Abstract:
Background: In the United Republic of Tanzania, the maternal mortality ratio, and neonatal mortality rate have
remained high for the last 10 years. It is well documented that many complications of pregnancy are avoidable by
providing skilled midwifery care during and immediately after childbirth. However, there have been delays in
providing timely and necessary obstetric interventions, most likely due to lack of proper monitoring during labor.
Yet, there has been little research concerning how midwives monitor the process of childbirth. Therefore, this study
aimed to describe how midwives monitored and managed the process of childbirth to achieve early consulting
and timely referral to obstetricians.
Methods: The design was qualitative and descriptive, using data from comprehensive semi-structured interviews of
midwives. The interviews were conducted at one hospital and one health center in Dar es Salaam, Tanzania’s largest
city. Eleven participants were purposively recruited and interviewed about their experiences managing complicated
intrapartum cases. After the interviews, data were analyzed using content analysis.
Results: Derived from the data were three activity phases: initial encounter, monitoring, and acting. During these
phases, midwives noticed danger signs, identified problems, revised and confirmed initial problem identification, and
organized for medical intervention or referral. The timing of taking action was different for each midwife and
depended on the nature of the prolonged and obstructed labor case.
Conclusions: For the majority of midwives, the processing of assessments and judgments was brief and without
reflection, and only a few midwives took time to continue to monitor the labor after the initial identification of
problems and before taking actions. To make a final judgment that the labor was becoming prolonged or obstructed,
midwives should consider taking time to review and synthesize all their findings.
