, and it is not broad in its nature.
• If someone has chosen a narrow topic, he/she must expand it through research and writing.
• Clear attention should be given to traditional midwifery dissertation topics in order to know their content and scope.
• The topic chosen must be aimed at explaining the profession in greater detail. The students choose the research topic which can help to improve the healthcare of mothers and their children.
• The students must enhance their basic knowledge for a better understanding of the subject.

Prenatal Care:

• The role of midwives in promoting healthy prenatal behaviors
• Assessing the effectiveness of prenatal education programs
• Addressing cultural barriers in accessing prenatal care

Postpartum Care:

• Strategies for improving postpartum support for new mothers.
• The impact of postpartum depression on maternal health outcomes
• Exploring alternative postpartum care models, such as home visits

Labor and Delivery:

• Examining the use of pain management techniques during labor
• Investigating the influence of birth environment on labor outcomes
• Evaluating the role of midwives in reducing cesarean section rates

Maternal Health:

• Addressing disparities in maternal healthcare access
• Exploring the impact of maternal nutrition on birth outcomes
• Investigating interventions to reduce maternal mortality rates globally.

Neonatal Care:

• Assessing the effectiveness of breastfeeding support in neonatal care units
• Exploring the role of midwives in neonatal resuscitation
• Investigating best practices for kangaroo care in low-resource settings

Women’s Health:

• Examining midwifery-led models of women’s health care
• Investigating the role of midwives in promoting sexual and reproductive health
• Addressing cultural taboos surrounding women’s health issues

Family Planning:

• Evaluating the impact of contraceptive counseling provided by midwives
• Exploring the role of midwives in providing abortion care
• Assessing barriers to accessing family planning services in rural areas

Midwifery Education and Training:

• Assessing the effectiveness of simulation training in midwifery education
• Exploring innovative teaching methods in midwifery programs
• Investigating strategies for mentorship and professional development in midwifery

Midwifery Ethics and Legal Issues:

• Examining ethical dilemmas faced by midwives in clinical practice.
• Exploring legal frameworks for midwifery practice across different countries
• Assessing the impact of litigation on midwifery practice

Mental Health in Pregnancy and Childbirth:

• Investigating the prevalence of anxiety disorders in pregnant women
• Exploring interventions for addressing trauma in childbirth
• Assessing the role of midwives in identifying and supporting women with perinatal mental health issues

Integrative Medicine in Midwifery Practice:

• Exploring the integration of complementary therapies in midwifery care
• Assessing the safety and efficacy of herbal remedies during pregnancy and childbirth
• Investigating cultural practices and rituals surrounding pregnancy and birth

Technology in Midwifery:

• Examining the use of telemedicine in midwifery practice
• Exploring the impact of mobile health applications on maternal and neonatal health outcomes
• Assessing the role of artificial intelligence in improving prenatal diagnosis and monitoring

LGBTQ+ Inclusive Care:

• Investigating the experiences of LGBTQ+ individuals in maternity care settings
• Assessing cultural competency training in midwifery education programs
• Exploring strategies for creating inclusive and affirming birth environments

Global Health and Midwifery:

• Examining the role of midwives in addressing maternal and neonatal health disparities in low-income countries
• Investigating the impact of international partnerships on improving midwifery services
• Assessing the cultural appropriateness of western midwifery models in diverse global contexts

Midwifery and Public Health:

• Exploring the role of midwives in promoting breastfeeding initiation and duration
• Assessing the impact of midwifery-led prenatal care on birth outcomes
• Investigating strategies for reducing maternal and neonatal morbidity and mortality through public health interventions

More Midwifery Dissertation Topics

In light of the above guidance, students can choose any topic from the following given midwifery dissertation topics.

• The impact of maternal obesity on birth outcomes
• The use of midwife-led continuity of care models in maternity care
• The role of midwives in promoting breastfeeding
• The use of technology in midwifery practice
• The impact of cultural diversity on midwifery care
• The use of midwifery-led care in low-risk pregnancies
• The role of midwives in reducing maternal mortality rates
• The use of telehealth in midwifery practice
• The impact of poverty on maternal and newborn health
• The use of water birth in midwifery practice
• The role of midwives in promoting maternal mental health
• The use of midwifery-led care in premature births
• The impact of the COVID-19 pandemic on midwifery practice
• The use of aromatherapy in midwifery practice
• The role of midwives in promoting gender equity in maternal health
• The use of midwifery-led care in home births
• The impact of policy changes on midwifery practice
• The use of midwifery-led care in rural and remote areas
• The role of midwives in promoting maternal and newborn nutrition
• The use of hypnobirthing in midwifery practice
• The impact of midwifery-led care on maternal satisfaction
• The use of midwifery-led care in women with complications in pregnancy
• The role of midwives in promoting maternal and child health
• The use of midwifery-led care in family planning
• The impact of the integration of midwifery practice and primary care
• The use of midwifery-led care in women with a history of trauma
• The role of midwives in promoting gender-sensitive care
• The use of midwifery-led care in low-income communities
• The impact of midwifery education on quality of care
• The use of midwifery-led care in women with chronic conditions.
• Role of a midwife: The role of the midwife in the present healthcare environments.
• Midwifery profession: Nursing and Midwifery-two identical yet different professions. Are they likely to go together? Or one will replace the other? What are the Prospects of males working in the midwifery profession?
• Improvements are needed in the midwifery profession in light of scientific developments in the health and childcare fields.
• The state of midwifery in developed and underdeveloped countries.
• Midwifery field: Discuss the latest practices in nursing and midwifery fields.
• The evolution of midwifery from ancient times to modern times.
• The relation between nursing and midwifery.
• The role of prenatal counseling in the growth of a child.
• Critical analysis of midwifery as the profession dominated by women.
• Midwifery service: How to improve midwifery services to less privileged women?
• What is the future growth of the midwifery profession?
• Pregnant women: Do the midwives influence decision-making and facilitate informed choices among pregnant women?
• Midwives’ descriptions and perceptions of pregnant women with problems of substance abuse .
• Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomized trial (the MidU study)

Midwifery is a noble profession with a lot of growth potential. There could be more thought-provoking nursing dissertation topics for research in this field. Interested in further details, call us for more Midwifery Dissertation topics.

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• Nursing and Midwifery (Theses and Dissertations)

Browsing Nursing and Midwifery (Theses and Dissertations) by Title

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A never-ending love story : a narrative exploration into the experiences of men who provide care in the context of dementia 

Alcohol use and alcohol-related harms: Exploring risk and protective factors among young people living in urban disadvantage 

An action research study evaluating the effect of an action learning programme on healthcare professionals' knowledge, attitudes and practice 

An exploration of mothers' experiences in caring for children with complex needs 

An exploration of stigma towards depression in rural Ireland : a mixed methods study 

An exploration of the respite needs and experiences of parents caring for a child with a life-limiting condition requiring palliative care 

An exploration of women's expectations of and preferences for childbirth experiences : a mixed methods study 

Anxiety during pregnancy and at three months postpartum: prevalence, variations and associated factors in a cohort of nulliparous women 

Attenuating anxieties : mental health nurses' responses to suicidal behaviour: a grounded theory study 

Attitudes and perceptions of medical and nursing staff to an emergency nurse practitioner service 

Breaking bad news: a phenomenological study into the giving and receiving of a cancer diagnosis 

Breastfeeding support groups in Ireland: a mixed methods investigation from a cultural historical activity theory perspective 

Bullying and work related post traumatic stress in nurses 

Caesarean section in nulliparous women: a mixed methods study of factors influencing decision-making and outcomes for women - the MAMMI Study Caesarean Section Strand 

Change and entrenchment in Irish maternity care policies and antenatal practices: An Institutional Ethnography 

Characteristics of Social Frailty among Older Adults with Intellectual Disability 

Childbirth in exile : refugee and asylum seeking women's experience of childbirth in Ireland 

Children who live in disadvantaged areas: a case study of the health and well-being perceptions and experiences of school-aged children and their families 

Children's and Parents' Experiences and Expectations of their Roles in Hospital-A Constructivist Grounded Theory study 

Cognitive Dissonance and Depression: An Exploration Using Mixed Methods 

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List of Midwifery Dissertation Topics & Research Titles

Midwives have been around for decades. Modern medicine does not change the role of midwives, however, their main role is still the same which is to care for and comfort expectant mothers during childbirth.

Midwives are trained specialists who are responsible to take care of pregnant women, new mothers, and babies throughout labor, delivery, and the early postpartum period. They also provide natural medical care for mothers and children. Moreover, registered nurses receive training that includes four additional years of education, extensive research on the methods used in midwifery, and writing on midwifery research proposal topics for dissertations.

The responsibility of a midwife is to provide service for healthy pregnancies and deliveries while supporting the rights and dignity of women. Every stage of women’s life is cared for by midwives, including preconception, postpartum, family planning, home delivery, and breastfeeding support.

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Hot Topics in Midwifery Research for Students

Midwifery education is difficult. The most difficult part is writing hundreds of exhausting health education topics in midwifery. Midwifery is a difficult medical specialty. But we can assist you! To help you become more knowledgeable, we selected the top prenatal care and pregnancy-related midwifery research topics.

Here are trending research topics for midwifery students. Have a look:

Recognizing Domestic Violence in Nursing and Midwifery

Research Aim : The study clearly states the problem, arguing that nursing education may be ineffective in teaching future practitioners to recognize domestic abuse. The authors discuss the study's practical implications and point out that domestic violence is a serious problem and that many nurses lack the confidence to identify it and take appropriate action. The study's goal is to find out how well-prepared students are to recognize and address domestic abuse during their practice.

Visual examination of the abdomen

Research Aim : The aim of this study is to provide information that will allow midwives to perform a visual abdominal examination. It emphasizes the value of a positive woman-midwife relationship and how crucial communication is to it. The requirement for consent is important to this aspect of care.

Nonverbal communication abilities to improve midwifery practice

Research Aim : This study explains the fundamentals of nonverbal communication and offers useful advice on how midwives can improve their work by speaking clearly to patients, coworkers, and families.

Midwifery Self-care and Resilience

Research Aim : In the current climate, resilience is essential for midwives. Midwives may experience stress as a result of rising birth rates, staff shortages, and sometimes negative cultures. The goal of this study is to offer midwives self-care guidance so they can increase their work-related resilience. Women and their families may be more confident in their midwife if staff well-being is improved, which will also increase patient satisfaction.

Evidence-based midwifery management of facial presentation

Research Aim : Face presentation is a rare, sudden occurrence during labor and delivery in which the fetal chin broadens (instead of bending down on its chest). Face presentation is a rare occurrence that may only take place a few times over the course of a midwife's multi-decade career. The purpose of this study is to encourage midwives to recognize distinctive facial expressions and to recognize when intervention or expectant management is necessary for the mother's and fetus's welfare.

Healthcare organizational culture

Research Aim : The NHS as a whole incorporates many different cultures and norms because of its complexity. The care given to women as well as their families is affected by the organizational culture of maternity services, which is consistent and lies beneath the surface. In order to explain how organizational culture affects health and maternity care, this study focuses on its definition.

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Final Words

If you’ve come this far, perhaps you’ve found some intriguing Midwifery dissertation topics for your work. However, if you still can’t decide on a topic, consult with our experts or use our dissertation writing services . They may be able to provide you with some excellent topic suggestions.

Additionally, you can speak with your professors, who will assign you project topics on midwifery based on your skills and areas of interest. If you read this blog several times, you might get an idea of how to carry out midwifery dissertation ideas.

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Interesting 40+ Midwifery Dissertation Topics for Students

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What Do You Understand by Midwifery Dissertation?

How to choose midwifery dissertation topics, latest midwifery dissertation topics 2024, trending midwifery dissertation topics 2024, midwifery dissertation literature review help, how our professionals can help.

Students are pursuing their studies in midwifery with the primary motive of gaining knowledge. Getting subject expertise requires hard work and concentration. Apart from that, students need to conduct a self-evaluation to examine their performance and progress. But talking specifically about midwifery dissertation topics, it offers a different range of research opportunities to explore maternal and newborn care. The term midwifery means it is a health profession that comes with the care of mothers and the various stages of pregnancy, childbirth, and the early postnatal period. To know more, read the information given in this blog, as it will tell you everything you need and will remove your query. Can anyone help me write my dissertation?

Midwifery refers to the healthcare of childbearing women and infants from pregnancy to post-birth. Where child protection during the pregnancy period is vital, maternal healthcare is also necessary. You can even use references from midwifery dissertation ideas to get clarity. 

When it comes to writing a lengthy document on midwifery, it allows researchers and doctors to find ways to avoid maternal and infant mortality. Therefore, medical students must choose good midwifery dissertation topics in their academics and dissertation modules. Now that you have understood the meaning, let’s move on to the next section on how you choose such topics.

