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Midwives' perception about their practice in a midwifery-led care model in karachi, Pakistan

02 March 2015
Volume 23 · Issue 3



To explore the experiences and perceptions of midwives practising the midwifery-led care model at two private facilities of women and children hospital in Karachi, Pakistan.


The descriptive qualitative data was collected through semi-structured questionnaires with 10 midwives.


The findings of the study revealed one theme and four related categories. The theme of the study emerged as ‘struggling to be a professional midwife’ and the related four categories were: (i) asking to perform within the full scope of practice, (ii) obstetricians’ reliance and trust in midwives' expertise, (iii) raising concerns about expensive midwifery services, and (iv) encountering barriers to practise midwifery as independent practitioners.


Midwives face some challenges practising the midwifery-led care model such as lack of visibility in society, low salaries and increased workload due to the shortage of staff. Lack of higher education was also highlighted by the midwives as they have no opportunities for career growth. This study will increase midwives' autonomous role and decision-making in the clinical setting.

According to the World Health Organization (WHO) 2010 statistics, every day about 1000 women die during childbirth. Of these deaths, 99% occur in developing countries (WHO, 2014). The global neonatal (0–28 days of life) mortality rate (NMR) is 23/1000 lives births; however, many of these deaths can be prevented by providing accessible antenatal, intrapartum, and postnatal care through skilled birth attendance (UNICEF, 2011). In Pakistan in 2008, the maternal mortality rate is between 260–700/100 000 and the NMR is reported to be 42/1000 live births—highest among all the South Asian countries (National Institute of Population Studies Islamabad, 2008; UNICEF, 2011). Furthermore, the availability of skilled birth attendants for women during childbirth is only 38.8% (Jafarey et al, 2008).

Globally, midwives are the primary carers for women before, during, and after childbirth. According to the literature, different models of care are practised to provide support and assistance to women during the antenatal, intrapartum and postnatal period (Sandall et al, 2013). The most commonly used models are obstetric, shared, and midwife-led care. In obstetric-led care, the obstetrician dictates and provides care during the antenatal, intrapartum, and postnatal period with support from midwives. In shared care, the responsibility is distributed among different health professionals such as obstetricians, midwives, and general practitioners during various phases of the maternity care (Sandall et al, 2013). Midwife-led care is where the midwife, primarily, carries out the planning, organising, and delivery of care though out a low-risk pregnancy and into to the postnatal period (Sandall et al, 2013). Evidence-based literature from both developed and developing countries highlights midwifery-led care as instrumental in reducing maternal and neonatal mortality (Rukanuddin et al, 2007; Gu et al, 2011; Sandall et al, 2013). In this model, continuity of care is the key to providing safe and effective care to women. Midwives work in collaboration with obstetricians to promote normality in childbirth. This independent and confident midwifery practice makes childbirth safe for women and produces effective outcomes, such as positive birth experiences and good physical and psychological wellbeing for women (Gibbins and Thomson, 2001; Homer et al, 2009; Gu et al, 2011; Anwar et al 2014).

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