Challenges Faced by Midwives in the Implementation of Facility-Based Maternal Death Reviews in Malawi.

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Abstract Background:Midwives are the key health care personnel involved in facility-based maternal death reviews in Malawi. Maternal death reviews provide in-depth understanding of causes of maternal deaths. Midwives are well positioned to provide positive and negative stories surrounding women’s pregnancy experiences which could provide a clear understanding of predisposing factors and potential solutions to maternal mortality. Despite midwives’ participation as members of the maternal death review team, maternal mortality continues to occur. Understanding the potential predisposing factors behind each death is key in devising evidence-based interventions to minimize the occurrence of maternal deaths. This study was therefore, conducted to explore and describe the challenges faced by midwives as they participate in maternal death reviews in the context of the healthcare system in Malawi.Methods:Forty midwives participated in data collection at six district hospitals. Twelve Registered Nurse Midwives in senior positions (6 District Nursing Officers & 6 Matrons) described challenges faced by midwives in the implementation of facility-based maternal death review through face-to-face interviews, two from each of the six selected district hospitals. Twenty-eight midwives: 12 Registered Nurse Midwives and 16 Nurse Midwife Technicians participated in five focus group discussions, 2 and 3 respectively explored possible solutions and recommendations to address the identified challenges. All the participants had a minimum of two years’ experience participating in maternal death reviews. Data were analysed manually using thematic content procedure. Results:Challenges identified were: knowledge and skill gaps; leadership gap and lack of accountability; lack of institutional political will and inconsistency in conducting FBMDR, impeding midwives’ effective contribution to the implementation of maternal death review. The possible solutions and recommendations that emerged were need-based knowledge and skills updates, supportive leadership, effective and efficient interdisciplinary work ethics, and sustained availability of material and human resources.Conclusion:Midwives have the highest potential to contribute to the reduction of maternal deaths. Practice development strategies are required to improve their practice in all the areas they are challenged with.

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