Many students face difficulty pursuing their studies in midwifery. Like any dissertation, it is tough to choose a topic and write about it. Midwifery dissertation topics give you the same feeling at times. It is not an exception. However, you must know the essential areas for selecting the topic for the dissertation. Therefore, first to last topic selection, read some of the tips that can help you on how to write a midwifery dissertation. The tips are as follows:

• You need to be sure of the focal point you will discuss and elaborate on the topic throughout the whole document. It will help you with topic selection in a better way.
• You can even look at the midwifery dissertation examples to take reference and get the basic idea. The examples will give you an idea of how you can choose a topic to minimize the hurdles.
• The midwifery dissertation must convey and focus on the serious problems faced by mothers and newborns. So you must choose a topic around that only.
• You need to ensure that dissertation topics in midwifery are specific and not too broad. In the topic selection process, you need to determine how much you can elaborate on and provide information.
• If you have chosen a narrow topic, you must broaden the field of research and writing. In this type of dissertation, research is a core element. So regarding it, you need to do proper research so that while writing, you don’t face any problems.
• Must give proper attention to traditional midwifery dissertation ideas about the topics to know the content flow and scope.
• The midwifery dissertation topics should aim to explain the profession in depth. It should define the focal point rather than going off track.
• Try to enhance your basic knowledge to understand the subject better. Knowledge is a core element because, without it, you cannot write and develop your thought process. You can even refer to midwifery dissertation titles.
• You can choose a topic on maternal health care and their infants. These types of topics are generic and descriptive. You can choose your topics around these terms to make the process easier.

Now that you have understood how to choose midwifery nursing dissertation topics. Let's explore the best topics that you can get the idea from. Therefore, these can be the topics of nursing also. You can also get assistance from  nursing dissertation help  for your convenience.

We have listed some of the latest dissertation topics in midwifery to help you find good topics relatable to your research. Read the topics carefully and understand how they can benefit you in the topic selection process.

• The Adverse cause of recurrent miscarriage
• The cultural perspective on male midwives 
• How practical are the WHO perinatal recommendations?
• Role of DNA testing in diagnosing a child's hereditary condition
• Trends involving males who work as midwives
• Elaborate on Surgical success in treating an umbilical hernia
• What are the hereditary factors that contribute to miscarriage?
• The significant importance of eating well and being nourished when pregnant
• Treatment for a ruptured hernia
• Midwives' treatment of postpartum depression
• Perinatal treatment for disabled women
• Miscarriages' underlying mechanisms
• What is the difference between pregnant women's expectations and birthing experiences?
• What dangers lurk in-home abortions?
• Techniques for promoting a normal birth during the second stage of labor
• Why do umbilical cord hernias occur?
• What part do infections play in miscarriages?
• The right to pick one's birthplace
• Management of perinatal depression
• Obese women are still able to give birth typically, right?
• Describe the variables that prevent natural birthing.
• Taking care of hepatitis B while pregnant

Selecting midwifery dissertation topics from the mentioned examples helps and makes your efforts countable. When you finish the deep analysis, our professionals have drafted these ideas for you to save time. You need to pick the topic that interests you and begin working on it. Therefore you can also get  dissertation help  from experts for your convenience. If you still feel 23 topic ideas are not enough, below are some more topics to take help from.

Also Read:  Mental Health Dissertation Topics

It is understandable how difficult is to research a specific topic for dissertation writing. We have a qualified team of expert writers with good experience to give you some of the trending midwifery dissertation topics. It will give a basic idea of the current issues happening in the midwifery field.

• Uses, expectations, perspectives, and experiences with birth plans
• What causes pregnancy fear, and how can midwives help women?
• Nurses and midwives manage hypoglycemia in healthy-term newborns
• Midwife experiences with asylum seekers' maternity care
• Pregnancy, childbirth, and IPV relationships
• Increasing normalcy with midwifery care: aquatic births
• During the postnatal period, it reduces pain and infection and promotes healing of the sutured perineum
• Fathers' postnatal depression
• Antidepressants and postnatal depression
• Enhanced maternal safety in the Philippines
• Pediatric, obstetric, and clinician-indirect home interventions for the Medicare population
• A comprehensive assessment of the qualitative literature on the experiences of health workers in acute hospital settings with teamwork education
• How have "care pathway technologies" affected integrating services in stroke care?
• How strong is the evidence for their success in this area?
• Our nation has a midwifery culture
• Midwives have experience with difficult deliveries
• Knowledge of gender in midwifery
• Early midwives among the Native Americans: The art of midwifery
• Midwifery trends happening in the nursing practice
• What role does midwifery play in society?
• A comprehensive assessment of the experiences of midwives and nurses working together to offer childbirth care
• Relationship between women and midwives and childbirth education in your nation.

These interesting midwifery dissertation topics can impress your professors and will give you quick approval as professionals choose them personally. So if you face issues while writing a dissertation you can linger upon it by taking professional assistance and giving all your worries to the professional's.

Also Read:  Quantity Surveying Dissertation Topics

Writing a midwifery dissertation is similar to a doctoral-level dissertation. Moreover, the area of study is highly competitive, and often it is a little time-consuming. Talking about midwifery dissertation topics it consists of dissertation literature segments also.

Choosing the Right Research Materials 

When you are ready to start writing your dissertation, you require assistance from different areas to ensure to write the content properly. You need help to find the correct research materials can be online references or online libraries.

The Professional Editor Assistance 

Finally, your next area of help will be with the assistance of an expert editor; however, taking help from them will be the best. They will be checking your grammar and spelling, as well as analyzing your argumentative choices.

If you do not understand how to research Midwifery dissertation topics, you can also take the help of experts.

Women's Physicians Group

The advisors will be more interested than willing to assist in your writing tasks. Another source of advice in your midwifery dissertation literature review help is the women's physician's group. It is a group of female physicians before they entered medical school and is specifically for women in the medical field.

Do you want to expertise in midwifery or need assistance with medicine nursing dissertation topics? We have a skillful team of experts to help you and can write your dissertation with 100% quality and accuracy.

As a nursing and midwifery student, you may need a dissertation written by an expert writer. Furthermore, it might require giving a  dissertation structure  and writing a dissertation proposal. We can give you all the essential steps to give what you need. It requires a lot of concentration. That is why you can get help from a professional writer who can complete your dissertation on time.We can give you all the essential steps to give what you need. Talking about choosing midwifery dissertation topics is not an easy job.

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Guide for Students to Find the Best Midwifery Dissertation Topics

Table Of Contents

• What Does Midwifery Mean? | Significance in the Real World 

What Are the Steps to Writing a Midwifery Dissertation?

• 21 Latest Midwifery Dissertation Topics for Undergraduate
• 22 Trending Midwifery Dissertation Topics for Students

Unsure About Your Midwifery Dissertation Topics? Get Help

Finding the best midwifery dissertation topics is a challenging job for students. To overcome this issue, Assignment Desk experts have prepared this blog. It will provide you with all relevant information on how to choose midwifery dissertation ideas , some good topics to choose from, and how to start writing your dissertation.

As a midwifery student, you will be required to write your dissertation . Although the dissertation is a mandatory task, students need to complete this work if they want to pursue midwifery as an occupation. Before starting your dissertation, find a suitable topic that might interest you and write about it in detail. The challenge in this process is identifying the best dissertation topics in midwifery . Every student must have a clear understanding of this step of dissertation writing. So, let's start with the basics of midwifery.

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What Does Midwifery Mean? | Significance in the Real World

In this blog, we're going to look at midwifery and where it fits in with our society today. As you may know, there's still some debate about its meaning. We'll dive into the best midwifery dissertation titles .

The word "midwife" is a little hard to define. It's derived from the Latin word "mater," which means "mother." Midwives are those who offer maternity care and health services. Midwifery is a caring occupation that strives to preserve natural childbirth, prevent maternal death, reduce maternal morbidity and mortality, and improve perinatal outcomes.

Some still use it about a woman who gives birth, while others use it as a slang term for childbirth education and training. It can be unclear because many women wish to become midwives even though they still need formal educational credentials.

Midwives are one of the oldest professions in human history. They care for women, children, and families through childbirth every year. The definition of midwifery means "midwife." The Greeks first used this term to describe women who helped with birth and prenatal care. This fact can be easily used in the dissertation structure to make it more realistic and trustworthy.

Midwives remain vital to our society because they help women maintain their dignity during labour. And help them make healthy decisions throughout their pregnancy.

All these facts about the oldest profession attract students to pursue it as a profession. They are so inspired that the most challenging job of finding midwifery dissertation topics and writing a dissertation is easy for them. It is because they follow a proper procedure to do so. In the next section, you will learn more about that procedure.

While writing a dissertation on midwifery, it's important to remember that time is of the essence. You need to make sure that you complete and prepare a perfect dissertation on time and in an efficient manner that also makes it meaningful.

Here are some tips for students who want to write their midwifery dissertation. Or they can also seek a lot of help from these tips and tricks to improve dissertation writing skills .

• Writing an outline is the first step of any dissertation writing. Starting with this sections of your dissertation will make it easily formatted.
• Create a timeline. The timeline should include all the significant steps and milestones you must pass to complete your midwifery dissertation on time.
• Each section should be divided into smaller subsections, each with clear midwifery dissertation topics UK and a relevant purpose for your research.
• When you have your outline, you can begin writing. One of the best ways to get started is by writing down everything that comes to mind about each section. Then begin with the formal content planning.
• Now, look at the resources available on your midwifery dissertation topics : books written about it, articles published in journals or magazines, and videos or documentaries about caregivers.

Try using a checklist before starting this dissertation phase so you remember essential steps to include in the content!

Now that you have all these tips and tricks, it's time to start finding suitable and interesting midwifery dissertation topics . With a little bit of planning and some effort, you'll be able to complete this on time!

21 Latest Midwifery Dissertation Topics for Undergraduate

We have listed some of the best midwifery dissertation ideas to help you find a good topic that suits your research.

• Midwife experiences with asylum seekers' maternity care
• What causes pregnancy fear, and how can midwives help women?
• Uses, expectations, perspectives, and experiences with birth plans
• Pregnancy, childbirth, and IPV relationships
• Increasing normalcy with midwifery care: aquatic births
• Fathers' postnatal depression
• Antidepressants and postnatal depression
• During the postnatal period, it reduces pain and infection and promotes healing of the sutured perineum
• Enhanced maternal safety in the Philippines
• Pediatric, obstetric, and clinician-indirect home interventions for the Medicare population
• Nurses and midwives manage hypoglycemia in healthy-term newborns
• A comprehensive assessment of the qualitative literature on the experiences of health workers in acute hospital settings with teamwork education
• A comprehensive assessment of the experiences of midwives and nurses working together to offer childbirth care
• How have "care pathway technologies" affected integrating services in stroke care? And how strong is the evidence for their success in this area?
• Our nation has a midwifery culture
• Knowledge of gender in midwifery
• Early midwives among the Native Americans: the art of midwifery
• Midwifery trends happening in the nursing practice
• What role does midwifery play in society?
• Relationship between women and midwives and childbirth education in your nation.
• Midwives have experience with difficult deliveries

Choose dissertation topic from the above-mentioned examples and make your efforts worthwhile. After a deep analysis, our expert has curated these ideas for you to save time. You are only required to pick the one that interests you and start working on it. if still, these 21 titles are not as per your expectation, then below are more dissertation topics in midwifery available for your help.

Also Read:  How Long Should a Dissertation Be?

22 Trending Midwifery Dissertation Topics for Students

We understand how difficult it is to research a suitable topic for academic dissertation writing. Keeping that in mind, we have asked our team of professional writers with years of experience to create some of the most sensible midwifery dissertation topics UK with the help of trends. These will give you a good idea of the current issues confronting midwifery.

• The cause of recurrent miscarriage
• The cultural perspective on male midwives
• Effectiveness of DNA testing in diagnosing a child's hereditary condition
• Surgical success in treating an umbilical hernia
• What hereditary factors contribute to miscarriage?
• The importance of eating well and being nourished when pregnant
• Treatment for a ruptured hernia
• Midwives' treatment of postpartum depression
• Miscarriages' underlying mechanisms
• Trends involving males who work as midwives
• What are the differences between pregnant women's expectations and birthing experiences?
• What dangers lurk in-home abortions?
• Why do umbilical cord hernias occur?
• What part do infections play in miscarriages?
• Techniques for promoting a normal birth during the second stage of labour
• Management of perinatal depression
• Perinatal treatment for disabled women
• Obese women are still able to give birth typically, right?
• Describe the variables that prevent natural birthing.
• How practical are the WHO perinatal recommendations?
• Taking care of hepatitis B while pregnant
• The right to pick one's birthplace

These interesting midwifery dissertation topics can impress your faculty and get you instant approval, as experts pick them personally. So, if you're having trouble with your dissertation, seek professional assistance and leave all of your worries to those who have done it before.

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Do you want to specialise in midwifery or do you need help with nursing dissertation ? We have a team of experts to help, who can write your dissertation with 100% originality.

As a midwifery student, you may require a dissertation to be written by an expert writer. Moreover, it might be necessary to outline the study and write your dissertation proposal. We can organise all the essential steps for you and provide strong online dissertation help .

Writing a dissertation in midwifery is a tough job that requires tremendous concentration, so it is always advisable to engage the services of a professional writer who can complete your dissertation on time. We do not just offer midwifery, but we also provide many other benefits on several subjects. You can also find assistance for Nursing dissertation topics or Nursing assignment help . So if you want help from experts, make sure you go to the Assignment Desk and only pay a nominal fee.

Anyone interested in learning different ways to write a dissertation and wants to explore its art can also contact us. We offer samples on many levels of assistance, such as assignment help or anything from medicine.

You cannot ignore the importance of midwives in today's world. A Midwifery dissertation topics will provide valuable insight into the field. If you have difficulty finding resources for your dissertation, remember that we are here to help! We create a multitude of dissertations from scratch just for you.

