Midwifery care providers and women's perceptions regarding the dynamic birth positions at Ntcheu and St Gabriel hospitals in Malawi.

Abstract

BACKGROUND

Dynamic birth positions involve various postures and movements during  labor and child birth. Allowing the birthing person to shift positions freely. Recognising their potential benefits, such as speeding up the labor process and reduced caesarian sections due to prolonged labor, Malawi<s ministry of health incorporated dynamic birth positions into strategies aimed reducing maternal and neonatal mortality rates. Despite evidence supporting these dynamic birth positions, most midwives in Malawis continue to rely on traditional lithotomy position. Alack of understanding among midwifery care providers and women regarding the dynamic birth positions, coupled with limited research into their perceptions ,has hindered progress in improving childbirth practices. This study sought to explore how midwifery care providers and women in Malawi perceive the dynamic birth positions.it aimed to explore their understanding of these positions and identify the barriers preventing their use within Ntcheu and St Gabriel hospitals.

RESEARCH METHOD

This phenominological qualitative study analysed secondary data from the ALERT study, conducted in two maternity care units  Ntcheu and St Gabriel hospitals in Malawi. Data were collected using semi-structured interviews(12), focus group discussions(2),observations(16),and two co-design workshops with maternity care providers in one faith-based hospital and one government-owned hospital, sampled purposively. Transcripts were imported into NVIVO 14 software, and thematic analysis was conducted guided by the Socio Cognitive Theory Framework. 

RESULTS

The study revealed that systemic, cultural, and resource -related barriers hinder the adoption of dynamic birth positions ,such as squatting and side-lying, among midwifery care providers and women. Many lacked sufficient knowledge due to limited training and exposure, which hindered the wider adoption of theses positions. Environmental factors, including privacy issues and space constraints in delivery wards, further discouraged their use. Cultural norms and minimal male involvement in the birthing process  also shaped practices. Decision-making during childbirth often leaned toward traditional lithotomy positions. Womens preferences for dynamic birth positions were frequently overlooked, reducing their autonomy and flexibility in the birthing process. This reflected a significant contrast between womens  choices and the practices upheld by health care providers.

CONCLUSION

The study revealed that systematic, cultural, and resource-related barriers hinder the adoption of dynamic birth positions in Malawi. Addressing theses challenges through targeted training, enhanced privacy measures, and supportive policies can promote the use of alternative birthing positions, improving maternal and neonatal outcomes. Future research should explore theses perceptions across a broader range of healthcare facilities to inform national  strategies for maternal health improvement.