Objective: To assess the quality of care midwives provide to clients during the
postpartum period.
Design: A cross sectional descriptive qualitative and quantitative survey among 65
practising registered nurse midwives. They were interviewed and observed in health
institutions while examining the mother and baby prior to discharge. A convenient nonprobability
sampling was used to identify and select respondents from 14 primary
health care facilities in northern Botswana, who were actively involved in provision
of maternal health services.
Method: Direct personal interviews using semi-structured questionnaires consisting
of open and closed ended questions and non-participatory observations were used to
collect data from informants at their respective places of work.
Results: Of the 65 midwives interviewed, a majority were females aged between 30-
39 years. Age and length of service were not significant predictors for type of service
provided. Most nurses provide quality care during immediate postpartum period. A
majority of nurses have good knowledge and practice in management of postpartum
activities but there are some areas that are not well done. Findings further show that
9% of clinic nurses have poor knowledge in management of post delivery severe
anaemia. Almost all nurses have good knowledge in promotion of breastfeeding
including its benefits to mother and baby. However, a majority of nurses have good
knowledge in most postpartum activities but poor practice on the same area. Almost
all nurses have good knowledge in management of breast engorgement, follow-up
care, counselling on family planning and pelvic exercises but have poor practice on
the same elements. Most nurses provide limited information to women on the
importance of the 6-8 weeks assessment. Among all facilities, a majority had
sufficient supply of equipment and consumables, but less than half had family
planning packs. Most clinic nurses have poor practice on examination of the baby.
Conclusion: Many nurses have good knowledge and practice, and provide quality
care during immediate postpartum period but not all. The need to provide refresher
courses on Safe Motherhood for all nurses involved in obstetric care to improve their
skills in identified weak areas is obvious. With close supervision, in-service training
and support, there is scope for improvement. With rapid trend of short hospital stay
and the impact of HIV/AIDS, most mothers will most likely need follow-up care and
advice on breast-feeding, safer sex, self and baby-care or other problems that may
arise. This study therefore recommends the development of nursing standards,
maternal health audits and re-introduction of domiciliary nursing along other
strategies to improve the quality of care.