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Midwifery refers to the health consciousness of childbearing women and infants from pregnancy to post-birth. Midwifery is an important academic subject in developed societies. Research in this field helps find ways to avoid maternal and infant mortality, which is crucial for the protection of children during pregnancy. Thus, medical students need to choose quality midwifery dissertation topics for their dissertation modules.

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Midwifery Dissertations: Choosing a Good Topic

The right topic for a dissertation is always a hard choice to make. Your midwifery dissertation is not an exception. Since you are not writing a midwifery essay that can be prepared in a couple of hours, you have to take the choice of a topic seriously.

In this article, you will find a short list of possible topics to cover in midwifery dissertations. Before that, we want you to read and consider some basic rules of selecting a topic for a midwifery dissertation.

Make sure you are going to research something really important. Midwifery is about dealing with people and being near in the most significant periods of their lives. Thus, your midwifery dissertation should be devoted to some acute problems that midwives and their patients might face.

Be specific and do not pick broad issues to discuss in your midwifery dissertation. Even if the issue you have chosen seems to be too narrow, it will transform and expand in the process of writing and researching.

Now, let us give you a couple of specific topic ideas for your midwifery dissertation.

Midwifery in the United States and other Western countries

In your midwifery dissertation, you may compare American midwife practices to those in other developed countries.

Home birthing and the role of midwives

Giving birth to a child is very different from that in a hospital. Tell in your midwifery dissertation about the peculiarities of home birthing, the role of a midwife, possible risks, etc.

Male midwives

This is a really interesting issue to investigate in the midwifery dissertation, since men are not that frequently involved in this field.

You are a novice dissertation writer, which means you need additional dissertation help. Our next article is devoted to some peculiarities of a dissertation research process.

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Doctoral Thesis Collection

This midwifery PhD thesis collection is an exciting new initiative for the RCM.

The aim of the collection is to provide a platform for midwives to showcase their academic work, and to inspire and support midwives who are considering or who are currently undertaking further academic study. Additionally, the collection will provide a source of open access midwifery generated evidence for everyone to use.

The opportunity for midwives to include details of the resultant publications and their social media details and institutional link, if appropriate will hopefully also support the creation of professional networks related to their academic interests. Authors may have also published articles from their thesis, so please use an author’s contact details to ask about this.

If you are a midwife and have a completed a PhD and would like to include your thesis in this collection, please complete the online form below.

If you would like to search the Thesis Collection, "Control+F" (or "Command+F" on a Mac) is the keyboard shortcut for the Find command. Pressing the Ctrl/Command key + the F key will bring up a search box in the top right corner of your screen. You can then use this to search the Collection for keywords.

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Challenges in day-to-day midwifery practice; a qualitative study from a regional referral hospital in Dar es Salaam, Tanzania

Hanna strømholt bremnes.

a Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway

Åsil Kjøl Wiig

Muzdalifat abeid.

b Department of Obstetrics and Gynecology, Temeke Regional Referral Hospital, Dar es Salaam, Tanzania

Elisabeth Darj

c Department of Obstetrics and Gynecology, St Olavs Hospital, Trondheim, Norway

d Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden

Background : Maternal and infant mortality rates in Tanzania have decreased over the past decades, but remain high. One of the challenges the country faces, is the lack of skilled health care workers. High fertility rates make midwives and their patients particularly susceptible to stress as a result of understaffing.

Objective : This paper explores the challenges midwives face in their day-to-day practice at a regional referral hospital in Tanzania, and investigates which measures the midwives themselves find necessary to implement to improve their situation.

Methods : A qualitative study design with focus group discussions (FGDs) was employed to explore which challenges the midwives experienced. Each focus group consisted of five to six midwives. A FGD topic guide covering challenges, consequences, motivation, ideal situation and possible solutions was used. These data were analyzed using Systematic Text Condensation.

Results : A total of 28 Midwives, six men and 22 women, participated in five FGDs. Four categories emerged from the collected material: Feelings of demoralization, shortage of resources, societal challenges and personal struggles. A feeling of demoralization was especially prevalent and was caused by a lack of support from the leaders and little appreciation from the patients. Shortage of resources, and shortage of personnel in particular, was also highlighted as it led to an excessive workload resulting in difficulties with providing adequate care. These difficulties were intensified by lack of equipment, facilities and a non-optimal organization of the healthcare system.

Conclusion : The challenges revealed during the FGDs prevent the midwives from providing sufficient midwifery care. To improve the situation, measures such as supportive leadership, reduction of workload, increasing availability of equipment and increasing knowledge of reproductive health in society, should be taken.

Maternal and neonatal health have been one of WHO’s key priorities for decades. The Millennium Development Goals (MDGs), and the Sustainable Development Goals (SDGs), have especially targeted the maternal mortality ratio (MMR) and the infant mortality ratio (IMR) [ 1 ]. In Tanzania, working to reach the MDGs has been important [ 2 ]. Tanzania has a total population of 45 million people, where women of childbearing age make up 47.1% [ 3 ]. The Total Fertility Rate is 5.2 [ 4 ]. The infant mortality rate is 43 per 1000 live births, which is lower than the average infant mortality in sub-Saharan region of 79.1 per 1000 [ 4 , 5 ]. The maternal mortality ratio (MMR) was estimated to be 556 per 100.000 births in 2016. This is higher than the ratios reported in 2010, but a decrease from the 2005-levels of 578 per 100.000 [ 4 , 6 ].

Method of Systematic Text Condensation for data analysis using an example from the collected material.

Overview of main categories and subcategories emerging from the focus group discussions with the midwives.

The fluctuations in MMR, and persistent high levels of mortality in both mothers and children, illustrates the required need for further research on how to improve the situation, which does not yet meet the goals postulated by WHO. One of the main challenges is that there are only four nurse-midwives per 10.000 inhabitants [ 7 ], which is considerably lower than the minimum of 23 per 10.000 recommended by the WHO [ 8 ]. This shortage of qualified personnel affects both healthcare professionals and their patients. The high fertility rate and large number of fertile women amplifies this problem and makes the shortage of midwives especially challenging.

Midwives and the barriers they face have been studied before and are regarded as key for improving child and maternal health. A worldwide systematic review on midwifery care in low and middle-income countries argues that barriers for providing good midwifery care are created by social, economic and professional factors [ 9 ]. The consequences of these barriers are feelings of exhaustion and moral distress, which in turn affects the quality of the care provided [ 9 ]. A study from Tanzania (2015) identified three main barriers to providing quality midwifery care in the country; poor-working conditions, lack of status and perceived lack of knowledge [ 10 ].

The aim of this study was to explore and highlight the challenges the midwives face in their day-to-day practice, and to investigate which measures the midwives find necessary to implement to improve their condition. This may enable actions to be taken informed by the midwives’ firsthand experience of the situation. Seeing their own suggestions being taken into account may lead to increased motivation, thereby improving the midwives’ working conditions, which in turn could better maternal and child health in the country.

Study design

A qualitative study design using focus group discussions (FGDs) was employed to explore the challenges midwifes at a regional referral hospital in Dar es Salaam face in their day-to-day practice. FGDs was considered a suitable method for data collection as it allows interactions between participants and provides the possibility of obtaining multiple views and perceptions of a subject [ 11 ]. The COREQ-guidelines for reporting qualitative research were followed [ 12 ].

Study setting

This study was conducted at the Obstetrics and Gynecology (OBGYN) department at a Regional Referral Hospital in Dar es Salaam, Tanzania. Tanzania has a pyramidal healthcare system organized in five levels, where regional referral hospitals serve as the fourth level of healthcare facilities. The hospital in question is responsible for providing healthcare to a population of around 1.6 million people in one district of Dar es Salaam [ 3 ]. The facility gets both self-referrals and referrals from the 55 government owned district health care facilities in the surrounding region [ 5 ]. The OBGYN department at the hospital has five wards; Antenatal ward with a capacity of 12 beds, labor ward with 20 beds, post-operational ward with 10 beds, post-natal ward with 30 beds and intensive care unit (ICU) with 6 beds. The hospital has approximately 17,000 annual deliveries, between 40 and 50 each day. The staff consists of doctors and nurse-midwives. Most deliveries and other routine work are performed by nurse-midwives. There are two to three midwives present per shift in the Labor ward, making the patient-nurse-ratio 10:1. In the other wards, except the ICU, there is fewer staff, with one midwife being responsible for up to 30 patients during afternoons and nights. When a complication arises a specialist doctor on call is summoned for intervention.

Study participants

Participants were recruited from the OBGYN department at the Regional Referral Hospital using a purposive sampling technique [ 13 ]. Midwives of both genders, all ages and of varying seniority were included in order to ensure a rich and diverse data material. The only inclusion criterion was to be employed as a midwife at the hospital and to be willing to participate in the study. Thirty nurse-midwives were asked to take part in the FDGs, of which two declined. In total, 28 participated, among them six men and 22 women. Their age ranged from 23 to 57, and their working experience from 2 months to 33 years.

Data collection

Five FGDs were conducted over a 2 week period with 5–6 midwives in each group. The group size was decided based on recommendation from Malterud [ 11 ], who regards 5–6 participants as suitable number to secure both participation and presentation of multiple views. After the 5 FGDs were conducted, the material was perceived to be saturated as no new topics emerged during the final interview [ 11 ]. To avoid compromising the patient care, the interviews took place during the least busy time of day, after ward rounds and before changing of shifts, and with midwives from different wards. The interviews were conducted in Kiswahili. An independent translator, who works as a midwife at another hospital in Dar es Salaam, moderated the FGDs assisted by the two first authors who observed and took notes. An FGD guide with topics covering specific areas was used, such as: challenges, consequences of the challenges, motivation, ideal situation and possible solutions. The FGDs were on average 60 minutes long and were audio-recorded with permission from the participants. The audio-recordings were translated verbally into English by the translator after the FGDs and simultaneously transcribed by the first authors into written English transcripts. The written translations were verified against the audio-recordings for accuracy by the local supervisor. No significant incongruences or mismatches were found.

Data analysis

The qualitative method of Systematic Text Condensation (STC), as described by Malterud [ 14 ], was applied to the material. This proved to be a suitable method for analyzing the manifest content of the material and provide a systematic presentation of the midwives’ experiences and situation. The main steps of the analysis involved interpretation of data through multiple readings of the transcripts and identification of themes and meaning units. The meaning units were then coded and grouped into categories and subcategories which were labeled at a manifest level and validated against the original transcripts ( Table 1 ).

All participants actively participated in the discussions. The atmosphere in the interview room was characterized by a shared frustration. The topics of challenges and solutions sparked passionate debates and the midwives eagerly shared their experiences. Four key categories emerged from the collected material: feelings of demoralization, shortage of resources, societal challenges and personal struggles ( Table 2 ).

Feelings of demoralization

One of the main concerns reported by the participants during the interviews was a feeling of demoralization induced by both their clients and their supervisors.

Blamed by patients

The midwives felt that when something went wrong, e.g. maternal death or stillbirths, the patients and their relatives would always blame them.

‘ I don’t think there is any nurse who would be happy for anybody to lose their baby, or that there is any nurse who would want a woman to die. These things are accidents, but the patient will always blame the nurse’. (Midwife 4 FGD3)

They reported to have been verbally abused by their patients, something that made them feel that their hard work was being undermined. It was their general impression that midwives had a bad reputation in the society, and they wished that the population would learn more about the work midwives do. Their hope was that this would make patients and their close ones appreciate their work to a greater extent.

Lack of support from superiors

The midwives also experienced a loss of motivation at work due to limited support from their superiors, something that contributed to their feeling of demoralization. They felt that they had no advocate in their leaders, and that the leaders always were on the patient’s side in conflicts. They wanted an arena for dialogue with their superiors and the possibility to defend themselves in situations where complications had occurred.

‘Well, our leaders are on the side of the patients, not us. That’s just politics. It’s painful, we always get the punch’. (Midwife 2 FGD1)

‘ Yes, that’s right. And you’ll just have to forget that something unfair happened to you yesterday’. (Midwife 5 FGD1)

The midwives also found it problematic that they were not compensated for working overtime, and this contributed to them feeling even more devalued in their work. Lack of other incentives for working, like tea or compensation for transport when staying late, enhanced this feeling.

Shortage of resources

The participants described a shortage of personnel, equipment and facilities that leads to problems with overwork and risk of infections for the midwives, and poor monitoring, delays in treatment and unnecessary complications for the patients.

All the participating midwives reported a substantially higher patient-nurse-ratio than the one recommended at the hospital. Two midwives could be responsible for up to 60 women in different stages of labor per shift when delivery frequency is at its highest. To make the situation bearable, each midwife has to work longer hours and more shifts than they are supposed to. ‘You come to work in the morning, and no matter how tired you are you can’t leave work when you are supposed to because there are too many women who needs your help.’ (Midwife 3 FGD1)

All participants reported being tired, something that affects patient care. Several of the midwives confessed that they sometimes acted rudely towards patients because they were tired and impatient. Increasing the amount of staff was seen as one of the most important factors for improving the working conditions and the care provided to patients.

