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.