# Midwives’ knowledge and perspectives on neonatal resuscitation and survival before and after Helping Babies Breathe training: a qualitative study in Uganda

## TL;DR

This study explores how midwives in Uganda improved neonatal resuscitation practices after training, highlighting challenges like workload and equipment access.

## Contribution

The study provides new insights into midwives' perspectives and challenges in applying neonatal resuscitation training in low-resource settings.

## Key findings

- Midwives faced challenges like excessive workload and limited clean equipment affecting neonatal resuscitation.
- HBB training improved practices but additional training and better work routines are needed for sustained impact.
- Ethical dilemmas and lack of support hindered midwives' ability to ensure patient safety.

## Abstract

Birth asphyxia is a significant factor contributing to neonatal mortality, particularly in low- and middle-income countries where most neonatal deaths occur. Encouraging women to deliver in hospitals has become a pivotal strategy. Numerous training programmes, such as Helping Babies Breathe (HBB), have been designed to impart neonatal resuscitation and infant care skills to support breathing at birth. Limited attention has been given to exploring the perspectives and experiences of midwives and their hospital managers in translating the acquired knowledge from these programmes into practice. This study aims to explores the understanding, perspectives, and first-hand experiences related to the factors impacting neonatal resuscitation practices and survival, both pre-HBB and post-HBB training.

Qualitative individual interviews and focus group discussions study. A data-driven inductive content analysis approach was used for the analysis.

The high-risk labour ward and theatre at a National Referral Hospital, Uganda.

45 clinically active midwives were enrolled; all had recently completed the HBB training programme.

Semistructured individual interviews (n=2) and focus group discussions (n=43, distributed across seven groups) were held from 26 April to 4 May 2018. Discussions were audio-recorded and transcribed verbatim.

Three emerging themes illustrated midwives’ knowledge, opinion on and experience of neonatal resuscitation and survival. Excessive workload, limited access to clean equipment, and ethical dilemmas hampered performance and neonatal survival. Midwives, facing inadequate support, strived to ensure patient safety. While HBB training addresses malpractices, additional training was needed.

Midwives had few opportunities to change their workload and improve their education. This highlights the need for a closer examination of the challenges faced by healthcare providers in ensuring effective neonatal resuscitation and survival in low-resource settings. To address this, we propose better routines for organising work, cleaning and maintaining equipment, and implementing better training routines.