‘Everybody is busy! Let’s talk about reality. So there are two midwives and there are 60 women in different stages of labor. And all these women expect to deliver under supervision of a midwife and afterwards have their babies assessed, is that possible? It’s impossible!’ (Midwife 5 FGD3)

The Tanzanian government state that delivery services should be free for all women, but the participants reported that the government does not provide the hospital with enough equipment to cover their most basic needs. They lacked everything from essential supplies like gloves, masks, syringes and catheters, to more advanced material like digital monitors of blood pressure and fetal heart rate. The lack of equipment endangers both the midwives and their patients.

‘We’ve got too low amounts of equipment compared to the number of women in the ward. Due to this we have to ask them to buy their own equipment, which makes the women angry because they’ve heard in the media that hospital treatment is free’. (Midwife 1 FGD1)

The midwives reported a constant fear of getting infected with for example hepatitis, HIV or TB because of the lack of protective gear, something that made them more reluctant to help women with known infections. They were convinced that if they had better and more available equipment, they would feel safer. More advanced equipment would also make it possible for them to monitor and follow-up patients more adequately and make it easier to determine which patients need their help the most.

‘The protective gloves are seasonal. It’s uncommon to help a woman deliver without getting blood on your forearms.’ (Midwife 5 FGD3)

When the hospital is out of equipment, the midwives have to ask their patients to go buy the equipment to be able to provide the required care. Since policy states that delivery services are free, the midwives reported that asking for equipment was often interpreted by the clients as asking for money for the midwives’ own personal use.

The participants reported a shortage of necessary facilities needed to provide good obstetric care. The lack of available theaters for conducting C-sections was the prime concern. The hospital only has one operating theater, which is shared by all departments. A frequently reported problem was the need to bring a patient in for an emergency C-section, but having to wait for several hours because the theater was busy, resulting in stillbirths that could otherwise have been avoided.

‘I had an incident where I took two women to the theatre and they had to wait in line. One got a low score baby and the other one was a stillbirth.’ (Midwife 2 FGD1)

Another issue was that there was only one ambulance available for the entire hospital. If the theater was busy and a woman needed a C-section, it would, in theory, be possible to refer her to the national hospital, but the lack of ambulances makes this difficult.

Societal challenges

During the FGDs it became clear that there were several societal factors that made the working situation at the hospital difficult. The midwives found the low education level in the population especially challenging. They thought that insufficient education caused delayed arrivals at the hospital. Lack of cooperation between health care facilities was another problem, especially the lack of a well-functioning referral system.

Low level of education in the population

The hospital is located in one of the most densely populated areas of Dar es Salaam. The participants reported that the population in the area has a low level of education, which affects their knowledge of family planning and reproductive health. The nurse-midwives postulated that the lack of knowledge resulted in more complications, because women arrived late at the hospital, often only if complications arose. A factor that contributed to an increase in complications was the use of local herbs to speed up labor, a common practice in the area, according to the participants. They wished that they had the resources to help educate women on reproductive health. This would lead to less complications and unnecessary deaths.

‘The clients that we take care of are challenging in themselves. These women come in when they have used local herbs to speed up the labor, or they delay coming to the hospital. Some come when it’s almost pushing time or when they have macerated babies’. (Midwife 3, FGD2)

Lack of cooperation within the health system

The healthcare system in Tanzania has a pyramidal organization where the women are supposed to attend antenatal check-ups in their local clinics during pregnancy. This was problematized by the midwives because some of the peripheral clinics did not collect or transfer vital information about the women, for example HIV-status, measuring of HB-levels and blood pressure (BP) control. This is problematic in emergencies and may cause delays in treatment.

‘BP is very crucial for a pregnant woman. If you don’t measure these women and they have no idea what eclampsia is, that’s when they end up coming here with eclampsia’. (Midwife 5 FGD4)

Another challenge the midwives pointed out was the fact that the women come without a referral letter, which increases the patient load. The hospital has many normal deliveries that could have been taken care of at a lower healthcare level. This would have eased the workload and given the midwives more time to care for the remaining patients.

Furthermore, the cooperation with the doctors was mentioned as a problem. The participants reported that they felt underrated by the doctors and that this sometimes led to delays in diagnosis and treatment because the doctors did not trust the midwives’ observations. Defined routines and teamwork between doctors and nurses was mentioned as a possible way of improving the healthcare provided.

Personal struggles

The participants reported that the heavy workload and stressful situation at work affected their personal and family lives in several ways. They experienced both physical and mental health problems, limited personal development and trouble with their families.

Health problems

The long shifts and heavy workload affect the midwives both psychologically and physically. They reported that the heavy lifting and the long hours causes back aches and disc prolapses. Some also had miscarriages. Because the work is so stressful, the midwives seldom have time to eat or sit down to rest, and they come home exhausted. Many find it difficult to leave work behind when they return home and continue thinking about their patients after their shift has ended.

‘We get health problems and severe back aches due to disc prolapse. A lot of the midwives have disc prolapse’. (Midwife 2, FGD2)

Lack of personal development

Opportunities for further education and promotions are limited, and the midwives felt that this makes it harder for them to gather motivation for their work. Low salaries and restricted compensation for overtime work contributed to this demotivation. The midwives reported that the few trainings and update courses that actually are arranged are unavailable to them, either because they are too busy working in the wards or because the people who work in administration are prioritized. More access to trainings and possibilities for career advancement would motivate them more and make them able to perform better at work.

Family life troubles

The participants highlighted that the long shifts at work are difficult to combine with family and social life. They complained that they do not see their spouses and children enough. They have no time for household chores or to follow up on their children’s school work. They were concerned that their maids were raising their children, and it bothered them not to be in control of their upbringing themselves.

‘Well your family perishes; you’re making other people’s family happy, but you’re making your own sad. You work on somebody else’s happiness when you’re killing your own back home’. (Midwife 2, FGD1)

The most prevalent findings in this study was the feeling of demoralization. Other factors of importance were personal struggles, shortage of staff, equipment availability, and unawareness and challenges in society. The feeling of demoralization and lack of motivation is in line with findings from other studies conducted in the region [ 15 – 17 ]. Positive support from supervisors have been demonstrated to be of importance for the quality of services that health workers are able to deliver [ 18 ]. In the World Health report on improving performance in healthcare, the WHO stress that supportive supervision can contribute to improved performance of health workers [ 18 , 19 ]. In situations where employees experience lack of motivation, consequences are lack of courtesy to patients, poor process quality and failure to treat patients at an appropriate time [ 20 ]. The health outcomes of patients are therefore critically dependent on the nurses’ motivation [ 21 ]. Changing the management strategy, or providing supportive management training for supervisors, are documented measures that can be taken to increase the level of motivation in the workplace [ 16 , 18 ]. Another important factor to improve performance is adequate salaries [ 21 ]. Hospitals where at least a minimum of allowances are paid, tend to have a more motivated work force, and consequently more content patients, according to Tibandebage et al. [ 16 ].

The experienced lack of opportunities for career advancement and personal development, which were presented in the category ‘personal struggles’, also contribute to the feeling of demotivation. Continued education is one of the most effective ways to heighten midwives’ motivation and cultivate midwives’ skills [ 22 ]. Skilled and motivated midwives with possibilities for career development has proven to be an efficient way to reduce mother and child mortality [ 5 ]. Another way to heighten motivation is through promotion. Providing midwives with the possibility of future education, and/or possibilities for promotion is therefore something that may lead to higher staff retention and a more motivated staff.

Shortage of staff, equipment and facilities were other reported barriers to providing adequate midwifery care, a finding supported by other studies from the region [ 16 , 17 ]. Delivery attended by skilled personnel with appropriate supplies and equipment has been found to be strongly associated with reduction of child and maternal mortality [ 23 , 24 ]. Taking measures to increase access to human resources is of great importance to improving patient care. One option is to bring in more qualified staff, but a severe shortage of healthcare providers in the region makes this challenging [ 23 ]. Another way of reducing the workload suggested by the midwives is to make changes to the organization of the healthcare service. If the referral system is more controlled and the patients are required to have a referral letter from their district hospital before they can come to the referral facility, the workload may be reduced. Shortage of equipment is ideally solved by getting more resources. However, governmental spending on health in percentage of GDP is decreasing, making less resources available [ 25 ]. At the same time, the government proclaim that maternal healthcare during pregnancy and delivery is free [ 26 ]. This is a challenge for the midwives, since it causes a gap between government policy and reality. The goal should be to provide free healthcare, as this has been shown to reduce mortality [ 26 ], but a prerequisite for this is an increase in governmental spending on health. Other factors important for the reduction of mortality are advanced monitoring equipment and available operating theaters for emergency C-sections [ 27 ]. Investments in monitoring devices that can detect problems early will help the midwives in prioritizing the patients that need closer attention or emergency care. Operating theaters for C-section will reduce unnecessary delays in treatment, and thus avoiding preventable deaths.

Being mistreated by their patients and having a bad reputation in society are also factors that were reported to be challenging for the midwives, contributing to the aforementioned feeling of demoralization. Women giving birth in healthcare facilities in Tanzania report limited support, neglect and physical and verbal abuse during labor [ 17 ]. A possible way to alter the midwives’ bad reputation is tackling some of the other challenges they face. If the midwives were more motivated, they might be more polite and attentive towards the patients, something that may lead to more frequent follow ups and better care, according to Franco et al. [ 20 ]. Increasing the amount of staff would be helpful since this will give the midwives more time to care for each patient. The same is true for obtaining the necessary equipment and facilities, as these are integral factors in providing quality healthcare [ 24 ].

The population’s knowledge of reproductive health was reported to be limited and increasing this can be another way to aid the midwives’ reputation and position in society. The knowledge will help patients understand the importance of getting qualified assistance during labor and the effect this has for birth outcome. Increased knowledge in itself has been documented to increase rates of facility-assisted deliveries, which in turn will have a positive effect on both mother and child mortality [ 28 ]. Higher levels of education have been shown to increase the use of delivery services [ 29 ]. Focusing on a general increase in education in the region, with emphasis on awareness of danger signs during pregnancy and delivery [ 30 ], might therefore have an effect on birth outcome, and help eliminate the problem of seeking professional help too late.

Strengths and limitations

In this study we have described what kind of challenges midwives meet practicing midwifery in a busy Tanzanian Referral Hospital, overcrowded with women in the wards and delivery rooms. One of the main strengths of the study is that it offers the midwives’ own perspectives on their working situation and their own thoughts about possible measures to improve it. This can create a foundation for further research on interventions that are adapted to the local context. A second strength is using a Tanzanian midwife as a moderator and translator. She understood the midwives’ situation, thereby making the participants feel more comfortable and willing to share their stories. Moreover, the preliminary results from the FGDs were presented both to the staff and administration at the hospital. This made it possible for the midwives to confirm the findings, which strengthens their credibility, and made sure that the midwives’ concerns were heard on an organizational level.

However, focusing solely on the perspective of the midwives is a limitation. Including patients, doctors or the hospital administration in the study would provide more diverse experiences and broader insight into the situation at the hospital. Other topics that affect the perceptions of workload and women’s utilization of the provided health care, such as education, culture, religion, economic status, women’s health seeking behavior and knowledge of danger signs, could also have been discussed further. A second limitation is that the study was conducted by two foreign researchers without the ability to speak Kiswahili and insight into the local context of midwifery. This might have affected the interpretation of the material. Using English was considered, but the authors concluded that this would lead to a more substantial loss of information than a translation process would. Measures taken to limit these disadvantages were spending time in the wards to familiarize with the midwives and their working environment before the interviews, having a co-author and local supervisor who works at the hospital and knows the midwives well, and using a moderator and translator who is familiar with the local context of midwifery, being a midwife herself. The local supervisor and co-author, who is fluent in Kiswahili, double-checked the recordings against the transcripts to make sure the quality of the translations was satisfactory, to limit the disadvantage of using only one translator.

Trustworthiness

The credibility of this study was ensured by describing the qualitative research method, the use of FGDs, analyzing the data with STC, frequently revisiting the data, and presenting the content with quotes from the research participants. Furthermore, the collaboration of students and international researchers was important for gaining an in-depth understanding of the data. This collaboration included two Norwegian fifth year medical students, a Tanzanian supervisor who works as an obstetrician in a busy District Hospital, and a Scandinavian professor and obstetrician, familiar with the Tanzanian context and with vast experience of research in reproductive health in several other low-income settings. In addition, the FGDs were conducted, within a short period of time, by a Tanzanian midwife fluent in Kiswahili and with understanding of the context, allowing for consistency throughout the data collection process, and thereby increasing its dependability. All material was immediately translated to English after each FGD. A clear and detailed description of the study context and setting, as well as descriptions of the participants, the data collection and analysis processes has been provided for the readers to improve transferability.

This study aims to show that midwives working at a regional referral hospital in Dar es Salaam face considerable challenges, both pertaining to the management of the healthcare service (locally and nationally), possibilities for advancement (education and promotion), availability of resources (materials and personnel) and reputation and knowledge in the population. The challenges they face, constitute barriers to providing good midwifery care for their patients, causes problems for them on a personal level, and demotivates them in their work. They therefore need to be addressed, both by government funders, health policy makers and regulators. A feeling of demoralization is particularly apparent. The main cause of this feeling is an absence of support and understanding from their leaders. Creating an arena for dialogue and implementing a more supportive leadership style would be efficient measures that can, and should, be taken to improve the midwives’ working conditions. Other important measures are reduction of workload, either with increased amount of staff or reorganization of the referral system, providing sufficient equipment, either through a larger supply or modification of polices, and increasing the knowledge level, both through providing training for the midwives and through educating the population. Taking these measures will improve the quality of care the midwives provide, which in turn can lead to improved health for both mothers and children in Tanzania.

