Strengthening primary care midwives' preparedness and readiness for emergency maternal and neonatal care in rural and remote resource-limited settings

Abstract

Midwives are essential to improving maternal and neonatal health outcomes in rural and remote communities in low- and middle-income countries yet often work in settings where access to education, clinical support, and emergency care resources is constrained. Despite recognition of the important contribution of midwifery to achieving global maternal and child goals, there is limited research exploring the preparation and support needs of primary care midwives working in this challenging context. 

This PhD investigated midwives support needs, and the challenges, enablers, and priorities for strengthening primary care midwives' emergency maternal and neonatal preparedness and readiness in rural and remote resource-limited settings. Following an extensive scoping review of the literature, the study used a mixed methods, multi-phased design incorporating surveys and in-depth interviews with midwives, educators, managers, policymakers, and maternal and newborn health experts, from nineteen low and middle-income countries. The thesis also incorporates an emotive autoethnography, drawing on the midwifery tradition of storytelling to explore the candidate’s personal experiences of midwifery preparedness and readiness while working in Southeast Asia and Sub-Saharan Africa. This process supported researcher reflexivity and provided deeper insight into stories of preparedness and readiness participants shared in the study.

Integrated findings highlight the importance of contextually relevant pre-service education and ongoing training and mentorship, supportive work environments, and professional support strategies for strengthening preparedness and readiness for emergency maternal and neonatal care. Priorities include strengthening educational, organisational, and policy partnerships to address the disconnect between the preparation of midwives for rural and remote practice and the expectations placed upon them once employed. Addressing poor infrastructure and resourcing, inadequate staffing, limited management support, and barriers to ongoing education and training, is essential, alongside efforts to build on midwives' resilience, motivation, and commitment to the communities they serve.

This thesis contributes new evidence regarding the complex factors that influence the preparedness and readiness of primary care midwives working in rural and remote resource-limited settings. By bringing together the insights and experiences of midwives, educators, managers, policymakers, and the researcher, the thesis offers a deeper understanding of what it means to be prepared and supported to provide emergency maternal and neonatal care in low-resource settings. The findings informed recommendations for policy, education, practice, and future research to strengthen midwives’ preparedness and readiness and improve care for women, babies, and families in communities where they are needed most.

Speaker

Kristen is a midwife, nurse, and PhD candidate at the National Centre for Epidemiology and Population Health at the Australian National University. She is a Lecturer in Midwifery at Federation University Australia, where she coordinates the Graduate Diploma of Midwifery. Kristen has worked in a range of midwifery, nursing, education, and research roles in Australia, England, Thailand, Sierra Leone, and Timor-Leste, with a focus on strengthening the quality of maternal, newborn, and child health care through workforce development, quality improvement, and community-based primary health care initiatives.  She is passionate about preparing future midwives to provide safe, evidence-informed, and woman-centred care while supporting the development of a strong and sustainable midwifery workforce in Australia and internationally. Her PhD and ongoing academic work contribute to the evidence base that informs policy, practice, education, and research, with the aim of improving outcomes for women, babies, and families.