Abstract:
The majority of women navigate pregnancy and childbirth without complication. A small and potentially growing number of women suffer severe acute maternal morbidity (SAMM) during pregnancy, birth or the puerperium. Obstetric patients are a discrete group within the health service who can be affected by conditions specific to pregnancy and whose management must consider the wellbeing of the foetus. Those caring for sick obstetric patients need skills in the provision of normal maternity care and knowledge about pregnancy disorders and the nuances of critical care. In one New Zealand hospital, midwives working in the obstetric high dependency unit provide traditional midwifery care and critical care to women with SAMM. Currently there is no specific training focused on high dependency care for the midwives working in this unit. This study sought to explore the experiences of midwives working in the obstetric high dependency unit caring for very sick women. Focus groups provided forums for 16 midwives to share their stories about their role in the obstetric HDU, their ability to provide critical care to sick women, the availability of support, education and training and their thoughts regarding the value of the service. The midwives found working in the HDU a daunting and overwhelming experience. They felt inadequately trained to provide competent critical care. They voiced concerns that their lack of knowledge and skills pertaining to the care of women with SAMM could potentially jeaopardise the wellbeing and health outcomes for this group of women. They attributed this inability to meet obstetric patients’ critical care needs as primarily a result of limited/no training, which they saw as the responsibility of the hospital who required them to undertake this unique, specialised midwifery role. The midwives desperately sought post-registration training focused upon the provision of obstetric high dependency care. The findings from this study are consistent with other studies reported in the literature.