Funding Statement

This work was supported by the Norwegian University of Science and Technology under Grant number 652010.

Responsible Editor Maria Emmelin, Umeå University, Sweden

Acknowledgments

The authors are grateful to all the midwives who participated in the study and willingly shared their thoughts, and to our eminent translator Yvone Kamala.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethics and consent

Ethical approvals to conduct the study are confirmed by Regional Committee for Medical and Health Research Ethics Mid-Norway (project reference number 2017/577), Norwegian Centre for Research Data (project reference number 54406) and obtained by the Ethics Review Committee at the Muhimbili National Hospital (project reference number (MNH/IRB/2017/011). The participants were briefed on the aim and purpose of the study before the FGDs took place. They were also informed that participation was voluntary, that they could withdraw at any time and that their names were not registered. They were aware that the FGDs would be audio-recorded, but that the information they provided would be anonymized and only used for research purposes. All participants gave a verbal consent of participation.

Paper context

Tanzania has a high fertility rate and lacks skilled health workers to provide care for delivering women. Combined, these factors cause excessive work-pressure for midwives in the country. Our research gives insight into midwives’ perception of their working situation and which measures they find necessary to implement to ease the burden. Findings from this study may provide a starting point for interventions to improve midwives’ working conditions and strengthen maternal and child health in Tanzania.

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Midwifery students’ perceptions and experiences of learning in clinical practice: a qualitative review protocol

Yang, Zhihui 1 ; Li, Xinxin 2 ; Lin, Huanhuan 2 ; Chen, Fanfan 2 ; Zhang, Lili 1 ; Wang, Ning 1

1 PR China Southern Centre for Evidence-based Nursing and Midwifery Practice: A JBI Centre of Excellence, Guangzhou City, Guangdong Province, PR China

2 School of Nursing, Southern Medical University, Guangzhou City, Guangdong Province, PR China

Correspondence: Ning Wang, [email protected]

The authors declare no conflict of interest.

Objective: 

This systematic review aims to investigate and synthesize qualitative evidence related to midwifery students’ perceptions and experiences of learning in clinical practice.

Introduction: 

Midwifery students are required to develop strong competencies during pre-registration education for future practice. Clinical placements provide a good opportunity for students to build essential practice capacities. Understanding the perceptions and experiences of midwifery students in clinical practice helps develop effective midwifery clinical educational strategies. A qualitative systematic review is therefore proposed to improve midwifery clinical education.

Inclusion criteria: 

This proposed review will consider qualitative studies that have explored midwifery students’ perceptions and experiences of learning in clinical practice in all degrees. The search will be limited to English-language published and unpublished studies to the present.

Methods: 

This review will follow the JBI approach for qualitative systematic reviews. A three-stage search will be conducted to include published and unpublished literature. Databases to be searched include PubMed, Science Direct, Web of Science, CINAHL, PsycINFO, American Nurses Association, Google Scholar, ProQuest Dissertation & Theses, and Index to Theses in Great Britain and Ireland. Identified studies will be screened for inclusion in the review by two independent reviewers. Any disagreements will be resolved through discussion. Data will be extracted using a standardized tool. Data synthesis will adhere to the meta-aggregative approach to categorize findings. The categories will be synthesized into a set of findings that can be used to inform midwifery education.

Systematic review registration number: 

PROSPERO CRD42020208189

Introduction

Due to strong advocacy for improved health and safety of pregnant women and their babies globally, many countries have made significant progress in increasing the proportion of pregnant women who give birth at health care facilities. 1 However, such effort has not led to the expected level of reduction in maternal and newborn mortality and stillbirths, 2 which can be caused by inadequacies in the quality of care provided in the health care facilities. 3

The delivery of quality and safe midwifery practice requires that health professionals develop strong competencies and high-level accountabilities. Evidence shows that well educated, regulated, and licensed midwives are associated with improved quality of care and rapid and sustained reduction in maternal or neonatal morbidity and mortality. 4 Pre-registration education is an important stage for midwifery students to develop the fundamental professional knowledge, skills, and judgment essential for their future practice. Clinical practice programs as a significant component of midwifery education provide a valuable opportunity for midwifery students to build hands-on capabilities that integrate with classroom theories, and to be socialized into their chosen profession. 5 Specifically, it helps students develop the required professional competencies for registration and ideas about their career preference, as well as smoothly transit to their future career. 6,7 It has been found that education undertaken through clinical placements provides up to 50% of the learning experience for students in pre-registration midwifery courses. 8

Midwifery refers to “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum throughout pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life.” 9 (p.1130) Midwifery practice involves a wide scope of care activities that are undertaken to pursue the overall well-being of pregnant women. This includes providing continuous support to the women during their antenatal, intrapartum, and postpartum periods, being responsible for conducting births, caring for the newborns, and preventing and managing complications in pregnancy and childbirth. 10 These require that midwives are highly competent in undertaking various work tasks in partnership with the women and to cope with the complex and dynamic nature of the practice environments. 11 To face such challenging learning requirements, midwifery students can become frustrated when they first enter a practice setting. Literature shows that student health professionals often face challenges and experience a high level of stress during their clinical placements, 12,13 and midwifery students experience more stress compared to students in other professions. 14,15 Research has found that the midwifery students’ clinical stress was either due to their low confidence in undertaking care and a fear of making mistakes, or their relationships with clinical educators and colleagues. 16 Negative clinical experiences perceived by the student midwives can pose a potential threat to their effective learning and recognition of their future professional career. 17-19

As a key part of successful midwifery education, a well-designed practice program with a supportive environment is essential for fostering students’ confidence and passion to pursue a future midwifery career and for building competencies for entry to their registrations. 7,20 Students’ perceptions and experiences about their clinical learning are considered a hallmark of quality education. 21 While there is a growing body of knowledge reported in the literature about these elements, a systematic aggregation of such evidence should identify implications for the educational and clinical faculties to develop appropriate and effective clinical training strategies and provide required support to the students. Our literature search has identified three reviews about student professionals’ learning experiences; however, these reviews have focused on the learning experiences of undergraduate nursing rather than midwifery students, 22 a setting other than clinical placements, 23 or the relationship between workplace culture and the practice experience. 24 This review addresses a gap in the literature by aggregating evidence about midwifery students’ perceptions and experiences of learning in clinical settings. The ultimate aim is to improve midwifery educators’ understanding of their students’ clinical experiences.

Review question

What are the perceptions and experiences of midwifery students’ learning in clinical practice?

Inclusion criteria

Participants.

This review will consider qualitative studies that focus on midwifery students’ perceptions and experiences of learning in clinical practice settings. There will be no limitation regarding age, gender, grade or year, or ethnicity of participants.

Phenomena of interest

The phenomena of interest will be midwifery students’ perceptions and experiences of learning in clinical practice settings.

This review will consider studies conducted in any settings identified as a clinical practice, including clinical placement or internship, in acute care, community care, or simulated learning environments.

Types of studies

This review will consider English-language qualitative studies that describe the perceptions and experiences of midwifery students in their clinical practice. These studies will focus on qualitative data including, but not limited to, designs such as phenomenology, grounded theory, ethnography, and action research. Qualitative data from mixed method studies will also be included.

The proposed systematic review will be conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. 25 The review has been registered in PROSPERO (CRD42020208189).

Search strategy

The search strategy aims to locate both published and unpublished studies. A three-step search strategy will be utilized in this review. An initial limited search of PubMed will be undertaken followed by analysis of the text words contained in the titles and abstracts, and of the index terms used to describe the articles. This preliminary search in PubMed will be used to develop a search strategy for this review that will include other databases. A second search using identified keywords and index terms will then be undertaken across all included databases. Thirdly, the reference list of all identified reports and articles will be searched for additional studies. A sample search strategy for PubMed is detailed in Appendix I. There is no date limit for the studies included in this review.

The databases to be searched for published studies include: MEDLINE (PubMed), Science Direct, Web of Science, EBSCO (CINAHL), and EBSCO (PsycINFO). The search for unpublished literature will include Google Scholar, American Nurses Association, ProQuest Dissertation & Theses Database, and Index to Theses in Great Britain and Ireland.

Study selection

Following the search, all identified citations will be collated and uploaded into EndNote v.9 (Clarivate Analytics, PA, USA) and duplicates removed. Titles and abstracts will then be screened by two independent reviewers for assessment against the inclusion criteria for the review. Potentially relevant studies will be retrieved in full and their citation details will be imported into the JBI System for the Unified Management, Assessment and Review of Information (JBI SUMARI; JBI, Adelaide, Australia). 26 The full text of selected citations will be assessed in detail against the inclusion criteria by the two independent reviewers. Reasons for exclusion of full-text studies that do not meet the inclusion criteria will be recorded and reported in the systematic review. Any disagreements that arise between the reviewers at each stage of the study selection process will be resolved through discussion or with a third reviewer. The results of the search will be reported in full in the final systematic review and presented in a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram. 27

Assessment of methodological quality

Papers selected for retrieval will be assessed by the two independent reviewers for methodological quality prior to inclusion in the review using the standard JBI critical appraisal checklist for qualitative research. 25 Any disagreements that arise between the reviewers will be resolved through discussion or with a third reviewer. Authors of primary studies will be contacted with questions on missing information or if clarification is needed. The results of the critical appraisal will be reported in narrative form, as well as in a table. All studies, regardless of the results of their methodological quality, will undergo data extraction and synthesis.

Data extraction

Qualitative data will be extracted from studies included in the review by the two independent reviewers using the standardized JBI qualitative data extraction tool for qualitative evidence (JBI SUMARI). The data extracted will include specific details about the participants, context, geographical location, study methods, and the phenomena of interest relevant to the review question and specific objectives. Findings will be verbatim extractions of the authors’ analytic interpretations, along with relevant illustrations. Each finding will be assigned a level of validity or credibility. Findings will be described as “unequivocal” or “credible,” as recommended in the JBI Manual for Evidence Synthesis . 25 All “unsupported” findings will be excluded from the review. Any disagreements relating to credibility that arise between the reviewers will be resolved through discussion or by a third reviewer.

Data synthesis

Qualitative research findings will, where possible, be pooled using JBI SUMARI with the meta-aggregation approach. 28 This will involve aggregation or synthesis of findings to generate a set of statements that represents the aggregation, through assembling and categorizing these findings on the basis of similarity in meaning. These categories will then be subjected to a meta-synthesis in order to produce a single comprehensive set of synthesized findings that can be used as a basis for evidence-based practice. The categories and synthesized findings will be agreed by discussion among the reviewers to ensure they support the meaning of the data. Where textual pooling is not possible, the findings will be presented in narrative form.

Assessing certainty in the findings

The final synthesized findings will be graded according to the ConQual 29 approach for establishing confidence in the output of qualitative research synthesis and presented in a Summary of Findings. The Summary of Findings includes the major elements of the review and details how the ConQual score is developed. Included in the Summary of Findings will be the title, population, phenomena of interest, and context for the specific review. Each synthesized finding from the review will then be presented along with the type of research informing it, score for dependability and credibility, and the overall ConQual score.

Acknowledgments

The library staff at Southern Medical University for their guidance and support on literature retrieval.

Appendix I: Search strategy

Medline (pubmed).

Search conducted August 2020

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• Published: 28 August 2024

Facilitators and barriers of midwife-led model of care at public health institutions of dire Dawa city, Eastern Ethiopia, 2022: a qualitative study

• Mickiale Hailu 1 ,
• Aminu Mohammed 1 ,
• Daniel Tadesse 1 ,
• Neil Abdurashid 1 ,
• Legesse Abera 1 ,
• Samrawit Ali 2 ,
• Yesuneh Dejene 2 ,
• Tadesse Weldeamaniel 1 ,
• Meklit Girma 3 ,
• Tekleberhan Hailemariam 1 ,
• Netsanet Melkamu 1 ,
• Tewodros Getnet 1 ,
• Yibekal Manaye 1 ,
• Tariku Derese 1 ,
• Muluken Yigezu 1 ,
• Natnael Dechasa 1 &
• Anteneh Atle 1  

BMC Health Services Research volume  24 , Article number:  998 ( 2024 ) Cite this article

Metrics details

The midwife-led model of care is woman-centered and based on the premise that pregnancy and childbirth are normal life events, and the midwife plays a fundamental role in coordinating care for women and linking with other health care professionals as required. Worldwide, this model of care has made a great contribution to the reduction of maternal and child mortality. For example, the global under-5 mortality rate fell from 42 deaths per 1,000 live births in 2015 to 39 in 2018. The neonatal mortality rate fell from 31 deaths per 1,000 live births in 2000 to 18 deaths per 1,000 in 2018. Even if this model of care has a pivotal role in the reduction of maternal and newborn mortality, in recent years it has faced many challenges.

To explore facilitators and barriers to a midwife-led model of care at a public health institution in Dire Dawa, Eastern Ethiopia, in 2021.

Methodology

: A qualitative approach was conducted at Dire Dawa public health institution from March 1–April 30, 2022. Data was collected using a semi-structured, in-depth interview tool guide, focused group discussions, and key informant interviews. A convenience sampling method was implemented to select study participants, and the data were analyzed thematically using computer-assisted qualitative data analysis software Atlas.ti7. The thematic analysis with an inductive approach goes through six steps: familiarization, coding, generating themes, reviewing themes, defining and naming themes, and writing up.

