1.1 Introduction
The attitudes of midwives towards women in labour certainly counts for their decision about where to give birth the next time they are pregnant. When the attitudes exhibit by midwives to mothers in labour are good, mothers tend to generalize a likeness to every midwife viewing the midwives as having the same character. Lucia (2005), states that a lot of mothers have expressed both satisfaction and dissatisfaction on the attitude of midwives during labour. Some women choose not to give birth in a hospital because of fear of being treated badly by midwives. Some of the experiences the women shared were positive, others described serious abuse and neglect by midwives, they were rude, refused to offer assistance, and in some cases threatened women in labour. This attitude was a major influence on women’s decisions about where to give birth. Many of these complications can be prevented by midwives positive attitude towards mothers in labour as well as access to good reproductive health services during pregnancy where midwives are considered to be caring during pregnancy and labour.
As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.
1.2 Background of Study
Over the past health workers have been contributing immensely to the primary prevention of disease in both community and health facilities with emphasis on the front-line health workers, these are the health care providers that are available to cater for the immediate health need of the patients, according to Agyeponget al., (2001) the Interventions to improve quality and responsiveness in healthcare have centered on professionals and frontline workers without recourse to a total system reform.
Lucia (2005) stated that midwives negative attitudes to women in labour influence their decisions about where to give birth. Some women choose not to give birth in a hospital because of fear of being treated badly by midwives. Pregnant women who were treated badly during labour looked elsewhere the next time they were pregnant and would not recommend these health facilities to other women. Negative attitudes by midwives to women in labour will elicit negative outcome in the birth process. On the other hand, positive behaviours of midwives to women in labour will bring about positive outcome in the labour process and make women take full control of the birth process.
Natukunda (2007) stated that women in labour complained of unfriendliness, rudeness, aggressiveness and abusive attitudes of midwives as a factor influencing their choice of delivery at the hospital. Women expected kind, courteous and professional treatment from midwives. Because of these negative attitudes of midwives, women may seek care in the hands of unqualified personnel resulting to complications like severe haemorrhage, fresh still birth, neonatal and maternal morbidity and mortality. Many of these complications can be prevented by midwives positive attitude towards mothers in labour as well as access to good reproductive health services during pregnancy where midwives are considered to be caring during pregnancy and labour. When the attitudes exhibit by midwives to mothers in labour are good, mothers tend to generalize a likeness to every midwife viewing the midwives as having the same character. On the other hand, when midwives exhibit a bad attitude to women in labour, it will be counted on the midwives as being wicked and unfriendly. As such negative attitude will bring negative outcome of the birth process such as prolonged labour and complications such as severe haemorrhage, severe labour pain and still birth. While positive attitude of midwives towards mothers in labour helps the mother to take control of the birth process.
Differences in health status, based on indices such as infant mortality, young and child mortality and maternal mortality, between developed countries and developing countries have witnessed historical documentation. Within the developing countries, the phenomenon has shown aggravation as we move from urban to rural areas. Unfortunately, the causes of this disturbing reality are illnesses that can be treated and deaths that can be prevented by simple interventions but for which inappropriate structures have constituted a stumbling block. In order to justify the amount of money spent on health and the number of workers employed, serious attention is required in improving quality of healthcare services while containing costs and also in planning of health care activities and carrying out effective management functions relating to health care delivery systems (HCDS).
This cannot be done outside the imperatives of utilization. This is because utilization is the most activity-related problem, being consumer-oriented with diverse dimensions in needs, perceptions and knowledge. To the extent that utilization entails the cooperation and invitation of people outside the health system crystallizes the magnitude of the problem. Indeed, utilization as a major factor in planning any health care delivery system is validated by past and contemporary situations around the world. In the United States of America, hospitals and related health facilities require formal utilization review procedures as condition for participation under health plans and some kind of utilization review process in each institution seeking accreditation.
These problems have resulted in inappropriate structures, faulty allocation of resources and incongruent staff scheduling which would not have arisen if potential utilization had formed the bases upon which the establishment of the facilities were initially hinged. This situation is a call to restructuring which can only be facilitated by x-raying the relationship between distribution of resources, health problems and patterns of utilization whereby identified determinants would reveal the services to be provided for the growing population as well as their magnitude.
Carrasquillo (2013) stated that utilization is often reported as the number of services used over a period of time divided by the population denominator. Or the percentage of persons who use a certain service divided by individuals eligible to use the service.
