Strategies to reduce stillbirths in the Fezile Dabi district, South Africa
INTRODUCTION AND BACKGROUND: The Fezile Dabi district of the Free State province is faced with the challenge of reducing perinatal deaths. The Perinatal Problem Identification Programme (PPIP) tool has been rolled out successfully in the Free State to assist health institutions and districts to identify possible causes of perinatal deaths, and develop preventive healthcare interventions to address the causes identified. However, no study has been done to explore beliefs and practices of mothers who experienced stillbirths, or their family members and midwives working in maternity units with regard to causes of stillbirths, and to compare the outcomes of the application of the PPIP record with the beliefs and practices of the stakeholders during the study period. AIM: To explore the beliefs and practices of mothers who presented at maternity units of Fezile Dabi district hospitals without foetal heart rate and who gave birth to stillborn babies, their family members or significant others and the midwives working in maternity units, with regard to the causes of these stillbirths, and to develop preventive healthcare strategies to reduce stillbirths. METHODOLOGY: A qualitative multi-method design was used to collect data through exploring the beliefs and practices of participants on the causes of stillbirths during the study period. Data was also collected through a record review of the PPIP data in the maternity units of Fezile Dabi district hospitals during the study period. The study setting was the homes of mothers who had experienced stillbirths and their significant others, and Interaction, Communication, Learning and Management rooms of Fezile Dabi district hospitals. AtlasTi Version 7 was used to analyse data. FINDINGS AND CONCLUSION: Of the six themes that emerged, three main themes, namely, empowerment, social norms and flexible environment, were used to analyse and compile a report. Stillbirths are caused by lack of empowerment; and social norms, beliefs, and practices, such as traditional practices, traditional role players, abuse by partners, and traditional restrictions or prescriptions, which contribute to poor attendance of clinics and pregnant women failing to seek medical assistance. The Emancipation Decision-making model and feminist perspective demonstrated that some pregnant mothers were oppressed and exploited by traditional norms and that empowerment may influence pregnant mothers’ healthcare choices positively. Aspects of an inflexible environment that might have contributed to stillbirths, include healthcare professionals’ incompetency, challenges related to emergency medical services, such as transport and call centre services, lack of access to quality healthcare, poor communication and an ineffective referral system, and policies at healthcare sites regarding caesareans. Negative attitudes of healthcare personnel and inadequate operational hours at clinics lead to pregnant mothers failing to attend healthcare facilities or prevent them from seeking assistance when they experience labour, causing stillbirths. The researcher, with the involvement of stakeholders, used the study findings to develop strategies to reduce stillbirths. RECOMMENDATIONS: Recommendations were made, taking into consideration the involvement of stakeholders, such as nursing education institutions, provincial Department of Health, healthcare personnel and communities who are responsible for the successful implementation of relevant strategies to reduce stillbirths. The recommendations outline the responsibilities of each stakeholder and emphasise the competency of midwives, the creation of a flexible and responsive healthcare environment, the importance of attending antenatal clinics, empowerment of women to report danger signs during pregnancy, person-centred care and healthcare dialogue. Reference is made to further research topics that need to be explored.