Two major themes were driven from facilitators of the midwife-led model of care (professional pride and good team spirit), and seven major themes were driven from barriers to the midwife-led model of care (lack of professional development, shortage of resources, unfair risk or hazard payment, limited organizational power of midwives, feeling of demoralization absence of recognition from superiors, lack of work-related security).

The midwifery-led model of care is facing considerable challenges, both pertaining to the management of the healthcare service locally and nationally. A multidisciplinary and collaborative effort is needed to solve those challenges.

Peer Review reports

Introduction

A midwife-led model of care is defined as care where “the midwife is the lead professional in the planning, organization, and delivery of care given to a woman from the initial booking to the postnatal period“ [ 1 ]. Within these models, midwives are, however, in partnership with the woman, the lead professional with responsibility for the assessment of her needs, planning her care, referring her to other professionals as appropriate, and ensuring the provision of maternity services. Most industrialized countries with the lowest mortality and morbidity rates of mothers and infants are those in which midwifery is a valued and integral pillar of the maternity care system [ 2 , 3 , 4 , 5 ].

Over the past 20 years, midwife-led model of care (MLC) has significantly lowered mother and infant mortality across the globe. In 2018, there were 39 deaths for every 1,000 live births worldwide, down from 42 in 2015. From 31 deaths per 1,000 live births in 2000 to 18 deaths per 1,000 in 2018, the neonatal mortality rate (NMR) decreased. The midwifery-led care approach is regarded as the gold standard of care for expectant women in many industrialized nations, including Canada, Australia, the United Kingdom, Sweden, the Netherlands, Norway, and Denmark. Evidence from those nations demonstrates that women and babies who get midwife-led care, as opposed to alternative types of care, experience favorable maternal outcomes, fewer interventions, and lower rates of fetal loss or neonatal death [ 6 , 7 , 8 ].

In Pakistan, the MLC was accompanied by many challenges. Some of the challenges were political threats, a lack of diversity (midwives had no opportunities for collaborating with other midwives outside their institutions), long duty hours and low remuneration, a lack of a career ladder, and a lack of socialization (the health centers are isolated from other parts of the country due to relative geographical inaccessibility, transportation issues, and a lack of infrastructure). Currently, in Pakistan, 276 women die for every 100,000 live births, and the infant mortality rate is 74/1000. But the majority of these deaths are preventable through the midwife-led care model [ 7 ].

The MLC in African countries has faced many challenges. Shortages of resources, work overload, low inter-professional collaboration between health facilities, lack of personal development, lack of a well-functioning referral system, societal challenges, family life troubles, low professional autonomy, and unmanageable workloads are the main challenges [ 8 ].

Due to the aforementioned challenges, Sub Saharan Africa (SSA) is currently experiencing the highest rate of infant mortality (1 in 13) and is responsible for 86% of all maternal fatalities worldwide. As a result, it is imperative to look at the MLC issues in low-income countries, which continue to be responsible for 99% of all maternal and newborn deaths worldwide [ 8 , 9 ].

Ethiopia’s has a Maternal mortality rate (MMR) and NMR of 412 per 100,000 live births and 33 per 1000 live births, respectively, remain high, making Ethiopia one of the largest contributors to the global burden of maternal and newborn deaths, placed 4th and 6th, although MLC could prevent a total of 83% of all neonatal and maternal fatalities in an environment that supports it. The MMR & infant mortality rate (IMR) in the research area were indistinguishable from that, at 150 per 100,000 live births and 67 fatalities per 1,000 live births, respectively [ 10 , 11 , 12 , 13 ].

Since the Federal Ministry of Health is currently viewing midwifery-led care as an essential tool in reducing the maternal mortality ratio and ending preventable deaths of newborns, exploring the facilitators and barriers of MLC may have a great contribution to make in reducing maternal and newborn mortality [ 14 ]. Since there has been no study done in Ethiopia or the study area regarding the facilitators and barriers of MLC, the aim of this research was to explore the facilitators and barriers of MLC in Dire Dawa City public health institutions.

In so doing, the research attempted to address the following research questions:

What were the facilitators for a midwife-led model of care at the Dire Dawa city public health institution?

What were the barriers to a midwife-led model of care at the Dire Dawa city public health institution?

Study setting and design

Institutional based qualitative study was conducted from March 01-April 30, 2022 in Dire Dawa city. Dire Dawa city is one of the federal city administrations in Ethiopia which is located at the distance of 515killo meters away from Addis Ababa (the capital city) to the east. The city administration has 9 urban and 38 rural kebeles (kebeles are the smallest administrative unit in Ethiopia). There are 2 government hospitals, 5 private hospitals, 15 health centers, and 33 health posts. The current metro area population of Dire Dawa city is 426,129.Of which 49.8% of them are males and 50.2% females. The total number of women in reproductive age group (15–49 years) is 52,673 which account 15.4% of the total population. It has hot temperature with a mean of 25 degree centigrade [ 15 ].

Study population and sampling procedure

The source population for this study included all midwives who worked at Dire Dawa City public health facilities as well as key informants from appropriate organizations (the focal person for the Ethiopian Midwives Association and maternal and child health (MCH) team leaders). The study encompassed basically 41 healthcare professionals who worked in Dire Dawa public health institutions in total, and the final sample size was decided based on the saturation of the data or information.

From the total 15 Health centers and 2 Governmental Hospitals found in Dire Dawa city administration, 8 Health centers and 2 Governmental Hospitals were selected by non-probability purposive sampling method. In addition to that a non-probability convenience sampling method was used to select midwives who were working in Dire Dawa city public health institutions and key informants from the relevant organization such as Ethiopian midwives association focal person and MCH team leaders. Midwives who were working for at least six months in the institution were taken as inclusion criteria while those who were working as a free service were excluded from the study.

Data collection tool and procedures

Focus groups, in-depth interviews, and key informant interviews were used in collecting data. A voice recorder, a keynote-keeping, and a semi-structured interview tool were all used to conduct the interviews. Voluntary informed written consent was obtained from the study participant’s before they participated in the study. Then an in-depth interview and focus group discussion were held with midwives chosen from various healthcare organizations. The MCH department heads and the Dire Dawa branch of the Ethiopian Midwife Association served as the key informants. In-depth interview (IDI) and key informant interviews (KII) with participants took place only once and lasted for roughly 50–60 min. In the midwives’ duty room, the interview was held. Six to eight people participated in focus group discussions (FGD), which lasted 90 to 100 min. Two midwives with experience in gathering qualitative data gathered the information.

Data quality control

The qualitative design is prone for bias but open-ended questions were used to avoid acquiescence and 2 day proper training was given for the data collector regarding taking keynotes and recording using a tape recorder. For consistency and possible modification, a pretest was done in one FGD and In-depth interviews at non selected health institutions of Dire Dawa city administrations. A detailed explanation was given for the study participants about the objectives of the study prior to the actual data collections. All (FGDs, key informant interview and In-depth interviews) were taken in a silent place.

Data analysis

Atlas.ti7, a qualitative data analysis program, was used for analyzing the data thematically. An inductive approach to thematic analysis involves six steps: familiarization, coding, generation of themes, review of themes, defining and naming of themes, and writing up. By listening to the taped interview again, the data was transcribed. The participants’ well-spoken verbatim was used to extract and describe the inductive meanings of the statements. The data was then coded after that. Each code describes the concept or emotion made clear in that passage of text. Then we look at the codes we’ve made, search for commonalities, and begin to develop themes. To ensure the data’s accuracy and representation, the generated themes were reviewed. Themes were defined and named, and then the analysis of the data was written up.

Trustworthiness of data

Meeting standards of trustworthiness by addressing credibility, conformability, and transferability ensures the quality of qualitative research. Data triangulation, data collection from various sites and study participants, the use of multiple data collection techniques (IDI, KII, and FGD), multiple peer reviews of the proposal, and the involvement of more than two researchers in the coding, analysis, and interpretation decisions are all instances of the methods that were used in order to fulfill the criteria for credibility. To increase its transferability to various contexts, the study gave details of the context, sample size and sampling method, eligibility criteria, and interview processes. To ensure conformability, the research paths were maintained throughout the study in accordance with the work plan [ 16 , 17 ].

Background characteristics of the study participants

In this study, a total of 41 health care providers who are working in Dire Dawa public health facilities participated in the three FGDs, six KIIs, and fifteen IDIs. The years of experience of study participants range from one year to 12 years. The participants represented a wide age range (30–39 years), and the educational status of the respondents ranged from diploma to master’s degree. (Table  1 )

As shown in Table  2 , from the qualitative analysis of the data, two major themes were driven from facilitators of MLC, and seven major themes were driven from barriers to MLC. (Table  2 ).

Facilitators of midwife-led model of care at a public health institution of Dire Dawa city, Eastern Ethiopia, in 2021

Professional pride.

This study found that saving the lives of mothers and newborns was a strong facilitator. Specifically, it was motivational to have skills within the midwifery domain, such as managing the full continuum of care during pregnancy and labour, supporting women in having normal physiologic births, being able to handle complications, and building relationships with the women and the community, as mentioned below by one of the IDI participants.

“I am so proud since I am a midwife; nothing is more satisfying than seeing a pregnant mother give birth almost without complications. I always see their smile and happiness on their faces , especially in the postpartum period , and they warmly thank me and say , “Here is your child; he or she is yours.” They bless me a lot. Even sometimes , when they sew me in the transport area , cafeteria , or other area , they thank me warmly , and some of them also want to invite me to something else. The sum total of those things motivates me to be in this profession or to provide midwifery care.“ IDI participants.

This finding is also supported by other participants in FGD.

“We have learned and promised to work as midwives. We are proud of our profession , to help women and children’s health. The greatest motivation is that we are midwives , we love the profession , and we are contributing a great role in decreasing maternal and child mortality….” FGD discussant.

Good teamwork

The research revealed that good midwifery teamwork and good social interaction within the staff have become facilitators of MLC. FGD participants share their experiences of working in a team.

“In our facility , all the midwives have good teamwork; we have good communication , and we share client information accurately and timely. In case a severe complication happens , we manage it as a team , and we try to cover the gap if some of our staff are absent. Further from that , we do have good social interactions in the case of weeding , funeral ceremonies , and other social activities. We do have good team spirit; we work as a team in the clinical area , and we also have good social relationships. “If some of our staff gets sick or if she or he has other social issues , the other free staff will cover her or his task.” FGD discussant.

Another participant from IDI also shared the same experience regarding their good teamwork and their social interactions.

“As a maternal and child health team , we do have a good team spirit , not only with midwives but also with other professions. We are not restricted by the ward that we assign. If there is a caseload in any unit , some midwives will volunteer to help the other team. Most of the time in the night , we admit more than 3 or 4 labouring mothers at the same time. Since in our health center only one midwife is assigned in the night , we always call nurses to help us. This is our routine experience.” IDI participants.

Barriers of midwife-led model of care at a public health institution of Dire Dawa city, Eastern Ethiopia, in 2021

Lack of professional development.

This study revealed that insufficient opportunities for further education and updated training were the main barriers for MLC. Even the few trainings and update courses that were actually arranged were unavailable to them, either because they did not meet the criteria seated or because the people who work in administration were selected. Even though opportunities are not arranged for them to upgrade themselves through self-sponsored. One of the participants from IDI narrates her opinion about opportunities for further education as follows:

“Training and updates are not sufficient; currently we are almost working with almost old science. For example , the new obstetrics management protocol for 2021 has been released from the ministry of health , and many things have changed there. But we did not receive any training or even announcements. Even the few trainings and update courses that were truly organized and turned in to us are unavailable since the selection criteria are not fair. As a result , we miss those trainings either because we did not meet the selection criteria or because those who work in administration are prioritized.” IDI participant.

FGD discussants also support this idea. She mentioned that even though opportunities are not arranged for them to upgrade themselves through self-sponsorship,

“There is almost no educational opportunity in our institution. Every year , one or two midwives may get institutional sponsorship. Midwives that will be selected for this opportunity are those who have served for more than five to ten years. Imagine that to get this chance , every midwife is expected to serve five or more years. Not only this , even if staff want to learn or upgrade at governmental or private colleges through self-sponsored programmes , whether at night or in an extension programme , they are not cooperative. Let me share with you my personal experience. Before two years , I personally started my MSc degree at Dire Dawa University in a weekend programme , and I have repeatedly asked the management bodies to let me free on weekends and to compensate me at night or any time from Monday to Friday. Since they refuse to accept my concern , I withdraw from the programme.“ FGD discussant.

Shortage of resource

The finding indicates that a shortage of equipment, staff, and rooms or wards was a challenge for MLC. Midwives claimed they were working with few staff, insufficient essential supplies, and advanced materials. This lack of equipment endangers both the midwives and their patients. One of the participants from IDI narrates her opinion about the shortage of resources as follows:

“Of course there is a shortage of resources in our hospital , like gloves and personal protective devices. Even the few types of medical equipment available , like the autoclave , forceps , vacuum delivery couch , and BP apparatus , are outdated , and some of them are unfunctional. If you see the Bp apparatus we used in ANC , it is digital but full of false positives. When I worked in the ANC , I did not trust it and always brought the analogue one from other wards. This is the routine experience of every staff member.“ IDI participants.