Health Care Utilization according to Carrasquillo (2013) is the quantification or description of the use of services by persons for the purpose of preventing and curing health problems, promoting maintenance of health and well- being, or obtaining information about one’s health status and prognosis. It refers to the use of health care services. Utilization can be described as the use or amount usage per unit population of health services. It stated that in health care, utilization is defined as the consumption of services or supplies such as the number of office visit a person makes per year with a health care provider, the number of prescription made or the number of days a person is hospitalized.
Therefore, in Enugu State where the research was carried out, the activities that was conducted is to know the Perception of Midwives Quality Teaching of Perinatal Care among Mothers attending the Uwani Health Centre.
1.3 Statement of Problems
Investigation revealed that poor quality care is not just evident in a lack of availability of services and care provision. While many women and infants have inadequate access to any care, there is global concern about the over-use of treatments that were originally designed to manage complications, with the consequence that many healthy women and newborns in high-income, middle-income, and low- income countries become exposed to the adverse effects of unnecessary interventions used routinely, including limited mobility in labour, episiotomy, and caesarean section.
Poor quality maternal and newborn care also has an economic impact on communities and countries and hampers efforts to tackle intergenerational inequalities in health. The quality of care is not directly related to the available resources in a health system. Despite their relative wealth, some high-income countries, such as the USA, rank lower on the health components of the 2013 Mothers Index than some far less wealthy ones, such as Poland and Estonia. Although the level and type of risks related to pregnancy, birth, postpartum and the early weeks of life differ between countries and settings, the need to implement effective, sustainable and affordable improvements in the quality of care is common to all, and midwifery is pivotal to this approach.
1.4 Aim and Objectives of Study
The aim of the study is to assess the Perception of Midwives Quality Teaching of Perinatal Care among Mothers attending the Uwani Health Centre in Enugu State. In achieving this aim, the following specific objectives were laid out as follows:
- To ascertain the perception of mothers attending Uwani Health Centre during midwives perinatal care teaching attitude;
- To investigate the effects of midwives perinatal care teaching attitude towards mothers attending Uwani Health Centre;
- To examine the factors inhibiting midwives perinatal care teaching among Mothers attending the Uwani Health Centre; and
- To determine the perceived effects of midwives perinatal care teaching attitude towards mothers attending Uwani Health Centre in Enugu State.
1.5 Research Questions
The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:
- Are there factors inhibiting midwives perinatal care teaching among Mothers attending the Uwani Health Centre?
- What is the perception of mothers attending Uwani Health Centre during midwives perinatal care teaching attitude?
- What are the effects of midwives perinatal care teaching attitude towards mothers attending Uwani Health Centre?
- What are the perceived effects of midwives perinatal care teaching attitude towards mothers attending Uwani Health Centre in Enugu State?
1.6 Research Hypothesis
In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.
Hypothesis One
- H0: There is no significant effect of midwives perinatal care teaching attitude towards mothers attending Uwani Health Centre in Enugu State.
- H1: There is a significant effect of midwives perinatal care teaching attitude towards mothers attending Uwani Health Centre in Enugu State.
Hypothesis Two
- H0: Socio-economic factors do not have significant influence on midwives perinatal care teaching among Mothers attending the Uwani Health Centre
- H1: Socio-economic factors have significant influence on midwives perinatal care teaching among Mothers attending the Uwani Health Centre
1.7 Significance of Study
The outcome of this study would be significant to community residents in Enugu State PHC and Nigeria in general in the following ways:
- The findings of this study would provide information on the adequacy or otherwise of health services provided to community residents in Enugu State PHC with a view to improving the services.
- The findings of this study would help policy makers to understand problems militating against effective utilization of health services among community residents in Enugu State PHC and the way forward.
- It would provide a basis for further research to other interested researchers.
- The findings of this study would contribute to existing knowledge on the provision and utilization of health care services.
1.8 Scope of Study
The scope of the study focuses on the Perception of Midwives Quality Teaching of Perinatal Care among Mothers attending the Uwani Health Centre in Enugu State.
1.9 Limitations of the Study
During the course of this study, many things militated against its completion, some of which are:
- Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
- Research material: availability of research material is a major setback to the scope of the study.
- Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
- Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).
1.10 Definition of Terms
Health: Health is the level of functional and metabolic efficiency of a living organism. In humans it is the ability of individuals or communities to adapt and self-manage when facing physical, mental, psychological and social changes with environment.
