Competency of Midwives in assisting vaginal breech births in lower-level health facilities of Hoima District

Abstract

Background: Globally, term breech delivery has attracted much debate as the presentation is associated with fetal morbidity and mortality. The policy to deliver all term breech presenting fetus by caesarian section is impractical in low resource countries. In this study, we investigated the competence of midwives in assisting vaginal breech births and the associated factors. Methods: A descriptive cross-sectional study was conducted among practicing midwives in health centre IIIs and IVs of Hoima district, Uganda. One hundred forty-three midwives were consecutively recruited to demonstrate the steps of each manouevre and a self-administered questionnaire was used to obtain the factors associated with the midwives‘ competence. We used a 30-item checklist to assess the application of the maneuver steps (Pinards, Love sets, and Mauriceau Smellie Viet maneuver). Each manoeuvre had 10 steps which were scored. The item scores were added to form a total competence score. Participants mean scores were calculated; those who scored > the mean were considered to be competent and those who scored < the mean were considered to be not competent. Descriptive statistics and percentages were used to summarize the findings. Bivariate and multivariate logistic regression was used to determine the factors associated with midwives‘ competence. Results: Overall, 87.4% of the midwives knew and mentioned at least one manoeuvre applied in VBBs. Slightly half 72(50.4%) study participants, with a mean score of 12.3 (SD: 2.7), were competent in the application of the steps of the three manoeuvres. The competence scores for Pinards, Lovesets and Mauriceau Smelie Viet manoeuvres were 69.2%, 44.1%, and 30.8%, manoeuvres respectively. Midwives who could mention any manoeuvre were 11 times more likely to be competent (Adjusted odds ratio [AOR]: 11.79, 95% CI: 2.23-58.35, P: 0.002). Midwives who felt confident (agreed and strongly agreed) were 5 times more likely to be competent (AOR: 5.95, 95% CI: 1. 23-28.80, P: 0.026). Conclusion: Midwives in this study had a low competence compared to some studies and high in others. The factors found associated with midwives‘ competence in assisting VBBs include being able to mention any type of the manoeuvres, and reported feeling of confidence to assist VBBs. Recommendations: We recommended in-service breech trainings, hands- on practice, and regular support supervisions of midwifery care service delivery.