Another participant from IDI also shared the same experience regarding the crowdedness of rooms or wards.

“In our health center , there are no adequate wards or rooms. For example , the delivery ward and postnatal ward are almost in one room. Postnatal mothers and neonates did not get enough rest and sleep because of the sound of laboring mothers. Not only is this , but even the antenatal care and midwifery duty rooms are also very narrow.“ IDI participants.

The study also revealed midwifery staff were pressured to work long hours because they were understaffed, which in turn affected the quality of midwifery care. The experience of a certain midwife is shared as follows:

“I did not think that the management bodies understood the risk and stress that we midwives face. They did not want to consider the risk of midwives even equal to that of other disciplines but lower than the others. For example , in our health centre , during the night , only one midwife is assigned for the next 12 hours , but if you see in the nurse department , two or more nurses are assigned at night in the emergency ward.” IDI participants.

The discussion affirms the fact that being understaffed and not having an adequate allocation of midwife professionals on night shifts are affecting labouring mothers’ ability to get sufficient health midwifery care. The above narration is also supported by the FGD discussant.

“In our case , only one midwife is assigned to the labour ward during the night shift. I think this is the main challenge for midwives that needs attention. Let me share with you my experience that happened months before. While I was on night shift , two labouring mothers were fully dilated within three or four minutes. It was very difficult for me , to manage two labouring mothers at the same time. Immediately , I call one of my nurse friends from the emergency department to help me. If my friend was so busy , what could happen to the labouring mother and also to me? This is not only my experience but also the routine experience of other midwives.” FGD discussant.

Unfair risk or hazard payments

It is reported that the compensation amount paid for risk is lower than in other health professions. The health risks are not any less, but the remuneration system failed to capture the need to fairly compensate midwifery professionals. The narration from the FGD discussant regarding unfair payment is mentioned below.

“Only 470 ETB is paid for midwives as risk payments , which is incomparable with the risks that midwives are facing. But contrary to that , the risk payments for nurses (in emergencies) are about 1200 Ethiopian birr (ETB) , and Anesthesia is 1000 ETB. I did not want to compare my profession with other disciplines , but with the lowest cost , how the risk of midwifery cannot be equal to that of nursing and other professions. I did not know whose professionals made such types of unfair decisions and with what scientific background or base this calculation was done . ” FGD discussant.

The above finding is also supported by an IDI participant.

“………………………….Even though the midwifery profession is full of risks , with the current Ethiopian health care system , midwives are being paid the lowest risk payments compared to other disciplines…………….” IDI participants.

Limited organizational power of midwives

Midwives’ interviews reported that limited senior midwifery positions in the health system have become the challenge of midwifery care. This constrains the decision-making power and capability of midwives. This was compounded by limited opportunities for midwifery personnel to address their concerns to the responsible bodies, as stated by one of the key informants.

“Our staff has many concerns , especially professional-related concerns , which can contribute to the quality of midwifery care. Personally , as department head , I have tried to address those concerns in different management meetings at different times. But since the leadership positions are dominated by other disciplines , many of our staff concerns have not been solved yet. But let me tell you my personal prediction… If those concerns are not solved early and if this trend continues , the quality of midwifery care will be in danger.“ Participant from Key Informant.

The above finding is also supported by another IDI participant.

“In our hospital , at every hierarchal and structural level , midwives are not well represented. That is why all of our challenges or concerns have not been solved yet. For example , as a structure in the Dire Dawa Health Office (DDHO) , there is a team of management related to maternal and child health. But unfortunately , those professionals working there are not midwives. I was one of three midwives chosen to meet with Dr. X (former DDHO leader) to discuss this issue. At the time , we were reaching an agreement that two or three midwives would be represented on that team. But since a few months later the leader resigned , the issue has not gotten a solution yet.“ IDI participant.

Feeling of demoralization

One of the main concerns reported by the participants during the interviews was a feeling of demoralization induced by both their clients and their supervisors about barriers to midwifery care. They reported having been verbally abused by their patients, something that made them feel that their hard work was being undermined, as stated by an FGD participant.

“I don’t think there is any midwife who would be happy for anybody to lose their baby , or that there is any midwife who would want a woman to die. These things are accidents , but the patient and leaders will always blame the midwife.” FDG discussant.

A narration from an IDI participant also mentioned the following:

“……….If something happens , like a conflict with the patients or clients , the management is on the patient side. Not only that , the way in which they communicate with us is in an aggressive or disrespectful manner . ” IDI participant.

Absence of recognition or /motivation from superiors

This study revealed that midwives experience a loss of motivation at work due to limited support from their superiors. Their effort is used only for reporting purposes. A midwife from FGD shared her experience as follows.

“In our scenario , till the nearest time , the maternal and child health services are provided in a good way. But this was not easy; it is the cumulative effort of midwives. But unfortunately , only those in managerial positions are recognized. Nothing was done for us despite our efforts. To me , our efforts are used only for reporting purposes.” FGD discussant.

This finding was also supported by IDI participants.

“Even though we have good achievements in the MCH services , there is no motivation mechanism done to motivate midwives.” But if something or a minor mistake happens , they are on the front lines to intimidate us or write a warning letter. Generally , their concern is a report or a number issue. We are tired of such types of scenarios.” IDI participant.

Insufficient of work-related security

One of the main concerns reported by the participants during the interviews was the work related security, which has become a challenge for MLC. The midwives’ work environment was surrounded by insecurity, especially during night shifts, when midwives were facing verbal and even physical attack, as mentioned by participants.

“In the labour ward , especially at night , we face many security-related issues. The families of labouring mothers , especially those who are young , are very aggressive. Sometimes they even want to enter the delivery room. They did not hear what we told them to do , but if they hear any labour sounds from their family , they disturb the whole ward. This leads to verbal abuse , and sometimes we face physical abuse. There may be one or two security personnel at the main gate , but since the delivery ward is far from the main gate , they do not know what is happening in the delivery ward. When things become beyond our scope , we call security guards. Immediately after the security guards go back , similar things will continue. What makes it difficult to manage such situations is that only one midwife is assigned at night , and labouring mothers will not get quality midwifery care.” IDI participant.

FGD discussants also shared their experience that their working environment is full of insecurity.

“In case any complications occur , especially at night , it is very difficult to tell the labouring mother’s family or husband unless we call security personnel. It is not only swearing that we face but also that they intimidate us.” FDG discussant.

Discussions

The aim of this study was to explore facilitators’ and barriers to a midwifery-led model of care at Dire Dawa public health facilities. In this study, professional pride was the main facilitator of the midwifery-led model of care. Another qualitative study that examined the midwifery care challenges and factors that motivate them to remain in their workplace lends confirmation to this conclusion. It was found that a strong feeling of love for their work was the main facilitator’s midwifery-led model of care [ 9 ]. Having a good team spirit was also another facilitator’s midwifery-led model of care in our study. Another study’s findings confirmed this one, which emphasizes that building relationships with the midwives, women, and community was the driving force behind providing midwifery care [ 7 , 18 ].

The midwives in this study expressed a need for additional professional training, updates, and competence as part of their continuing professional development. Similar findings have been reported in the worldwide literature that midwives were struggling for survival due to a lack of limited in-service training opportunities to improve their knowledge and skills [ 19 ]. This phenomenon does not seem to differ between settings in high-, middle-, and low-income countries [ 7 , 9 , 18 ], in which midwives experienced difficult work situations due to a lack of professional development to autonomously manage work tasks, which made them feel frustrated, guilty, and inadequate. As such, this can contribute to distress and burnout, which in turn prevent midwives from being able to provide quality care and can eventually cause them to leave the profession [ 19 ].

Shortages of resources (shortage of staff, lack of physical space, and equipment) were the other reported barriers to midwifery care explored in this study. They reported that they are working in an environment with a shortage of resources, which leads to poor patient outcomes. This finding is supported by many other studies conducted around the globe [ 20 , 21 , 22 , 23 ]. Another qualitative finding, which likewise supports the aforementioned finding, which emphasizes that a shortage of resources was reported as a barrier to providing adequate midwifery care [ 19 ]. Delivery attended by skilled personnel with appropriate supplies and equipment has been found to be strongly associated with a reduction in child and maternal mortality [ 24 ].

The feeling of demoralization and lack of motivation from their superiors were other barriers to midwifery care explored in this study. This finding is concurrent with other studies conducted around the globe [ 19 , 25 , 26 , 28 ]. The above finding is also is in accord with another qualitative narration, which emphasizes that feelings of demoralization and a lack of motivation were the main challenges of midwifery care [ 22 ]. Positive support from supervisors has been demonstrated to be important for the quality of services that health workers are able to deliver. In the World Health Organization’s report on improving performance in healthcare, the WHO stresses that supportive supervision can contribute to the improved performance of health workers [ 27 ].

Unfair risk payment was the other challenge identified by the current study. Even though there is no difference in the risk they face among health professionals, the risk payment for midwives is very low compared to others. This finding was in conformity with another qualitative narration, which emphasizes that the lack of an equitable remuneration system was experienced by the DRC midwives, and it has also been confirmed to be highly problematic in other studies in low- and middle-income settings [ 7 , 8 , 22 , 28 ], leading to serious challenges. In settings where salaries are extremely low or unpredictable, proper remuneration is seen as crucial to worker motivation and the quality of midwifery care [ 29 , 30 ].

The limited organizational power of midwives was another identified challenge of MLC. This finding was in step with other studies that emphasize that limited senior midwifery positions in the health system constrain the decision-making power and capability of midwives. This was compounded by limited opportunities for midwifery personnel to address their concerns to the responsible bodies. Hence, midwives need to take control of their own situations. When midwives are included in customizing their work environments, it has proven to result in improved quality of care for women and newborns around the globe [ 8 , 15 ].

Lack of work-related security was another barrier to MLC explored in this study, in which the midwives’ work environment was surrounded by insecurity, especially during night shifts, when midwives are facing verbal and even physical attack, as mentioned by participants. This finding is supported by many other studies conducted around the globe [ 22 , 23 , 25 , 31 ]. The above finding is also in agreement with another qualitative narration, which emphasizes that the midwives’ work environment was surrounded by insecurity, especially during night shifts due to a lack of available security personnel; they often felt frightened on their way to and from work [ 7 ]. In order for midwives to provide quality care, it is crucial to create supportive work environments by ensuring sufficient pre-conditions, primarily security issues [ 31 ].

Conclusions

The study findings contribute to a better understanding of the facilitators’ and barriers of a midwifery-led model of care in the case of Dire Dawa public health facilities. Professional pride and having good team spirit were the main facilitators of midwifery-led model care. Contrary to that, insufficient professional development, shortage of resources, feeling of demoralization, lack of motivation, limited organizational power of midwives, unfair risk payment, and lack of work-related security were the main barriers to a midwifery-led model of care in the case of Dire Dawa public health facilities. Generally, midwifery care is facing considerable challenges, both pertaining to the management of the healthcare service locally and nationally.

Study implications

The findings of the study have implications for midwifery care practices in Eastern Ethiopia. Addressing these areas could potentially contribute to the reduction of IMR and MMR.

Strengths and limitations

The first strength of the study is that the participants represented different healthcare facilities, both urban and rural, thereby offering deeper and more varied experiences and reflections. A second strength is using a midwife as a moderator. She or he understood the midwives’ situation, thereby making the participants feel more comfortable and willing to share their stories. However, focusing solely on the perspective of the midwives is a limitation.

Recommendations

To overcome the barriers of midwifery care, based on the result of this study and in accordance with the 2020 Triad Statement made by the International Council of Nurses, the International Confederation of Midwives, and the World Health Organization, it is suggested that policymakers, Ethiopian federal ministry of health, Dire dawa health office, and regulators in Dire Dawa city and settings with similar conditions coordinate actions in the following:

To the Ethiopian federal ministry of health (FMOH)

Should strengthen regular and continuous educational opportunities, trainings, and updates for midwives, prioritizing and enforcing policies to include adequate and reasonable remuneration and hazard payment for midwives. Support midwifery leadership at all levels of the health system to contribute to health policy development and decision-making.

To dire Dawa health Bureau

Ensure decent working conditions and an enabling environment for midwives. This includes reasonable working hours, occupational safety, safe staffing levels, and merit-based opportunities for career progression. Special efforts must be made to ensure safe, respectful, and enabling workplaces for midwives operating on the night shift. Midwifery leaders should be involved in management bodies within an appropriate legal framework. Made regular mentorships on the functionality of different diagnostic instruments in respective health facilities.

To Dire Dawa public health facility’s

Create an arena for dialogue and implement a more supportive leadership style at the respective health facilities. Should address professional-related concerns of midwives early. Ensure midwives’ representation at the management bodies. Ensure the selection criteria for educational opportunities and different trainings are fair and inclusive. Ensure the safety and security of midwives, especially those who work night shifts. Should assign adequate staff (midwives and security guards) to the night shifts.

Ethiopian midwifery association

Should influence different stakeholders to solve midwife’s concerns like hazards payment and educational opportunity.

Data availability

All the datasets for this study are available from the corresponding author upon request.

