Than Kyu Kyu, Mohamed Yasmin, Oliver Victoria, Myint Theingi, La Thazin, Beeson James G, Luchters Stanley
Burnet Institute, Melbourne, Australia.
Department of Medicine, University of Melbourne, Melbourne, Australia.
BMC Pregnancy Childbirth. 2017 May 17;17(1):146. doi: 10.1186/s12884-017-1324-6.
In Myanmar, postpartum haemorrhage is the leading cause of maternal mortality and contributes to around 30% of all maternal deaths. The World Health Organization recommends training and supporting auxiliary midwives to administer oral misoprostol for prevention of postpartum haemorrhage in resource-limited settings. However, use of misoprostol by auxiliary midwives has not formally been approved in Myanmar. Our study aimed to explore community and provider perspectives on the roles of auxiliary midwives and community-level provision of oral misoprostol by auxiliary midwives.
A qualitative inquiry was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, auxiliary midwives, community members and mothers with children under the age of three were conducted. Ten key informant interviews were performed with national, district and township level health planners and implementers of maternal and child health services. All audio recordings were transcribed verbatim in Myanmar language. Transcripts of focus group discussions were fully translated into English before coding, while key informants' data were coded in Myanmar language. Thematic analysis was done using ATLAS.ti software.
Home births are common and auxiliary midwives were perceived as an essential care provider during childbirth in hard-to-reach areas. Main reasons provided were that auxiliary midwives are more accessible than midwives, live in the hard-to-reach areas, and are integrated in the community and well connected with midwives. Auxiliary midwives generally reported that their training involved instruction on active management of the third stage of labour, including use of misoprostol, but not all auxiliary midwives reported using misoprostol in practice. Supportive reasons for task-shifting administration of oral misoprostol to auxiliary midwives included discussions around the good relationship and trust between auxiliary midwives and midwives, whereby midwives felt confident distributing misoprostol to auxiliary midwives. However, the lack of clear government-level written permission to distribute the drug was perceived as a barrier to task shifting.
This study highlights the acceptability of misoprostol use by auxiliary midwives to prevent postpartum haemorrhage, and findings suggest that it should be considered as a promising intervention for task shifting in Myanmar.
在缅甸，产后出血是孕产妇死亡的主要原因，约占所有孕产妇死亡的30%。世界卫生组织建议培训并支持辅助助产士在资源有限的环境中使用口服米索前列醇预防产后出血。然而，在缅甸，辅助助产士使用米索前列醇尚未得到正式批准。我们的研究旨在探讨社区和提供者对辅助助产士的作用以及辅助助产士在社区层面提供口服米索前列醇的看法。
在缅甸的纳贝镇进行了定性调查。与助产士、辅助助产士、社区成员以及有三岁以下子女的母亲总共进行了15次焦点小组讨论。与国家、地区和乡镇级别的妇幼保健服务规划者和实施者进行了10次关键 informant 访谈。所有录音都逐字转录为缅甸语。焦点小组讨论的记录在编码前完全翻译成英语，而关键 informant 的数据则用缅甸语编码。使用 ATLAS.ti 软件进行主题分析。
家庭分娩很常见，辅助助产士被视为难以到达地区分娩期间的重要护理提供者。给出的主要原因是辅助助产士比助产士更容易接触到，生活在难以到达的地区，融入社区并与助产士联系良好。辅助助产士普遍报告说，他们的培训包括关于第三产程积极管理的指导，包括使用米索前列醇，但并非所有辅助助产士都报告在实践中使用了米索前列醇。将口服米索前列醇的任务转移给辅助助产士的支持性理由包括围绕辅助助产士与助产士之间良好关系和信任的讨论，由此助产士对向辅助助产士分发米索前列醇感到放心。然而，缺乏政府层面明确的书面许可来分发该药物被视为任务转移的障碍。
本研究强调了辅助助产士使用米索前列醇预防产后出血的可接受性，研究结果表明，这应被视为缅甸一项有前景的任务转移干预措施。
