Knowledge, attitude and practice of midwives in the management of women with postpartum mental disorders at Moi Teaching and Referral Hospital, Eldoret, Kenya

Abstract

Introduction: Midwives predominantly focus their care on women and their families throughout pregnancy, labour, childbirth, breastfeeding and peurperium. The midwives can influence the health and well-being of women and their infants. The care of women with postpartum mental disorders (PMD) remains an issue of great concern to midwives. However, midwives receive little or no training on this issue since the curriculum does not include the competences on midwifery mental disorders. The incidence of PMD in this hospital is not documented. Methodology: Descriptive cross sectional design was used. Population was all midwives in post-natal and mental health units. Sixty four midwives were sampled using stratified disproportionate sampling /census. Data was collected using Questionnaires and patient hospital records, entered and analyzed using Statistical Package for Social Science (SPSS) version and presented in graphs, tables and descriptions. Findings: The midwives (41%) reported socio-demographic characteristics as signifcant. Most midwives (45.3%) reported primiparas as the most vulnerable group. Married women, living with spouses were at most risk of PMD (50%). Some midwives (37%) cited contributory factors as strain and stresses, poor social support and previous history of mental illness. Most midwives (67.2%) reported impaired concentration, mood swings, and self neglect as clinical features. Some midwives (28%) identified knowledge and skills gaps amongst themselves. However 23% reported that midwives gave low priority to patients, leaving decisions to doctors, referring them to other disciplines for management and shifting care to relatives. Most midwives (68.8%) indicated that PMD registered at MTRH cut across all socioeconomic classes. However, 67% of midwives indicated that mothers with PMD were separated from their infants and families. Infant complications included malnutrition, anemia, diarrheal diseases, pneumonia and poor weight gain. Majority, (60%) of the midwives had their clients booked for psychiatric, social workers’ and counselors’ follow up or left to the relatives. The midwives had divided views on the availability of screening services with 50% agreeing and 50% disagreeing. Conclusion: It is evident that there are knowledge and skills gaps among midwives, the attitude of the midwives towards the care of women with PMD tended to lean on the negative and that although the midwives may have been competent, the actual practice and care provided to women with PMD had been met with shortfalls and challenges, hence, women with PMD did not receive adequate management from the midwives. Recommendation: A more comprehensive KAP research study, involving midwives and reproductive health personnel on peri-natal mental disorders should be conducted. There is also need to carry out a needs assessment study and possible capacity enhancement for the midwives. A study on community involvement in the care of women with perinatal mental disorders.There is need for midwives to take active roles in the management of women with PMD and equip self with necessary knowledge and skills. Continuous Education Modules should be developed to educate/update the midwives on mental health disorders and their management. There is need to develop and utilize Screening tools for PMD. Interventional studies in PMD and publishing results in peer reviewed Journals for worldwide sharing would go a long way to improve psychiatry midwifery care.