Abbreviations

Focused group discussion

In-depth interview

Infant mortality rate

Key informant interview

Maternal and child health

Midwives led model of care

Neonatal mortality rate

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Acknowledgements

We are very grateful to Dire Dawa University for the financial support for this study and to the College of Medicine and Health for its monitoring ship. All study participants for their willingness to respond to our questionnaire.

this work has been funded by Dire Dawa University for data collection purposes. The Dire Dawa University College of Medicine and Health Sciences was involved in the project through monitoring and evaluation of the work from the beginning to the result submission. However, this organization was not involved in the design, analysis, critical review of its intellectual content, or manuscript preparation, and its budget did not include publication.

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Mickiale Hailu, Aminu Mohammed, Daniel Tadesse, Neil Abdurashid, Legesse Abera, Tadesse Weldeamaniel, Tekleberhan Hailemariam, Netsanet Melkamu, Tewodros Getnet, Yibekal Manaye, Tariku Derese, Muluken Yigezu, Natnael Dechasa & Anteneh Atle

College of Health Sciences, Wachemo University, Hossana, Ethiopia

Samrawit Ali & Yesuneh Dejene

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Contributions

MH developed the study proposal, served as the primary lead for study implementation and data analysis/interpretation, and was a major contributor in writing and revising all drafts of the paper. AM, DT, NA, LA, and SA supported study implementation and data analysis, and contributed to writing the initial draft of the paper. YD, TW, MG, TH and, NM supported study recruitment and contributed to writing the final draft of the paper. TG, YM, TD, MY, ND and, AA conceptualized, acquired funding, and led protocol development for the study, co-led study implementation and data analysis/interpretation, and was a major contributor in writing and revising all drafts of the paper. All authors contributed to its content. All authors read and approved the final manuscript.

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Correspondence to Mickiale Hailu .

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All methods were followed in accordance with relevant guidelines and regulations. The institutional review board of Dire Dawa University has also examined and evaluated it for its methodological approach and ethical concerns. Ethical clearance was obtained from Dire Dawa University Institutional Review Board and an official letter from research affairs directorate office of Dire Dawa University was submitted to Dire Dawa health office and it was distributed to selected health institutions. Voluntary informed written consent was obtained from the study participant’s right after the objectives of the study were explained to the study participants and confidentiality of the study participants was assured throughout the study period. Participants were informed that they have the right to terminate the discussion (interview) or they can’t answer any questions they didn’t want to answer.

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Hailu, M., Mohammed, A., Tadesse, D. et al. Facilitators and barriers of midwife-led model of care at public health institutions of dire Dawa city, Eastern Ethiopia, 2022: a qualitative study. BMC Health Serv Res 24 , 998 (2024). https://doi.org/10.1186/s12913-024-11417-x

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Midwifery: Forming Questions

• Getting Started
• Forming Questions
• Search/Research
• Entry to Practice Resources

A Good Question...

• Focuses your information needs
• Identifies key seach concepts
• Points you in the direction of potential resources

Background Questions

These questions are general in nature and provide foundational information on a single concept. Background questions cover topics including:

• Terminology
• Health Promotion
• General Drug Information
• Midwifery Interventions

What are some examples of culturally rooted birthing practices ?

What drugs are used to treat hypertension ?

What types of education resources exist for mothers with gestational diabetes ?

How is sepsis  diagnosed?

What does fetal heartbeat  sound like?

Answers to these questions may be found in text-book like resources, handbooks, manuals, and in resources providing overviews.

Online Resources

• The Well Built Clinical Question Duke University Medical Center Library and Health Sciences Library
• Focusing Clinical Questions Centre for Evidence-Based Medicine, Oxford

Foreground Questions

These questions bring together multiple concepts related to a specific clinical situation or research topic.  They are typically divided into two categories:

• Qualitative Questions  aim to discover meaning or gain an understanding of a phenomena.  They ask about an individual's or population's experience of certain situations or circumstances
• Quantitative Questions often  aim to discover cause and effect relationships by comparing two or more individuals or groups based on differing outcomes associated with exposures or interventions.

These questions are often best answered using the resources found in the 6S Pyramid.

Forming Foreground Questions

Building an effective foreground question can be challenging.  The following models will help:

Qualitative Questions: The PS Model

P - Patient/Population

S - Situation

How do/does ___ [P] ____ experience _____ [S] _____?

Ex. How do mothers with a detailed birthplan  experience deviations from this plan ?

___________________________________________________________________________

Quantitative Questions: The PI/ECO(T) Model

A quantitative approach can answer many different types of questions, but all can be formatted by following the  PI/ECO(T) Model  outlined below:     

PICO(T) Templates

In ___ [ P ]___,  do/does ___[ I ]___ result in ___[ O ]____ when compared with ___[ C ]___ over ___[ T ]____?

E.g.) In infants unable to latch for breastfeeding , does prompting through  finger feeding  result in a higher rate of latching   when compared with prompting through bottle feeding over the first year of life ?

Are ___[ P ]___  with  ___[ I ]___  over ____[ T ]____ more likely to ___[ O ]____ when compared with ___[ C ]___ ?

E.g.) Are mothers  given cesarian sections in their first pregnancy  more likely to experience uterine rupture during subsequent pregnancies  when compared with first time mothers giving vaginal birth ?

Is/are ___[ I ]___ performed on ___[ P ]___   more effective than ___[ C ]___  over ___[ T ]____in ___[ O ]____?

E.g.) Is transvaginal ultrasound  performed on expectant mothers  more effective than laparoscopy   in  diagnosing ectopic pregnancies ?

In ___[ P ]___,  do/does ___[ I ]___ result in ___[ O ]____ when compared with ___[ C ]___ over ___[ T ]____?

E.g.) In  women experiencing their first pregnancy , do   pregnancy-tracking mobile apps  result in  fewer unneccesary hospital visits  when compared with self-tracking  over the course of the pregnancy ?

Do/does ___[ I ]___ for/performed on ___[ P ]___   lead to  ___[ O ]___  over ___[ T ]____compared with ___[ C ]____?

E.g.) Do Mommy-and-Me programs for  first time mothers   lead to  quicker return to pre-pregnancy body image    over the first year of motherhood  compared with no intervention ?

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I'm stuck. Choose me a midwify dissertation topic.

EccentricaGallumbits · 30/09/2009 12:02

Things I like Normal birth Water Art Placentas Knitting. TIA.

The role of the knitted placenta in art.

also there has to have been at least 10 research papers already done on said subject.

Homebirth - is it an unacknowledged feminist stance against the male-dominated hegemony of the obstetric unit? !!

Interested in this thread?

Then you might like threads about this subject:

Aha...that's where my idea comes unstuck I suspect

...and knitting

Antenatal preparation and mode of birth? I thankfully escaped a dissertation, but sometimes wonder, if I had to...then shudder, and have a cup of tea.

Can't you do your own research? If I wasn't so lazy and could motivate myself to do my dissertation I'd want to do some research. I was thinking about doing research on partnerss feelings about the birth. But then I realised I wouldn't have enough time for Mn'ing and decided to stick at a diploma.

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Breech presentation in pregnancy and the demise of knowledgeable clinicians available to assist with vaginal birth.

who the bloody hell thought it would be a good idea to do this to myself? am sorely tempted to jack it in and go back to nursing.

not enough time / energy for primary research. Has to be literature review. Breech is tempting. Perhaps something about whether nurses make better midwives or not. spirituality ad birthing? but what focus?

Do women need spiritual care from midwives? Spirituality, midwifery and childbirth in the UK?

Spirituality of midwives and its impact on maternal care Does midwives' experience of water-assisted birth affect their attitudes towards it? (could you manage a questionnaire as well as a literature review?) Like the 'Does previous nursing training affect midwives' practice?' idea.

Im a mental health nurse (with interest in perinatal mental health). I did my dissertation on Post Traumatic Stress Disorder following childbirth. Quite a few 'recent' (from 1994) papers out there.

Or what about ante natal care in prisons?

Still haven't decded. I really don't want to do something tat will traumatise me for the next 10 months so things like PTSD, emergencies and cappitity while interesting are out. I'm wondering about language used by midwives / medical peeps, whether women mind us talking bollocks a different language? whether women have jargo or medical / professional terms explained? and if it makes a difference to their experience? what do you think?

how about hypnosis & birth? there's some research going on in Adelaide at the moment Think the language issue a good one... interesting how rhetoric is used to manipulate choices ie get women so afraid they will agree to whatever medics want.

EccentricaGallumbits I'm being a bit cheeky (hijack) but can I just ask you, your a nurse, yes? Did you train as a nurse with midwifery in mind to do after initial nurse training, and do you think that it has benefited you by doing the nurse training first? Sorry lots of questions it's just I have started an access course to do nursing/midwifery....slightly undecided which pathway and am applying now to uni's. Any advice would be amazing......

pnd incidence related to birth experience Or, is it helpful to tell women they are not in labour until 2cm dilated?

cultural issues, esp as affecting women who are displaced, like asylum seekers? tho' might be a bit traumatic. I'd like a quick hijack, too- having a midlife crisis and considering long term dream of mw training? good idea or not?

well can you knit your own stretchy cervix and birth canal?

Hokay. Hijackers! I did always have an incling to do midwifery. I did nursing first because a. there was a nursing campus near me and the DDs were littler so less travelling. b. direct entry midwifery is hellishly competetive to get into so thought nursing might give me a leg up on the way (it did) c. I wasn't completely sure about the midwifery so thought having nursing as a base would be a good start because you an do lots of stuff, specialisms, etc from it. I am very glad I did nursing first because I actually love nursing, just don't like the crappy beurocracy that goes with it. not that midwifery is any different in that way but there are other options and a different supervision system. The nursing bit does help hugely when actually working in maternity. You have a more rounded view of medicine, surgery, physiology, pain, communication, psychology, sociology etc etc. However that's not to say that all that stuff isn't covered in the 3 year course. I think it just helps being more practiced in it before you start. If you do consider the nursey bit first then it may be useful checking with local universities if they do the 18 month conversion because lots don't and you may have to commute miles. And finally perfect for a midlife crisis career change. I have to say that. Thanks for suggestions. keep them coming. Am liking the decision making angle to the language thingy.

and yes. i have been known to knit uteri

hellishly competitive have to say I made a rather fine placenta out of felt with dressing gown cord covered with tights as umbilical cord (when I was nct teacher) I had this idea that 'visual' aids should be homely, would be more empowering...so...if you have knitted a uterus, what about something on women's understanding of physiology, how that relates to their exp of labour? prob no primary research on this tho. love your name btw.

(yes, hijacking again) Just wondering how you managed studying nursing with little children. i am considering a nursing degree but don't know how on earth i would make time for my 4 kids!?

post-traumatic stress incidence following instrumental delivery and impact on postnatal depression and/or bonding with baby

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Home » Blog » Dissertation » Topics » Nursing » Midwifery » Midwifery Dissertation Topics List (30 Examples) For Your Research

Midwifery Dissertation Topics List (30 Examples) For Your Research

Mark Dec 14, 2019 Jun 5, 2020 Midwifery , Nursing No Comments

As a student, if you are finding Midwifery dissertation topics, you have visited the right site. We offer a wide range of midwifery dissertation topics and project topics on midwifery. As the field has evolved, the research topics on midwifery are based on new and emerging concepts and ideas. You can choose any of the […]

As a student, if you are finding midwifery dissertation topics, you have visited the right site. We offer a wide range of midwifery dissertation topics and project topics on midwifery. As the field has evolved, the research topics on midwifery are based on the new and emerging concepts and ideas.

You can choose any of the give topic for your research in midvfery and our team can offer quality dissertations according to your requirements.

A list Of midwifery dissertaton topics

Emerging trends in midwifery and obstetrical nursing.

Modern trends of the N education in midwives and modern methods in practical training.

The impact of delayed umbilical cord clamping after birth.

How the cell-free DNA screening is helpful in identifying genetic problems in the baby?

Limiting interventions during low-risk labor.

The concept of cost containment in healthcare deliver.

The importance of family centred care and natural childbirth environment.

An interpretive research on the disparity between women’s expectations and experience during childbirth.

Systematic literature review on the extrauterine life management focusing on lung functions in new born.

To analyse the role of perinatal care to pregnant women.

Studying the treatment alternatives for urogenital infections in rural women.

Conducting a systematic review on how midwifery students plan their career.

Strategies adopted by midwives to advise pregnant women about nutritional values and healthy food consumption.

Studying the impact of Hepatitis B in pregnant women.

Analysing how frequent miscarriages are linked with higher anticardiolip antibodies.

Studying the relationship between perinatal mortality rates and physical activity levels.

How can nurses recommend preventive strategies to avoid sexual transmission of Zika virus to new born?

Evaluating the attitude of women related to the implementation of basic immunisation programs in village.

Analysing the modern trends of the education in midwives and new methods in practical training.

To study the advance trends in gynaecology and obstetrics.

The role of midwives in saving the lives of unborn foetus.

Exploring the global trends in nursing and midwifery education.

Analysing the role of optimal midwifery decision-making during second-stage labour.

To study the integration of clinical reasoning into midwifery practice.

A literature review on labouring in water.

Exploring the experiences of mothers in caring for children with complex needs.

An ethnography of independent midwifery in Asian countries.

To explore the perceptions of control in midwifery assisted childbirth.

Analysing the decision-making between nurse-midwives and clients regarding the formulation of a birth plan.

The role of Vitamin D supplementation during pregnancy .

Topic With Mini-Proposal (Paid Service)

Along with a topic, you will also get;

• An explanation why we choose this topic.
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• Suitable methodology with identification of raw sample size, and data collection method
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